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Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 197-201

Medical education challenges during remote learning: Open book assessments

Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Submission27-Jan-2021
Date of Decision02-Mar-2021
Date of Acceptance19-Mar-2021
Date of Web Publication05-Jul-2021

Correspondence Address:
Dr. Manish Taywade
Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Room Number: 322, 3rd Floor, Academic Building, Bhubaneswar - 751 019, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_12_21

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Teaching, learning, and assessment methods have changed during the COVID-19 pandemic. The teacher and student need to be acquainted with various options available in such a crisis. The need of the hour is to avoid crowding in medical schools. Open book and virtual assessments are suitable, compelling options. The COVID-19 pandemic has resulted in a transformation from conventional teaching-learning methods to online platform along with other options. Open book examination and assessment are likely to be one of the keys to the new medical education during the pandemic. Loss of professional years can be minimized using the open book examination.

Keywords: Assessment, COVID-19 pandemic, learning, medical education, open book examination

How to cite this article:
Das A, Akshaya R, Pentapati SS, Taywade M, Parida SP. Medical education challenges during remote learning: Open book assessments. Curr Med Issues 2021;19:197-201

How to cite this URL:
Das A, Akshaya R, Pentapati SS, Taywade M, Parida SP. Medical education challenges during remote learning: Open book assessments. Curr Med Issues [serial online] 2021 [cited 2022 Dec 9];19:197-201. Available from: https://www.cmijournal.org/text.asp?2021/19/3/197/320638

  Introduction Top

COVID-19 is a respiratory illness which originated in Wuhan, China, at the end of the year 2019.[1] Subsequently, the World Health Organisation declared it as a pandemic in March 2020 following the surge of cases globally.[2] Many countries went into lockdown as cases increased over time. India declared a nationwide lockdown on March 24, 2020.[3] As of January 2021, 223 countries have been affected with the COVID-19 pandemic with 102 million confirmed cases and 2.1 million deaths worldwide.[4] The COVID-19 pandemic has changed the modes of interaction and communication in many working fields and medical education is no exception to it. Medical schools, where education is primarily based on learning by doing, are rapidly transforming the education pattern to abide by the social distancing guidelines, due to the threat of virus transmission. The fact remains that teachers and students are potential carriers of the virus.[5] To cope with these challenges, learning and evaluation process have shifted from live to virtual mode, where both teachers and students are trying to adapt to this new form of interaction.

  Traditional Learning Methods in Medical Schools Top

The classical methods of teaching in medical science are both theory and practical oriented. The theory classes are mainly didactic lecture type, where the class gains knowledge about a particular topic from their teachers. Practical classes are carried out with a predetermined number of students in which demonstration is given or hands-on training is undertaken. In clinical classes, students are given the opportunity to examine and elicit important clinical findings in a patient, not just by observation, but also by examining patients themselves. Apart from this, students also read in institutional libraries to enhance their knowledge of medicine.

  Methods of Assessment in Medical Schools Top

Timely assessment is equally important to measure academic deficiencies and rectify them accordingly. Assessment of medical students in India is done mainly through semester and final examinations. For each of these examinations, students need to appear in theory, practical, and grand viva sessions. Apart from these, regular periodic assessments in classes/laboratories/clinics assess knowledge and skills learned in that specific period.

  Impact of the COVID-19 Pandemic on Medical Education Top

The above-mentioned methods of learning and evaluation require, more or less, live interaction between students and teachers, but the current pandemic and associated lockdown has proven to be a big hurdle. Keeping in mind the easy transmission of the virus, every medical college was advised to follow the social distancing guidelines, which has compelled them to look for alternatives to continue the pace of medical education for the current academic year.

  Methods Adopted for Teaching, Training, and Examination Top

It is the responsibility of the administration and the concerned departments to continue the medical education with the same spirit and enthusiasm during this pandemic, to make sure that the learning of the students is not hampered. To serve this purpose, many medical schools throughout the world have come up with new methods of teaching and examination where students can attend lectures and undergo practical's and examinations virtually.[6],[7],[8],[9],[10] The availability of the internet and technologies even in remote areas helped resume the new normal medical education.

  Virtual Education Top

Although distance learning is not a new concept, its needs are felt now even more than before. Correspondence courses and distance courses are provided by some universities in India and abroad. Students need to get clinical and practical orientation and training in the form of online lecture sessions; video recording of practical demonstrations and clinical examination have been very helpful in imparting knowledge to students during the lockdown period.[6],[7],[8],[9],[10],[11],[12] In many international school like the Imperial College of London, students have access to an online repository of patient interview recordings and cases.[13] Other medical institutions and schools are also working along similar lines.

Theory Lectures

Theory classes are now being taken online with the help of video conferencing platforms such as Zoom, Cisco Webex meeting, Google Meet among others where a large number of students can listen and interact with their teachers. Learning management system (LMS) has evolved recently for professional development. LMS is an e-learning technique of delivering content anytime, anywhere in an efficient manner keeping in view, the adult learning principles.[14],[15],[16],[17]

  Practical and Clinical Class Top

William Osler once said “To study the phenomenon of disease without the books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” This quote signifies the importance of clinics in medical science. To facilitate continuing practical demonstration and clinical examinations, even during this pandemic, the same are being recorded and shown online to students in the form of small tutorials.

  Resource Materials Top

Students and scholars are also being benefited by some of the publishers who have opened up all their resource materials as free access on online platforms, in the form of e-books or e-journals.[18] Students also have access to e-libraries of their respective institutions.

  Assessment Methods Top

Competency-based assessment of medical students, which reflects what they have learned so far and how they are going to apply it in future practice is done each year. There are different methods of assessment of knowledge of students and their performance. Methods used for assessing knowledge and its application are multiple-choice questions (one best answer type, extended matching type), key feature questions, short answer questions, essay questions, modified essay questions, and script concordance tests, to name a few. Assessment of performance is by checklists, rating scales, objective structured clinical examination, short cases, long cases, 360° evaluation, miniclinical evaluation exercises, and portfolios.[19]

Most of these methods of formative assessments require assessor input at certain points under the close observation of the assessor. However, to avoid overcrowding and maintaining social distancing, alternate modes of evaluation have to be thought of and open book examination is one of such kind which can be adopted for conducting at least the theory examination, if not the practical assessment.

  Open Book Examination Top

Open book examination is an assessment method where the examinee can refer to books, notes, or other relevant materials for answering questions.[19] In examinations such as the law examination and Hindi literature examination, this practice is not rare, but for other disciplines, this will certainly be a new method.

  Conventional Teaching and Examinations so Far Top

Assessing the information content has been the only objective of all conventional forms of examination so far. Often higher levels of cognitive thinking are not assessed by many medical colleges. The quantity of information memorized would then decide the level of knowledge. This age-old practice creates a false belief that teaching institutions, whether schools, colleges, or universities, are meant just for the dissemination of knowledge and transfer of information.

  Teaching for Stimulating Ideas Top

Teaching is not a mere transfer of information from books or class notes to the minds of students, and it is rather a way to develop intellectual power among students which would equip them with problem-solving and decision-making skills. Teaching should provide students the ability to acquire knowledge and apply it in real-life situations. Students should have out of box thinking and not be just be mechanical readers.

Open book examination will not only enable students with all the aforesaid qualities, but it will also substantially reduce the risk of virus transmission as students can be allowed to give examinations from home.

  Types of Open Book Examination Top

Open book examination can be categorized into two types: restricted and unrestricted type.[19] In restricted type open book examination, students are allowed to bring some specific documents and materials approved by the teacher. In unrestricted open book examination, students can bring anything which they think would be helpful for their examination.

In restricted open book examination, textbooks, log tables, and dictionaries can be brought to the examination hall. Printed documents and handwritten materials would not be allowed in this kind of an examination. In unrestricted, otherwise known as free type open book examination, students can bring any document, book, or even handwritten notes. But here, the answers are often note that straight forward would easily be found in a book and hence would develop intellectual skill of students. That's why no content-based question would be asked in this format.

  Advantages of Open Book Examination Top

Burden of mugging up facts and information by students would be the first thing that will go away by implementing open book examination. Apart from this, open book examination would enhance retrieval skills of students substantially [Table 1].
Table 1: Advantages and disadvantages of conventional and newer education methods

Click here to view

  Pitfalls of Open Book Examination Top

All students may not have all the necessary resource materials, so it is quite hard to ensure if all students are equally prepared for the examination or not. Besides this, students can spend more than the required time to find an answer. They can get lost in the books in search of an answer instead of creating an answer. Furthermore, it is quite hard to know if any student has someone at his back for the answers [Table 1].

  Demerits/Challenges of Online Teaching and Learning Top

Twenty first century is the age of technology and everyone has to get acquainted with the necessary computer skills required to excel in any field. However, there are challenges at the same time that cannot be ignored. The challenges need to be addressed and overcome if there is serious need of replacing conventional teaching with online teaching due to similar crisis in the future.

Although electronic gadgets (computers, laptops, tablets, and other devices) are available at affordable price, challenges in the form of poor and unstable connectivity remain. Practical demonstration can never be replicated through online teaching methods, but innovation and adaptability is the key to success of medical education during the pandemic.

  Conclusion Top

Although no examination technique is free from pitfalls, open book examination seems to be quite promising as a better alternative to all conventional examination patterns during the current pandemic wherein students can attend examinations from home.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Timeline of WHO's Response to COVID-19. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline. [Last accessed on 2021 Jan 30].  Back to cited text no. 2
Government of India Issues Orders Prescribing Lockdown for Containment of COVID-19 Epidemic in the Country. Available from: http://Pib.gov.in/Pressreleaseshare.aspx?PRID=1607997. [Last accessed on 2021 Jan 30].  Back to cited text no. 3
Coronavirus Disease (COVID-19) – World Health Organization. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. [Last accessed on 2021 Jan 30].  Back to cited text no. 4
Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. Lancet Infect Dis 2020;20:777-8.  Back to cited text no. 5
Sahi PK, Mishra D, Singh T. Medical education amid the COVID-19 pandemic. Indian Pediatr 2020;57:652-7.  Back to cited text no. 6
Singh K, Srivastav S, Bhardwaj A, Dixit A, Misra S. Medical education during the COVID-19 pandemic: A single institution experience. Indian Pediatr 2020;57:678-9.  Back to cited text no. 7
Karki P. My e-learning experience as a medical student during the COVID-19 pandemic. J Nepal Med Assoc 2020;58:624-6.  Back to cited text no. 8
Hodgson JC, Hagan P. Medical education adaptations during a pandemic: Transitioning to virtual student support. Med Educ 2020;54:662-3.  Back to cited text no. 9
Rose S. Medical student education in the time of COVID-19. JAMA 2020;323:2131-2.  Back to cited text no. 10
Ferrel MN, Ryan JJ. The Impact of COVID-19 on Medical Education. Cureus. 2020;12:e7492. Published 2020 Mar 31. doi:10.7759/cureus.7492.  Back to cited text no. 11
Mishra L, Gupta T, Shree A. Online Teaching-Learning in Higher Education during Lockdown Period of COVID-19. Available from: https://www.sciencedirect.com/science/article/pii/S2666374020300121#! [Last accessed on 2021 Mar 03].  Back to cited text no. 12
Mian A, Khan S. Medical education during pandemics: A UK perspective. BMC Med 2020;18:100.  Back to cited text no. 13
Meagan W, Teresa S. Harnessing the power of learning management systems. J Nurs Prof Dev 2017;33:138-41.  Back to cited text no. 14
Davis R, Surajballi V. Successful implementation and use of a learning management system. J Contin Educ Nurs 2014;45:379-81.  Back to cited text no. 15
Hart J. Centre for Learning and Performance Technologies: LMS and Learning Platforms; 2016. Available from: http://c4lpt.co.uk/directory-of-learning-performance-tools/instructional-tools-course -learning-management-systems/. [Last accessed on 2021 Mar 01].  Back to cited text no. 16
Sáiz-Manzanares MC, Escolar-Llamazares MC, Arnaiz González Á. Effectiveness of Blended Learning in Nursing Education. Int J Environ Res Public Health. 2020;17:1589. Published 2020 Mar 1. doi:10.3390/ijerph17051589.  Back to cited text no. 17
Kumar NP. Impact of COVID -19 on MSMEs in India. Int J Mod Trends Sci Technol 2020;6:76-9.  Back to cited text no. 18
Al-Wardy NM. Assessment methods in undergraduate medical education. Sultan Qaboos Univ Med J 2010;10:203-9.  Back to cited text no. 19


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  In this article
Traditional Lear...
Methods of Asses...
Impact of the CO...
Methods Adopted ...
Virtual Education
Practical and Cl...
Resource Materials
Assessment Methods
Open Book Examin...
Conventional Tea...
Teaching for Sti...
Types of Open Bo...
Advantages of Op...
Pitfalls of Open...
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