Medical Student Assessment in the Time of COVID-19

Abstract

Background Medical student education in the era of the COVID-19 outbreak is vastly different than the standard education we have become accustomed to. Medical student assessment is an important aspect of adjusting curriculums in the era of increased virtual learning. Methods Students took our previously validated free response clinical skills exam (CSE) at the end of the scheduled clerkship as an open-book exam to eliminate any concern for breaches in the honor code and then grades were adjusted based on historic norms. The National Board of Medical Examiners (NBME) shelf exam was taken with a virtual proctor. Students whose clerkship was affected by the COVID-19 pandemic were compared to the students from a similarly timed surgery block the previous 3 years. Primary outcomes included CSE and NBME exam scores. Secondary outcomes included clinical evaluations and the percentage of students who received grades of Honors, High Pass, and Pass. After the surgery clerkship was completed, we surveyed all students who participated in the surgery clerkship during the COVID-19 crisis. Results There were 19 students during the COVID-interrupted clerkship and 61 students in similarly timed clerkships between 2017 and 2019. Prior to adjustment and compared to historic scores, the COVID-interrupted clerkship group scored higher on the CSE, NBME exam, and performance evaluations (median, CSE:75.2 vs 68.7, shelf:68.0 vs 64.0, performance evaluation mean: 2.96 vs 2.78). The percentage of students with an honors was marginally higher in the group affected by COVID (42% vs 32%). Out of 19 students surveyed, 9 students responded. Seven students stated they would have preferred a closed-book CSE, citing a few drawbacks of the open-book format such as modifying their exam preparation, being discouraged from thinking prior to searching online during the test, and second guessing their answers. Conclusions During the initial outbreak of COVID-19, we found that an open book exam and a virtually proctored shelf exam was a reasonable option. However, to avoid adjustments and student dissatisfaction, we would recommend virtual proctoring if available.

Internal Medicine Clerkship Amidst COVID-19 Pandemic: A Cross-Sectional Study of the Clinical Learning Experience of Undergraduate Medical Students at Makerere University, Uganda

“…The impact of interruption of clinical clerkship in internal medicine due to the COVID-19 pandemic and whether the experience of clinical clerkship during the pandemic has affected performance in theory and clinical exams of our students is not known. However, in Columbia, 17 students who sat their exams during the pandemic had higher scores compared with historic cohort. However, these high scores were attributed to the open book nature of the exams and that students had more time to prepare for them.…”

“…Previous studies have evaluated the impact of the COVID-19 pandemic on surgical training 13 and fellowships, 14 radiology residency, 15 gastroenterology residency 16 and assessment of medical students. 17 Between 40% and 100% of surgical residents reported severe impact of the COVID-19 pandemic on their training. 13 However, there is no published study examining experience of medical students or residence in general internal medicine.…”

Medical Education During the COVID-19 Pandemic

“…Ensuring safety during tests has been an area of concern, with medical schools evaluating and implementing the use of virtually proctored shelf examinations. 78 At the time of writing this review, there were no plans for delivering videoproctored examinations from the American Board of Internal Medicine; however, precautions are in place to mitigate transmission per the Centers for Disease Control and Prevention and World Health Organization guidelines, including use of masks during the administered board examinations. 79 The American Board of Internal Medicine has also provided alternative testing dates for various examinations and an option to defer the examination to the following year.…”

Internal medicine clerkship amidst COVID-19 pandemic: clinical learning experience of undergraduate medical students at Makerere University, Uganda: a cross-sectional study

“…Besides interrupting with clinical clerkships, the COVID-19 pandemic has brought a myriad of challenges in clinical bedside teaching since medical students now have limited direct patient care activities, such as physical examinations and procedures [11,12]. In this study, we found that nearly Previous studies have evaluated the impact of the COVID-19 pandemic on surgical training [13] and fellowships [14], radiology residency [15], gastroenterology residency [16] and assessment of medical students [17].…”

“…Previous studies have evaluated the impact of the COVID-19 pandemic on surgical training [13] and fellowships [14], radiology residency [15], gastroenterology residency [16] and assessment of medical students [17]. Between 40 and 100% of surgical residents reported severe impact of the COVID-19 pandemic on their training [13].…”