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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 203-208

Hybrid assessment as a formative assessment tool for undergraduates in pathology: An untapped boon during the COVID-19 pandemic


1 Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
2 Medical Education Unit, Hamdard Institute of Medical Sciences and Research, New Delhi, India

Date of Submission18-Oct-2022
Date of Acceptance08-Nov-2022
Date of Web Publication30-Nov-2022

Correspondence Address:
Sabina Khan
Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi - 110 062
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_126_22

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  Abstract 


Background: The online portal has been a vital tool for both teaching as well as assessment during the COVID-19 pandemic. While being the only safe option available during this period, online assessment has its own drawbacks. Students have access to their books as well as the internet; therefore, there is no regulation over plagiarism, compromising the reliability of the examination. On the other hand, traditional offline assessment, apart from issues of safety during the pandemic, also requires a substantial infrastructure. Aims: The study was conducted to explore the possibility of using a hybrid assessment method-an online examination in an offline setting-with the aim of compensating the shortcomings of both type of assessments and evaluating its potential as a formative assessment tool. Settings and Design: The study was conducted over a period of 1 month in the Department of Pathology of a Medical College of New Delhi. A batch of 100 students belonging to the second professional MBBS were evaluated toward the end of their fifth semester. Materials and Methods: A blueprint of the online practical examination was prepared by the faculty, including the entire syllabus. The assessments were conducted 4 times for a batch of 25 students at a time. Students were called on the day of their assessment with their mobile phones, and the test was sent through Google forms. At the end of the examination, a quick evaluation of the result was done question wise and the faculty gave detailed feedback discussing the results. Following this, the students were asked to fill out an online feedback form to gather their perceptions regarding hybrid assessment. Results: Most of the students considered hybrid practical assessment to be a better mode than conventional practical assessment, and the majority thought that this mode can be useful for final exam preparation and should be conducted more frequently. Most of the students were satisfied with the time given for answering the questions as well as with the difficulty level of the questions, and felt that the syllabus was appropriately covered. However, a few students faced problems such as Internet connectivity and form reloading issues. Conclusions: A hybrid assessment method that is conducting an “on campus” online examination can be effective mode of conducting regular formative assessments. It has the advantage of requiring minimal infrastructure as well as examination faculty.

Keywords: COVID-19 pandemic, formative assessment, hybrid assessment, pathology, undergraduates


How to cite this article:
Sehgal S, Khan S, Husain M, Jetley S. Hybrid assessment as a formative assessment tool for undergraduates in pathology: An untapped boon during the COVID-19 pandemic. Saudi J Health Sci 2022;11:203-8

How to cite this URL:
Sehgal S, Khan S, Husain M, Jetley S. Hybrid assessment as a formative assessment tool for undergraduates in pathology: An untapped boon during the COVID-19 pandemic. Saudi J Health Sci [serial online] 2022 [cited 2023 Jan 28];11:203-8. Available from: https://www.saudijhealthsci.org/text.asp?2022/11/3/203/362377




  Introduction Top


The COVID-19 pandemic has significantly influenced medical education. The crisis still continues, and it is important to develop creative ways of teaching and assessment which maintain the standards of medical education as well as continue to accommodate the present environmental and social limitations brought by coronavirus.[1]

The online portal has been a vital tool for both teaching as well as assessment during these times. Medical colleges all over the world are now relying mostly on e-learning as well as e-assessment techniques. While online assessments have a sound theoretical basis and have been the only safe option available during this period, data to establish their educational benefits are unknown. In addition, this system has its own drawbacks, mainly concerning the reliability of the examination as students have access to their books as well as the internet, and there is no regulation or control over plagiarism.

On the other hand, traditional offline assessment, apart from issues of safety during the pandemic, also requires a substantial infrastructure. In addition, giving individual feedback is time-consuming and is often not feasible in large-sized classes. The analysis of question reliability and validity in paper-based offline assessments is a difficult task.[2],[3]

With this background in mind, we explored the possibility of using a hybrid assessment method-an online examination in an offline setting with the aim of compensating the shortcomings of both types of assessments and evaluating its potential as a formative assessment tool for practical pathology in undergraduate medical students.


  Materials and Methods Top


The study was conducted over a period of 1 month (January 2021) in the Department of Pathology of a Medical College of New Delhi. Ethical approval waiver was provided as the study was done for educational purposes with no patient involvement. It was a descriptive study in which a batch of 100 students belonging to second professional MBBS was evaluated toward the end of their fifth semester. A hybrid assessment was planned and executed by two faculty members, designated as Faculty A and Faculty B.

At the end of the IInd professional year, a batch of 100 students was divided into four groups (I, II, III, IV) of 25 students each to ensure social distancing and avoid crowding of students keeping in view the ongoing COVID-19 pandemic. Theory lectures for all subjects were already completed online. For practicals, each group was posted in the four departments of phase II for 1 week on a rotation basis. Therefore, each group was posted with pathology department for 1 week. Revision practical classes were conducted for 5 days and the hybrid assessment was planned on the last day of the week for every batch. Therefore, hybrid assessments were conducted 4 times in which one group of 25 students was evaluated at a time.

A blueprint of the hybrid practical assessment was prepared by Teacher A, including the entire syllabus and the weightage of different components of the practical examination was decided [Table 1]. The questions covered different levels of cognitive domain and included multiple choice questions (MCQs), completion type short answer questions (SAQs), and picture-based audiovisual triggers from general pathology, systemic pathology, and hematology, including gross images, photomicrographs, instrument-based questions, and case cards. Care was taken that the images of specimens, instruments, and photomicrographs were the same as those shown to them during previous practical classes and were not taken from the internet [Figure 1].
Table 1: Blueprint of the online assessment examination

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Figure 1: Various question formats included in the hybrid assessment model (gross image, instruments, microscopy, case cards, MCQs, Problem-based questions). MCQ: Multiple choice question

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The assessment paper was prepared on Google forms by Teacher B. A mock examination was also conducted with the junior faculty of the department to assess the feasibility, the time allotted for each question and quality of the images. For each group assessment, a new set of questions was prepared, strictly following the blueprint. The test comprised 20 questions and the time allotted was 30 min.

A feedback questionnaire was formulated on Google forms by Teacher A and B. It comprised 10 prevalidated questions and the Likert scale was utilized.

Four Google groups for each of the four groups of 25 students were formed. The designated group of students was called to the department on the day of their assessment with their mobile phones and the test was sent through Google forms to the Google group.

The assessment was conducted in the presence of a single invigilator. Proper spacing was kept in the seating arrangement so as to maintain social distancing as well as to prevent cheating. At the end of the examination, a quick evaluation of the automatically generated result was done by Faculty B on Google forms question wise. Both Faculty A and B gave a detailed feedback discussing the results and reasons for wrong answers.

Finally, the students were asked to fill out the feedback form and the results were automatically generated on Google forms.

To assess the robustness of hybrid assessment, the performance of the students was compared with their results in formative assessment held 3 months ago in completely online mode.


  Results Top


A hybrid assessment was conducted four times for groups of 25 students each. The feedback taken at the end of each assessment was compiled to gather student reflections. The students rated hybrid assessment highly in all aspects of the feedback. Around 73% of the students considered online practical assessment to be a better mode than conventional practical assessment and 74.4% found this mode useful for final examination preparation. Around 81% of students agreed that it should be conducted more frequently [Table 2].
Table 2: Students' response in feedback on hybrid assessment

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Most of the students were satisfied with the time given for answering the questions (79.1%) as well as with the difficulty level of the questions (84.8%) and felt that the syllabus was appropriately covered (77.9%). The immediate feedback given by the faculty to the students postassessment was useful, 87.2% of the students felt that feedback should be provided after every assessment to improve student learning [Figure 2].
Figure 2: Feedback by students on hybrid assessment

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Around 71% of the batch agreed that the possibility of cheating was minimal with hybrid assessment. This was highlighted when we compared the results with the previous formative assessment held 3 months ago, which was completely online. The average score of students in hybrid assessment was 68.5%, while in the online mode it was 88.7%. Eighty-six students scored more than 80% in the online examination while only 20 students had this score in the current assessment. While none of them had score <50% in the previous online examination, six students could not obtain the qualifying marks in the hybrid assessment examination [Table 3]. This suggested that hybrid assessment was more authentic and reliable than pure online mode since there is no control over cheating in the latter.
Table 3: Comparison between results of online formative assessment and hybrid formative assessment

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Around 60% of the students agreed that internet connectivity is a major hindrance to online assessment. However, in our study, only 2 students experienced network problems.

The overall satisfaction level with hybrid assessment was 75.6% [Table 2]. Many students gave additional comments like they found hybrid assessment to be a fast, economical, and environment-friendly method. The option to select and deselect the answer was great and the students were able to learn time management. It was a good method for quick revision and easing final examination anxiety. The questions were found to be useful for final professional as well as competitive examination preparation. Many students considered it to be less stressful than conventional practical examination since they did not have to struggle with the microscope. Overall, it was found to be a useful method for learning and discussion by the students.

[Table 4] summarizes what went well and what were the shortcomings experienced in this innovative assessment technique.
Table 4: Summary of the pros and cons of hybrid assessment technique

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  Discussion Top


Hybrid assessment is an “on campus” online examination which incorporates the advantages and overcomes the shortcomings of online assessment as well as traditional offline examination. This blended technique can be useful for conducting regular formative assessments and help in improvising the overall student learning experience and academic performance.

In medicine, the assessment of learning involves both theory and practical examination. In Pathology, while regular formative assessments for theory are part of the syllabus in all medical colleges, periodical practical examinations are rarely held.[4] Organizing a practical examination in pathology requires a lot of planning if conducted traditionally. This includes arranging the practical hall as well as samples, microscopic slides, specimens, instruments, equipment as well as adequate faculty for taking viva. This is the major reason why regular practical assessments are often neglected. The coronavirus pandemic has further made this task very tedious and challenging.[5] While regular formative assessments for theory are continuing in the pandemic, practical assessments have taken a back seat. The use of a hybrid assessment model can solve this problem since it requires minimal infrastructure, time, and examination faculty. It is a fair, more objective, and unbiased method which is easy to administer and even more interesting.

In this study, the faculty was satisfied with this innovative method because it required minimal preparation and human resources. Issues such as arranging early morning patient samples and faulty microscope adjustments were overcome. A wider content of the Pathology syllabus was covered in this assessment within a short time span. In addition, questions pertaining to higher order thinking skills were also included. This method was flexible and could be customized depending on what practical aspect the teacher wants to focus on. The result generated was immediate and there were reduced malpractices.

The immediate face-to-face feedback given to the students was the unique feature and considered to be the most significant advantage. The provision of feedback strongly influences student achievement because it helps in strengthening the learning process.[6] One of the major weaknesses of modern higher education systems is failure to provide adequate feedback to the students on their learning.[7] Immediate face-to-face feedback in hybrid assessment allows the learners as well as the teachers to identify areas of weakness and work on these. In addition, in this method, feedback can be combined with short sessions of relevant learning. Conduct of regular hybrid assessments can aid in learning and relearning concepts, integrate a variety of concepts learned throughout the course, and give regular insight into students' current performance and areas of potential improvement which can be addressed before the final professional examination.

In this study, the question formats included MCQs, SAQs, and audiovisual triggers to cover different aspects of the pathology practical curriculum. Video-projected practical examination with a similar blueprint has been used previously for formative assessment in practical pathology.[4] However, in this, each student answer sheet has to be manually checked by the examiner and is a tedious process. Automated marking in hybrid assessment accelerates the time-consuming burden of medical institutions and the tutors can easily monitor the individual students' progress. It is especially advantageous in institutions with a shortage of faculty.

The National Medical Commission has recently defined and elaborated on the use of different online assessment techniques.[8] These web-based assessments have been popular with preclinical and clinical medical students in the pre-COVID era also.[2],[9],[10] A high level of acceptance for the online assessment using MCQs was noted among students in one study who considered the method more objective and better suited for cognitive assessment.[11] During the pandemic online mode of assessment has been explored further in different fields of medicine. Elzainy et al. reported high levels of student achievement and faculty satisfaction with e-learning and assessment.[12]

The hybrid assessment model incorporates the advantages of online assessment and also overcomes its major drawback of cheating. For hybrid assessment, both physical and online security measures are combined to prevent cheating. Physical measures include assessing a small batch of students at a time as well as having appropriate distancing in the seating arrangement, both of which were used in our case. Using data analysis tools which enable assessors to see if candidates who consistently gave the same wrong answers were located closely to each other in the examination hall can be useful. Furthermore, the availability of software which allows no access to other web pages while performing the assessment will prevent plagiarism. However, such tools and software were not used in our model.

The main drawback of the hybrid assessment technique is the strong reliance on technology and internet connection. Internet is slow many times and connections are disrupted. Some servers do not hold major load.[13] In fact, in one of the assessments, there was a slight delay in starting the examination because of poor wifi network on the campus. Troubleshooting was done by the IT department and the problem was immediately rectified so that the examination could be started. Malfunctions of the hardware, software, and even the power supply can also contribute. New and developing technologies shall, however, make unreliability a phenomenon of the past. Possibility of installing a backup internet connection in institutions which regularly utilize a hybrid assessment model would be useful.

Another shortcoming of hybrid assessment is that it cannot assess the students' attitude and behavior. The face-to-face discussion in viva voce which is the crux of any practical examination is missing in this portal. However, this method can be used as an adjunct to viva voce and can replace spots and few practical exercises.

Many resourceful initiatives have been implemented during the coronavirus pandemic and will ultimately contribute to the progress of Medical Education.[14] The incorporation of hybrid assessment as a regular routine can contribute to providing structure to the undergraduate curriculum. It will facilitate continuous assessment, continuous feedback, and continuous learning as advocated in the new competency-based medical education curriculum. It can contribute to be an important part of the assessment toolbox used in Practical Pathology.

The main limitation of the study was that it had been conducted only once for the undergraduates. Hybrid assessment should be used more frequently to assess its feasibility and acceptance. In addition, this technique should be also explored in large-scale studies in various institutions to validate its utility, especially during the COVID-19 pandemic.


  Conclusion Top


A hybrid assessment method that is conducting an “on campus” online examination can be an effective mode of conducting regular formative assessments. Immediate face-to-face feedback is the strength of hybrid assessment and is the essence of conducting a formative assessment. If carried out regularly and properly, hybrid assessment can improvise and refine student learning when used repeatedly and regularly as a formative assessment tool.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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