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Online Assessment: Concept and Applications

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Journal of Research in Medical Education & Ethics
Vol. 10, No. 2, July, 2020, pp-79-89 IndianJournals.com
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DOI: 10.5958/2231-6728.2020.00005.0

REVIEW ARTICLE

Online Assessment: Concept and Applications

Anuradha Joshi1, Amrit Virk2, Shaista Saiyad3, Rajiv Mahajan4 and Tejinder Singh5*

*Corresponding author email id: drtejinder22@gmail.com

ABSTRACT

Assessment is resource intensive and needs careful evaluation and response to a learner’s objectives and details of how the
target was achieved. Although in medical training, assessment is largely conducted in offline mode, except for some computer-
based formative assessment in certain specific areas current COVID-19 crisis has opened the doors for introducing online
innovations for assessment of students. Online assessment provides computer rich, comprehensive, formative feedback that
can scaffold the learning process and helps the learner to self-evaluate and enhance their learning outcome while preparing for
summative assessment. It also eliminates the inconvenience due to rudimentary, traditional clinical assessments, for example,
the need for examination halls, printed paper, and accommodation, travel and subsistence for both invigilator and candidate.
The bottom line of using e-assessment tools in the field of medical education is that it offers substantial potential benefits but
needs to be carefully managed to minimise potential risks. This article seeks to revisit basic concepts of e-assessments and the
ways in which it can support learners to develop domain knowledge and professional skills with the hope of encouraging
thought and reflection among medical educators.

Keywords: Online assessment, Medical education, Formative assessment, e-learning, COVID-19

INTRODUCTION by technological advances with expectations for

Assessment is universally recognised as one of the most
important and powerful elements of an educational
experience, as it provides observable evidence of
learning, determines student progress and demonstrates
understanding of the curriculum. Assessment also forms
the basis for student independence and aids in
development of the necessary skills for autonomous and
self-directed (also lifelong) learning [1]. In contemporary
knowledge-intensive, higher education scenario;
individual and societal development is largely steered
enhanced access, freedom and involvement in the co-
construction of learning, including assessment methods
and protocols. Recent decades have witnessed a wave
of technological advances, including technology-assisted
open universities, virtual modes of instructional delivery,
and computer modelling and simulation as instructional
tools [2]. Internet-based student–faculty interactions and
student-to-student networking have gained momentum
as the new norm in many higher education programmes
including medical education.

1
Professor, Department of Pharmacology, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
2
Professor, Department of Community Medicine, Adesh Medical College and Hospital, Mohri, Ambala, Haryana, India
3
Assistant Professor, Department of Physiology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
4
Professor, Department of Pharmacology, Adesh Institute of Medical Sciences & Research, Bathinda, Punjab, India
5
Professor, Department of Pediatrics and Medical Education, Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar,
Punjab, India

IndianJournals.com 79
 Anuradha Joshi et al.
In one form or another, e-assessment has been around
for more than two decades. Historically e-assessment
has been analogous with the development of e-Learning.
The earliest forms of computer-assisted learning (CAL)
mostly made use of multiple-choice questions (MCQ),
with feedback or branching algorithms in response to
individual choices. Although e-assessments are
developed from conventional forms of assessment by
converting paper-based versions of multiple choice, true-
false, multiple response and extended matching questions
into e-formats, it has now been realised that it offers a
number of opportunities and advantages to transform
and complement conventional assessment making it more
relevant, valid, engaging and a meaningful process. E-
assessment has served as a potential catalyst to translate
conventional assessment practices in response to
emerging assessment challenges such as distance
learning, high student–faculty ratio, objective and high-
quality feedback [3].
EMERGENT NEED
E-assessment has largely been used for formative
purposes. Entrance examinations to various courses in
India are invariably conducted through online mode. The
use of e-assessment for summative purposes is restricted
to ‘digital portfolios’. But the current natural calamity
of COVID-19 is necessitating the use of technology for
assessment. Recently, University Grants Commission
(UGC) in its revised guidelines has asked all universities
in India to complete terminal semester/final year
examinations in offline, online or blended mode by the
end of September 2020 [4]. Earlier, Medical Council of
India has asked all medical colleges in India to finish
with the process of conduct of final year university
examinations of postgraduate students by June end,
where a provision was made for external examiners to
be connected through video conference [5].
Next biggest hurdle is conduct of final examinations of
undergraduate medical students. Medical training being
largely skill training necessitates face-to-face interaction
and experiential learning, as well as assessment using
80
direct observations. Although these can’t be tested
entirely by online assessments, provisions can still be
made to conduct a large part through online mode,
particularly during this crisis period.
One should always contemplate that assessment is
always related and aligned to learning. If we are not
able to teach skills due to COVID-19, then online
assessment loses its meaning. So, we must use discretion
and decide what needs to be assessed on priority and
what can be staggered for later occasions. One should
not use online assessment blindly following the
bandwagon. Although online assessment has enormous
potential, it should not meet the same fate as other
measures during corona crisis, like-people just put
something on the face without bothering if it is the right
material, covering the right area of the face or if it is
protecting them at all! Online assessments should not
be indulged in, simply because ‘they are being done’;
rather, a careful thought must go in regarding their
purpose and utility.
PURPOSE AND ADVANTAGES
Application of online assessment within the academic
context should not be considered as a mere incremental
activity; its use should be based on an academic rationale
and demonstrate how it supports and is supported by
the curriculum, departmental and institutional e-learning
strategies so as to enrich the students learning
experience. The primary purpose of e-assessments is
no different from conventional assessments; for students
it can be attainment of the learning outcomes, receiving
formative feedback, a grade or for certification. E-
assessment in medical education offers many advantages
over conventional forms of assessment [6]; for the
students, teachers, institutions and the broader
educational goals (Table 1).
BENCHMARKING BEST PRACTICES IN E-
ASSESSMENT
Assessment, being a core component of learning is at
the heart of medical education. As of date, there are
Vol. 10, No. 2, July, 2020
 Online Assessment: Concept and Applications

Table 1: Advantages of Online Assessments

Students  Higher control, friendly interface
 Higher flexibility
 Fast and easy to use
 Easy accessibility from remote areas
 Receive immediate feedback
 Increased motivation to enhance performance
Teachers  Greater flexibility with any place and any time assessments
 Better utilisation of time through simplified and quicker examination procedures
 Improved quality of feedback to students
 Can track students’ progress
 Easy to make analysis across assessments
 Reduced workload
 More flexible and imaginative assessments possible, with greater relevance for students, example; by
using simulations, audio and video clips
Institution  Fast and accurate results
 Reduced cost for institution
Educational goals  Supports higher-order thinking skills like critiquing, problem-solving, reflection on cognitive processes
and facilitate group work projects
 Provide accurate results by adaptive testing

varied forms of e-assessment strategies that can be
used; however, they should be pedagogically
appropriate’, [7] implying that e-assessment needs to be
so designed that the learning outcomes are considered
as the driving force to decide the ways in which the
available technology can be brought to use while being
fully aware of what is practical and/or feasible in the
students’ individual learning environments.
Assessment of student learning in an online setup cannot
be simply transferred from a conventional face-to-face
classroom but needs rethinking to weigh its benefits and
drawbacks as a medium of communication [8]. The e-
assessment guidelines developed by the Canadian
Association for Community Education can be applied
to develop pedagogically appropriate benchmarks for
best practices for e-assessment in medical education [9]
(Figure 1).
A broader view to the same guidelines combining the
best of quantitative and qualitative assessment
approaches has been suggested by Kendle and
Northcote, [10] that focus on underlying principles of
variety, authenticity, collaboration, feedback, online
resources and student responsibility.
Variety
Both quantitative as well as qualitative methods of
assessment should be included in order to cater to the
different learning styles. Encourage use of methods that
ensures collaboration, feedback methods, problem-based
learning, simulation, portfolios of evidence, etc. and not
just surface learning.
Authenticity
Design and develop well-defined, assessments that
simulate the real-time situations/tasks students will come
across after graduation.
Collaboration
Allow and encourage interaction between students,
faculty, members of the local or global community and
experts from other institutes. Communications
technology existent within the online environment should
be made use of.

Journal of Research in Medical Education & Ethics 81

 Anuradha Joshi et al.

Frequent and Appropriate

Timely and
responsive to
Aligned to the learner needs
stated Competency
learning based
outcomes

Variety of Valid and

methods reliable

Conducted by
Authenticity E-assessment trained
assessors

Figure 1: Pedagogically Appropriate E-Assessment Guidelines

Feedback information, there exists an immense capacity to

Mechanisms for appropriate, continuous and timely
feedback should be included throughout the online
assessment process.
Online Resources
Ensure students make full and appropriate use of the
multitude of resources the Internet offers.
prolifically utilise a wide array of assessment
approaches that promote and evaluate student learning
in higher education.[11] Considering the crucial role online
assessment plays in current pandemic and otherwise,
the following section outlines the various tools which
can be efficiently utilised for e-assessment.
Computer-Assisted E-Assessments

Student Responsibility While multiple choice, true-false, multiple response,

Provide students with opportunities that encourage
accountability within course and assessment tasks. Such
accountability of the learning process takes care of
individual student interests, thus influencing motivational
outcomes.
TYPES AND TOOLS OF E-ASSESSMENT
The digitalisation of the world today presents one with
a plethora of opportunities to exhibit innovation and
creativity in the arena of pedagogical assessment. With
a wide range of availability of digital tools and pervading
extended matching questions and are being used
routinely, few old and newer ones like filing the gap
(cloze), [12] text or number entry, labelling questions are
being used by some medical educators globally. Focus
of MCQs can range from recall type questions to
questions that demand higher levels of cognitive
engagement [13].
Hotspot Questions
These require students to place a mark on an image or
a diagram while dragging labels directly over an image
[14]
. Such systems will enable examiners to formulate

82 Vol. 10, No. 2, July, 2020

 Online Assessment: Concept and Applications
questions, store them on a shared online system, select
from such questions for the actual examination and then
finally test them prior to the examination.
Confidence-Based Marking
This e-assessment modality can be applied to basic
sciences courses for medical students employing true/
false and MCQ formats with confidence ratings. [15]
Choice of confidence ratings is built upon mathematical
theory in which students require to select a rating of
reasonably confident if greater than 67% sure of their
answer, and a rating of highly confident if greater than
80% sure of their answer.
Open Labyrinth
It is a web application comprising of educational
research platform that supports virtual patients and
virtual scenarios [16]. Virtual patients developed using
Open Labyrinth are aligned with MedBiquitous Virtual
Patients Specifications [17]. It can be attached to a local
server and consists of a virtual patient as a screen-based
computer simulation of a case that can take many formats
with the help of an Info-button. Such Info-buttons include
images and hyperlinks to other web sites.
Moodle
Medical Institutions can choose to make use of e-
assessment facilities already existent within learning
management systems (LMS) such as the likes of Moodle
and Blackboard [18]. Typical assessment tasks supported
by the Moodle LMS include calculation questions,
calculated MCQs, calculated simple questions, essay
questions, matching questions, numerical questions,
random short-answer matching questions, short-answer
questions, true/false questions and description questions
[19]
. short answer questions/essay-based exams to assess
Clickers
For study group quizzes and discussion prompts, medical
educators can use personal response systems like
Journal of Research in Medical Education & Ethics
clickers or Audience Response Systems (ARSs)
providing teachers with real-time information about
student learning. ARS or clickers can run on a mobile,
tablet or a laptop [20]. The cycle begins with the instructor
asking a question or a problem. The students initially
work independently towards a solution and by selecting
the appropriate numbered or a lettered response on their
clicker ‘vote’ on what they consider to be correct
answer. The results are then displayed across the entire
class to inspect and view.
Calibrated Peer Review
Calibrated peer review is a type of web-based writing
development program, consisting of a central assignment
library. Its main objective is to educate and assess
medical students’ patient note-writing skills in a
standardised fashion by inculcating peer-reviewing
practices [21].
Digital ‘Open Book’ Exam
This consists of either a traditional sit-down/limited-time
exams, with varying degrees of access to resources and
references, or a take-home open-book exam which can
be conducted offsite in an unproctored environment. The
papers are marked automatically online. Open-book
exams allow students access to any resource material
needed during exam. In addition, it can consist of
questions pertaining to patient diagnosis and clinical
scenarios. Properly designed open-book assessment for
formative assessment can enhance learning outcome[22].
Context-Rich Short Answer Questions
Assessment System
Context-rich short answer questions (CR-SAQ) is a type
of learner-centric platform consisting of context-rich
learners, using an automated essay scoring systems [23].
CR-SAQ exams enable both learner and medical trainer
to observe and record the chain of thought process that
led to an answer.
83
 Anuradha Joshi et al.
Remote Assessment via Video Evaluation
(RAVVE)
Evaluation of post-graduate competencies is a complex
process that can include multiple components, from
blueprinting to patient encounters. Since assessment of
communication skills and clinical performance can be
conducted with the help of Direct Observation of Clinical
Encounters Examination (DOCEE) between physicians
and their patients, in view of this, one can try video-
based feedbacks which allow recording of learner and
patient encounters. This in turn is sent to external as
well as internal reviewers for comments and evaluation.
Literature reports use of such video-based feedbacks
as a beneficial modality for assessment in medical and
non-medical education. Along with this it also improves
one’s practical skills, for example, surgical techniques[24].
Video-Based Communication Assessment
Video-based Communication Assessment (VCA) is a
type of an innovative and a flexible system that assists
in overcoming the challenges of assessment in
communication skills. Video patient vignettes can be
used using a computer, tablet or a smartphone, to which
users reply as if conversing with the patient in the
vignette. Besides this VCA helps provide meaningful,
individual one-to-one feedback reinforcing the concepts
and skills of proper communication between medical
student and patients [25].
Objective Structured Video Exam (OSVE)
OSVE is another novel, rapid technique for effective
assessment of specific cognitive aspects of trainee’s
clinical communication skills. It consists of a scoring
scheme. The OSVE assesses the student’s awareness
and knowledge regarding consequences of different
types of communication skills [26].
Online Progress Testing
Herein, students undertake a series of online
assessments during the year that samples questions from
84
the entire course. Students are given a period of time, a
week, for instance, to take the test following which they
are presented with a mark and the average mark for
the year [27]. They are then permitted to go back into the
online assessment to check the questions they answered
correctly or incorrectly and to read the feedback
comments built into the questions beforehand.
Assessment of Clinical Competencies Using CIVA
Well-constructed Clinical Image and Video Assessment
(CIVA) is a computer projected, class administered test
consisting of 40–50 scenario-rich electronic stations
(slides) displaying clinical vignettes/images or premium
quality videos accompanied by short questions [28]. CIVA
conforms well with OSCE and DOCEE.
Simulations
Use of simulation in graduate medical education affords
unique opportunities to improve the quality of a resident’s
educational experience as well as to enhance
competencies in specific field. In context of this, Virtual
Patient Simulation (VPS) is preferred to traditional
assessment methods when used for both learning and
evaluation [29]. This could further lead to the development
of virtual rounds, wards and virtual communities which
enhance the diagnostic efficiency, critical thinking and
so on [30]. Virtual patients can promote clinical reasoning
skills, decision-making skills and have been used to
assess interviewing skills. Invasive surgical trainer
(MIST-VR) and the Endoscopic Sinus Surgery Simulator
(ES3) type simulations can be used in surgical practice
for purpose of assessments. The MIST-VR uses
spheres, cubes and virtual surgical instruments to
simulate laparoscopic surgery [31].
Digital Portfolios Assessment
E-portfolios can be used to exhibit competencies across
a range of clinical and non-clinical skills [32]. For the
purpose of assessment, the e-portfolio documents
specific learning outcomes and must, therefore, be
designed to reflect knowledge, skills or behaviours
Vol. 10, No. 2, July, 2020
 Online Assessment: Concept and Applications

specified in particular outcomes in core curriculum
areas, for example, activities like students adding videos
specific tasks performed as a part of formative or
ongoing assessment made over time. Contents and
criteria used to assess portfolios must be designed to
serve those purposes.
Electronic Logbook
Logbooks are commonly used to set learning goals in
clinical settings and standardise teaching [33]. An e-
logbook is essentially an e-journal/database that
illustrates learning objectives and outcomes. Such
database is useful for both teachers and students as it
offers a portal for regular and continuous tracking of
competencies achieved and assessment of clinical
training along with systematic feedback [34]. Advantages,
uses and applications of some commonly used e-
assessment tools have been detailed in Table 2.

Table 2: Advantages and Applications of Some Commonly Used Online Assessment Tools

Tools Type of Advantages Use and application

assessment
[35]
e-portfolio F or S  Aims for metacognition, authentic tasks,
contextual feedback, learner
responsibility and depict learner abilities
developed during a learning process.
 Presents a snapshot of achievements and
skills, captures performance data and
promotes critical self-assessment.
 By keeping track of early efforts,
learners and teachers can monitor
progress in knowledge, skills, ability or
other outcomes.
Online discussion F  Promote thoughtful conceptualisation
and presentation of ideas
 Encourage learners intimidated by face-
to-face discussion
 Enables teacher monitoring discussions
to identify problems early
Online Quizzes F  Can be used as a diagnostic tool to
assess the level of learner knowledge at
the beginning of the topic
 Instant online feedback can be given to
learners through questionnaires and
MCQs
Simulations/ F or S  Create a realistic and immersive learning
Simulated OSCE/ and assessment environment replicating
Virtual laboratories aspects of actual clinical practice.
 Learners are required to construct
knowledge and use metacognitive
strategies
 Simulation-based OSCE stations can
assess practical skills or passive
stations such as written or video
analysis, commonly used to assess
theoretical knowledge.
 E-Portfolios are electronic compilations of
academic, personal, and professional growth
and are developed using a variety of online
tools or computer software products. LMS
often have portfolio facilities where learners
can gather a range of materials appropriate
to the course.
 Facilitators have easy access to learner
products and performances, and other
learners can also access class portfolios to
provide feedback and reviews.
 Include discussion or participation online
through chat rooms, forums and threaded
discussion.
 Teachers can monitor contributions by
learners as a component of the class
assessment.
 Encourage learner contributions, with the
incentive of credit for participation example;
case-based clinical discussion.
 Can be used for a small component of final
assessment, as formative assessment during
the course, ensuring sufficient skills and
knowledge have been attained before
attempting a final assessment.
 Viable educational method to teach and
practice a diverse range of clinical and non-
clinical skills.
 Simulated tasks are reproducible and can be
standardised for training and assessment
purposes.
 Allows performance and skill-based
assessment

Journal of Research in Medical Education & Ethics 85

 Anuradha Joshi et al.
PROCESS AND DELIVERY OF E-ASSESSMENT
Online assessment not only includes a mere assessment
of students, but also includes execution, delivery,
feedback and analysis of different type of online
assessment tests. A whole e-system is required for
online assessment consisting of e-administrator, e-
support staff, e-learners, e-teachers. Planning for online
assessment, like other forms of assessment needs
careful considerations regarding types of assessments
required with respect to intended outcomes. Assessment
strategy is decided by delivery media and available
resources. Using current traditional assessment tools
for online assessment would be catastrophic. Hence a
thorough review of all the assessment tools with respect
to aims, objectives and outcome is essential. Once the
tools are finalised, appropriate delivery system must be
selected. Since e-learning is here to stay, it is wise for
administrators to invest in e-learning applications that
support administration and logistics of e-learning
environment including e-assessment.
One can opt for special online assessment tools which
are usually embedded in many LMS, course management
systems or virtual learning environments. However, if
dedicated online assessment system is not available it
has to be incorporated to existing routine assessment
system. In that case, factors like availability, cost,
feasibility, interoperability with existing system, means
of delivery, etc. must be taken into consideration.
Reliability of computer system is of vital importance.
Reliability can be increased by using primary storage
error-correcting code to prevent crash of software.
Uninterruptible power supply is necessity because online
assessment is completely dependent on Internet.
Essential administrative task regarding online
assessment is audit, quality assurance and compliance
including internal and external scrutiny.[11] Availability
of trained educational technologist is a must for online
assessment. Educational technologists act as bridges
between educators’ expectations and students output.
86
They are responsible for technical and creative aspects
of online assessment.
Since online assessment methods require usage of web,
special attention should be paid to security,
confidentiality, system resilience, invigilation system and
confidentiality of students identity and security [11]. Online
assessment depends entirely on Internet and technical
issues, there should be provision of recovery and
backups, in case of any lapse.
CHALLENGES AND THEIR MANAGEMENT
IN ONLINE ASSESSMENT
Major challenge for future of online assessment will be
like finding the ways for shifting from a cottage industry
approach lead by individuals to mass-produced system
lead by management process.[36] Major challenges have
been highlighted in Figure 2.
Since online assessments are totally dependent on
technology, they can involve high costs for assessment
system software licence, servers, large number of
computers, well-trained support staff and large spaces
[14]
. In addition to this, dedicated assessment servers
and content educationalist also incur additional costs. It
is debatable whether using high-end online assessment
COST
ACADEMIC FDP AND
DISHONESTY AWARENESS
Challenges in Online
Assessment
INFRASTRUCTURE LEGAL
HACKING
AND
VIRUSES
Figure 2: Challenges in Online Assessment
Vol. 10, No. 2, July, 2020
 Online Assessment: Concept and Applications
strategies are cost-effective or not. Instead, we can use
this COVID opportunity to build capacity for future
disruptions.
Online assessment is relatively new, regular faculty
development programs should be conducted by
administrators to keep all stakeholders updated with all
technological mechanisms of assessment delivery.
Similarly, student’s awareness programs should also be
regularly conducted to make them familiar with online
assessment strategies.
Biggest challenge in online assessments is safety from
hackers and viruses. This can be overcome by investing
in good licensed anti-viral software and anti-hacking
system. A firewall (either hardware or software) is a
system that controls requests and protocols accepted
and transmitted by a server. Most assessment systems
will require HTTP or ideally HTTPS (encrypted)
protocols so a firewall can be used to deny access to
other protocols such as FTP and e-mail.
Another issue is legal-in the form of copyright of content,
pictures, videos sound, assessment material from other
institutes, etc. Hence, the copyright of all the content
material intended to be used has to be obtained from
concerned authorities. Academic dishonesty in the form
of online cheating and plagiarism is an important issued
to deal with in online assessments, especially in high
stakes summative online tests. Ensuring identity of the
student is a big challenge. Since students are not face
to face, chances of identity fraud are more. Certain steps
can be taken to ensure identity of students like monitoring
specific login ID, face and eye recognition through
computer software, proctoring through video, etc. Extra
attention should be given to plan for online assessments
with respect to students having special needs like colour-
blind students, students having physical disabilities, etc.
CONCLUSION
Many advantages are offered by online assessments
like administration of assessment is less time consuming,
Journal of Research in Medical Education & Ethics
automated marking, less paperwork, instant feedback
about learner’s progress, instant monitoring of student’s
performance, etc. Although administration of
assessment is less time consuming, preparation time is
more. Also, online assessment is totally technology
based, thus, incurring huge costs, which is not always
feasible for all institutes. Also, it is very difficult to assess
skills and affective domain from online assessments.
Hence, we can take best parts of online assessment
and using online assessment for continuous assessment,
feedback and learning.
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Received: 11.07.2020
Accepted: 27.07.2020

Journal of Research in Medical Education & Ethics 89

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