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Comparing performance and integrity of proctored physical, unproctored online, and proctored online MBBS exams.

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Title: Comparing performance and integrity of proctored physical, unproctored online, and proctored online MBBS exams.
Authors: Krishnamurthy, Kandamaran1 (AUTHOR), Kumar, Alok1 (AUTHOR) alok.kumarsingh@uwi.edu, Cohall, Damian1 (AUTHOR), Campbell, Michael H.1 (AUTHOR), Connell, Kenneth1 (AUTHOR), Emmanuel, Maisha1 (AUTHOR), Seecheran, Naveen2 (AUTHOR), Morris, Euclid1 (AUTHOR), Paul-Charles, Joanne1 (AUTHOR), Majumder, Md Anwarul Azim1,3 (AUTHOR)
Source: Medical Teacher. Sep2026, Vol. 48 Issue 9, p1497-1505. 9p.
Subject Terms: *Medical education, *Rating of students, *Educational tests & measurements, *Student cheating, *Retrospective studies, *Academic achievement, *School discipline, *Comparative studies, *COVID-19 pandemic, Cronbach's alpha, Descriptive statistics, Chi-squared test, Odds ratio, Medical records, Acquisition of data, One-way analysis of variance, Online information services
Geographic Terms: West Indies
Abstract: Introduction: The rapid pivot to online assessment during COVID-19 raised concerns about the fairness and psychometric quality of high-stakes medical examinations. This study compared performance and integrity indices across three successive modalities of The University of the West Indies Final MBBS Medicine and Therapeutics written paper. Methods: Institutional records for every candidate in 2019 (proctored physical, n = 508), 2020 (un-proctored online, n = 529) and 2021 (physically onsite proctored online, n = 361) were analyzed retrospectively (N = 1 398). Mean scores, score dispersion, categorical outcomes, Cronbach's alpha, and item-difficulty indices were contrasted with one-way ANOVA, χ2 tests, and odds ratios. Results: Examination modality significantly influenced performance. The mean (± SD) scores were highest in the unproctored online exam (2020: 68.4 ± 6.5), followed by proctored physical exam (2019: 64.2 ± 7.2) and proctored online (2021: 60.5 ± 7.3). The difference in the mean score of the three modalities was highly significant (p < 0.0001). Pass rates peaked in 2020 (92%) versus 2019 (81%) and 2021 (70%). The odds of failing the examination in 2021 were more than five times higher than in 2020 (OR = 5.652). Reliability (Cronbach's α) highest in 2019 (0.813) and 2021 (0.770) but very low in 2020 (0.307). Odds of failing in 2021 were 5.65 times higher than 2020. Discussion: Examination modality strongly impacted on performance and reliability. Unproctored online exams led to grade inflation, reduced variability, and low reliability, while proctored formats—physical or virtual—reinstated assessment rigor, fairness, and psychometric integrity, emphasizing the need for robust invigilation in high-stakes medical assessments. [ABSTRACT FROM AUTHOR]
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Comparing performance and integrity of proctored physical, unproctored online, and proctored online MBBS exams.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Medical+Teacher%22&quot;&gt;Medical Teacher&lt;/searchLink&gt;. Sep2026, Vol. 48 Issue 9, p1497-1505. 9p.
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: The rapid pivot to online assessment during COVID-19 raised concerns about the fairness and psychometric quality of high-stakes medical examinations. This study compared performance and integrity indices across three successive modalities of The University of the West Indies Final MBBS Medicine and Therapeutics written paper. Methods: Institutional records for every candidate in 2019 (proctored physical, n = 508), 2020 (un-proctored online, n = 529) and 2021 (physically onsite proctored online, n = 361) were analyzed retrospectively (N = 1 398). Mean scores, score dispersion, categorical outcomes, Cronbach&#39;s alpha, and item-difficulty indices were contrasted with one-way ANOVA, χ2 tests, and odds ratios. Results: Examination modality significantly influenced performance. The mean (&#177; SD) scores were highest in the unproctored online exam (2020: 68.4 &#177; 6.5), followed by proctored physical exam (2019: 64.2 &#177; 7.2) and proctored online (2021: 60.5 &#177; 7.3). The difference in the mean score of the three modalities was highly significant (p &lt; 0.0001). Pass rates peaked in 2020 (92%) versus 2019 (81%) and 2021 (70%). The odds of failing the examination in 2021 were more than five times higher than in 2020 (OR = 5.652). Reliability (Cronbach&#39;s α) highest in 2019 (0.813) and 2021 (0.770) but very low in 2020 (0.307). Odds of failing in 2021 were 5.65 times higher than 2020. Discussion: Examination modality strongly impacted on performance and reliability. Unproctored online exams led to grade inflation, reduced variability, and low reliability, while proctored formats—physical or virtual—reinstated assessment rigor, fairness, and psychometric integrity, emphasizing the need for robust invigilation in high-stakes medical assessments. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Medical Teacher is the property of Taylor &amp; Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1080/0142159X.2026.2628961
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      – Code: eng
        Text: English
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        StartPage: 1497
    Subjects:
      – SubjectFull: Medical education
        Type: general
      – SubjectFull: Rating of students
        Type: general
      – SubjectFull: Educational tests & measurements
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      – SubjectFull: Student cheating
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      – SubjectFull: Retrospective studies
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      – SubjectFull: Academic achievement
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      – SubjectFull: Comparative studies
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      – SubjectFull: COVID-19 pandemic
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      – SubjectFull: Cronbach's alpha
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Chi-squared test
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      – SubjectFull: Odds ratio
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      – SubjectFull: Acquisition of data
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      – SubjectFull: One-way analysis of variance
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      – SubjectFull: West Indies
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      – TitleFull: Comparing performance and integrity of proctored physical, unproctored online, and proctored online MBBS exams.
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              Text: Sep2026
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