Abstract

Only educated people can develop a nation. Educational success requires good testing. Expertise is best assessed by exams. Tests demonstrate pupil understanding. The study studied medical students' test system satisfaction and assessment method preferences. From September 2021 to March 2022, all Nowshera Medical College (NMC) students completed a cross-sectional summary questionnaire. The query followed a short teacher and test supervisor poll. A–C themes. Percentages and counts. 34% of students gave B marks, 33% gave C grades, and 61% said the method is not helping them build ideas. 82% wanted a more practical system, with 35% favouring a semester system, 26% PBL, and 22% engaging sessions. Most students support the current test system with PBL. Some suggested a quarter system.

Key Words

Examination System, Problem-based Learning

Introduction

No nation can develop without investing in its people. In today's world, only the highly trained and schooled will find success. An effective testing framework is necessary for educational success to be achieved (Norcini & McKinley, 2007). Exams are the most reliable method of measuring how much a person has learned about a specific subject. Exams are used to verify that students have retained the material covered this semester (Bauer et al., 2010).  The benefits of exams include a more fair and accurate assessment of a large student body and a smaller window of opportunity for deception (Brenner et al., 2017). Top ranked medical university like Harvard University in America's also using the semester examination system for conducting medical examinations (Capan Melser et al., 2020). Some institute of Medical Sciences in India also use the semester examination system. The M.B.B.S course follows a semester system each semester consisting of Six months & is divided into three phases via preclinical, para-clinical and clinical phase (El-Dwairi et al., 2022). While the Higher Education Commission's National Committee on Examination System (NCES) discussed the pros and cons of both the Annual System and the Semester System of Examination, the latter of which it recommended be implemented in the future, the former was found to be in need of some tweaks (Hoang & Lau, 2018). Examining and reformulating a consistent semester system structure to meet foreign standards, HEC established the NCES in 2003 (Holmboe et al., 2010). In Agha Khan, currently there is an annual examination system but since 2009 several meeting conducted to introduce the semester system (Javaeed et al., 2020). Dow has been conducting annual exams for its students. According to the new Semester system, it is expected that exams will divide the academic calendar into two (Javaeed, 2019). Similarly, the examination system in KMU is annual but initiatives are being taken to introduce the semester system, in this regard, KMU conducted a number of workshops on the creation of MCQs (Multiple Choice Questions) and Short Essay Questions (SEQs), as well as the need for, and the path towards, shifting the undergraduate medical curriculum and mode of instruction to problem-based learning (PBL) (Javaeed, 2019b). The aim of the study was to bring our examination system at the level of the world top rank medical universities examination system. The examination system all over the world has never been consistent over the years. New systems are being introduced and thought to be implemented for betterment of students. According to Myron tribus (1994), “there are innumerable proposals for reforms, the target is to have the comprehensive attitude to practice many good works to us” (Johnson et al., 2014) (Tribus, 2019). Many countries across the world like British and USA have now shifted to a quarter or semester system from an annual system (Krishnan 2022). Similarly the European Quality Education System and Caribbean Examination Council (CXC) proposed changes in assessments and strongly focuses on ?self-assessment” , University of Ilorin, Nigeria, proposed that the focus should be on the ability to perform rather than on certificates (Kumar et al., 2021). Pakistanis have inherited an educational system from the British and for many years in the past we have been operating under the principles and methods of ?an annual education system”. In many countries, especially in the West, the quarter semester system is under research for implementation and the annual system is referred to as TAP ''Tuition Assistance Programme'' and Only that system of education is good which ensures effective learning (Latif & Wajid, 2018). A study on the attitude of students towards the examination system which tests knowledge, comprehension and memory and towards an annual system in which most of the students expressed that the examination systems only tests the students textually knowledge and hence memory. Only on occasions the students? higher mental abilities are tested and there is hatred and phobia for the exams as might be expected because of the whole year’s burden which is to be done within two months, the semester system is better than the annual system as it enhances learning, ensures that education goes on throughout the year and the students are not burdened (Moore et al., 2009). However in Pakistan higher Education Commission, There has been a shift in the educational landscape as a consequence of concerns that students are not benefiting from the currently implemented trimester system. The NCES was formed in 2003 to identify weaknesses in the country's yearly testing system and make recommendations for improving it (Murad & Aly, 2021). During the late 90?s the shift in the assessment system from annual to semester there was a significant difference in the quality of results in the two systems in Punjab Board Exams semester system is open and transparent, therefore favored by the students and the administration (Javaeed et al., 2020) (Murad & Aly, 2021). In a research project on the implementation of the semester system in Bahawauddin Zakariya University Multan, it was concluded that the semester system is the best way to educate and assess students (Abbasi et al., 2011). About the medical colleges'? examination system’’, graduates from Ayub Medical College, Abbottabad has expressed that instead of conventional monthly stages/ internal evaluation, there should be some modification in the assessment system (Aziz et al., 2014). They suggested to test the students in the form of theory plus vivas and practicals and suggested to start PBL on a weekly basis and making these clinically oriented (Aziz et al., 2014).

Materials and Methods

The cross-sectional study of descriptive type was carried out in Nowshera Medical College, Nowshera over six months period from September 2021 - March 2022. A questionnaire was designed after an extensive literature review by choosing different parameters related to the current examination system. The data obtained from the questionnaires was presented in different graphical forms using SPSS (version 13). Graphs were made using MS EXCEL. All effort was put to make the study useful for future planning. Volunteer Medical students from all four years, both male and female, were included. in the study while the students who did not volunteer to participate, were excluded from the study.

Results

34% of students gave a B grade where as 33% gave a C Grade. 61% of the students found that the present system was not helping them in building concepts while 82% believed that the present system needed switching to a more practical approach among which 35% favored semester system, 26% liked PBL and 22% wished to be examined via interactive sessions.

Figure 1

Knowledge of students to the present examination system.



Figure 2

Grading the current annual examination system in order of preference.



Figure 3

M.C.Qs/S.E.Qs & scenario based questions as a positive approach towards checking the knowledge of the students.



Figure 4

Present examination system being biased



Figure 5

Marks distribution of theory and practical exam (viva) in annual examination.



Figure 6

Students being pressurized during



Figure 7



Figure 8

Internal evaluation weight age included in annual exams.



Figure 9

Stages, sub-stages & presentations help students stay in touch with books.



Figure 10

Scenarios & MCQs asked in stages help students in preparing for annuals.



Figure 11

Teaching the way students are examined in annual examinations.



Figure 12

Examination system being solely for purpose of memorization rather than making concepts.



Figure 13

Present examination system helping the student's in future post-graduate training and examinations.



Figure 14



Figure 15

Present examination system helpful in making internationally competent doctors



Figure 16

Examination system students prefer for the better assessment of knowledge.



Figure 17

Problem based learning or interactive sessions between teachers and students help the students in understanding and building up their concepts.



Figure 18

Performance in semester system as compared to the annual examination system.



Discussion

The cross-sectional study was carried out in NMC and data was collected through a questionnaire in order to know the views of students of NMC about the present examination system. The result show that Stages sub-stages and presentations help students to stay in touch with their books. The internal evaluation methods were appreciated by 230 (77%) of the students and the remaining 70 (23%) have contrary views. According to 118 (39%) students weightage of internal evaluation should be included in annual exams and should be 10% and 71 (24%) student were of the opinion that these marks should not be included in the final exam while 64 (21%) are in favor of 25 weightage of internal evaluation marks in annuals and 47 (16%) were in favor of 50% weightage. Shirazi, Muhammad Jawad Haider (2004), proposed after the study finding that our examination system revolves around the results, and proposed replacing external examination with a system of internal and ongoing assessment by instructors themselves in all institutions that provide instruction. Staff members at testing centres and even parents are complicit in the cheating. (Sharma et al., 2019). The finding of this study shows that 16% students are comfortable with equal weightage i.e. 50% marks for internal evaluation and 50% marks for external. The result also show that that according to 207(69%) of students, the present examination system is biased. The majority of students i.e., 225 (75%) are in favor of M.C.Q?s and S.E.Q?s while 75 (25%) of students do not agree to this point. Results show that scenarios and MCQ tests that are taken by teachers as part of internal evaluation help students in preparing for annuals. (68%) students take benefit from scenarios and MCQ that are a part of their internal evaluation tests. 97 (32%) do not have a similar opinion. A research work by Dr. Mohammad Javed Iqbal et al intended to assess the quality of Allama Iqbal Open University's test process. They arrived at the conclusion that evaluation tasks that focused on subject knowledge improved students' ability to learn and broadened their educational experience (Sallis, n.d.). From the first year of medical school through advanced degrees, a student seeking a profession in medicine can expect to spend anywhere from ten to fifteen years taking exams, according to research by Saeed Farooq. The failing rates of medical school applicants from Asia have been found to be significantly greater than those of British medical school graduates. This high incidence of failure is not specific to F.C.P.S. but is seen as a characteristic of all the 'prestigious' exams, largely a remnant of the British medical school system. The General Medical Board of the United Kingdom has recently implemented significant changes to the British medical school system. Recommendations on the future structure of student medical education made in the history text Tomorrow's Doctor would be "wholly thwarted if the current assessment system were to persist" . The study concludes that 186 (62%) of students think that the Present examination system is not helpful in making internationally competent doctors while 114 (38%) students say that this system is good enough to generate doctors that are internationally competitive and 194 (65%) students find this present pattern of examination helpful in future post graduate training and exam. In this study majority of students are satisfied with the pattern of examination and they appreciated its outcome and finds it helpful for postgraduate studies but a graduate of current system do not find it helpful in competing with students on international levels and they were of the opinion that this examination system is not good enough to make them internationally competent and suggested modification in assessment system and this point of the study is parallel to view of Saeed Farooq. Further Problem based learning and interactive sessions between teachers and students help more in understanding and building up concepts according to 232 (77%) students and 68 (23%) do not agree to this point. Diana F Wood research show that PBL is an effective way of delivering medical education in a coherent, integrated program and offers several advantages over traditional teaching methods. The Journal of Pakistan Medical Association published an article "opinion of medical students regarding problem-based learning, show that 79 % (82 out of 104) of medical students liked the PBL session at Karachi medical and dental college. In this study, group learning was strongly appreciated by most of the students.

In this study 219 (73%) students of NMC were in favor of the semester system remaining 81 (27%) students voted for the annual system. According to Tayyaba Malik and Priya Avais there is a significant difference in the quality of results under annual and semester systems not only on the basis of numerical results but also in terms of the competence of the students that they show in the field situation. Check and balance systems and training of teachers can help both the semester and annual systems to assure quality (Vanderbilt et al., 2013). Prof. N. Prabhakara Rao, writes that the semester system is a very proactive system as it engages both the faculty and the students throughout the year in academic activity. While in the annual system, a student studies only during exam time. The semester system is the need of the hour and a very effective one (Wagener 2015: Walsh, 2015). The views of students of NMC are similar to Prof. N. Prabhakara Rao as they prefer the semester system for better evaluation of their knowledge in medical colleges. At a symposium arranged by the Khyber Medical University (KMU) on „Curriculum Development,? participants agreed to work towards the implementation of the semester system in the affiliated colleges. The facilitators emphasized that commitment of the faculty would be required for the implementation of the semester system and some infrastructural development would also be required in the respective colleges and same was endorsed by Dr.Hafizullah EX VC KMU and said in view of the drawback of the annual system in most of the institutions other than medical colleges the annual system has been replaced by semester system. In our study majority of students at NMC are not much satisfied with the annual system and thy think they can do well in the semester system. The result of the study shows that 61% (182) of the students feel under pressure during the viva exam in annual whereas 39% (118) of the students. This study supports many of the findings of previous studies, in that majority of the medical students experience some level of anxiety during exam

Conclusion

Medicine is a tough career to be carried in life. Medical students have higher rates of overall psychological distress than both the general public and age-matched peers. One of the challenges faced by medical student is examination during their career. On the basis of this study, it is concluded that the present system needs some modifications like PBL, Semester system. These suggestions should be considered for implementation to improve the knowledge and concepts for a glistening future of medics and it will also reduce the ratio of failure in exams and a way out of depression for some of the students.

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