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Abstract

Background: The world of medical education is rapidly replacing the traditional face-to-face assessments of students by switching to online systems, and Pakistan is also undergoing this transition in its medical colleges and universities. It is therefore essential to obtain data on the performance of medical students in this new mode of assessment so that a smooth transition is enabled. Objective: To evaluate the academic performance of medical students in face-to-face and online examinations based on gender and professional year. Methods: A comparative study was performed at Rehman Medical College, Peshawar, Pakistan, from November 2023 to January 2024, on face-to-face and online examinations attempted by MBBS students of the first to fourth years. The results of first-to-fourth year MBBS modules were compared through a non-probability approach by universal sampling on a total of 768 students included in the study; 387 had given online assessments, while 381 were evaluated face-to-face. Students of the two sessions were included in the study; the examinations for one session were face-to- face, while for the other were online. The course content was same for both the examinations. The Moodle learning management system (LMS) was used for online examinations. All the online examinations were MCQ-based, single best answer type with similar difficulty levels. Students who partially completed the paper were excluded from the study. Data analysis was performed on SPSS 22. After testing data for normality by the Kolmogorov—Smirnov test, ANOVA was used for comparing the marks based on professional year, followed by post hoc tests of significance. An independent t-test was used for comparing mean scores of male and female students in both the examinations. Results: The mean scores of the students in online and face-to-face examinations were as follows: first year; 66.1 ± 11.2 and 52.0 ± 29.7, second year; 56.5 ± 7.8 and 37.6 ± 15.3, third year; 32.4 ± 21.7 and 28.9 ± 9.7, and fourth year; 14.1 ± 2.6 and 59.8 ± 10.9 respectively. The means scores of both the examinations were significantly different by MBBS year (p < 0.05). Overall, female students outperformed their male counterparts in most of the online and face-to-face examinations, however the difference was not significant statistically. The mean scores of females in online and face- to-face examinations were 43.4 ± 23.7 and 40.8 ± 2 respectively. Similarly, the mean scores of males in online and face-to-face examinations were 39.4 ± 21.7 and 36.5 ± 16.8 respectively. Conclusion: Overall, the female students achieved higher mean scores both in online and face-to-face examinations. The results favored online examinations up to the mid-third year. Later, a decline in this trend was noticed, and stu dents started performing better in face-to-face examinations. This could be due to the foundational nature of early coursework, which may rely more on memorization and less on clinical reasoning or hands-on skills. Therefore, medical schools that rely mainly on online examinations should consider adopting hybrid assessment models and giving more weightage to in person exams particularly in the later years of training, to better align with students’ academic progression and clinical development.

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