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Online Exam Software in Medical Education

It’s no secret that the use of online exam software continues to grow. However, in medical education, there are many complexities and considerations to make before deciding on the right software.

When it comes to teaching and assessing our future doctors, the stakes are particularly high. To ensure they’re ready to face the challenging world of medicine when they graduate, not only do they need to demonstrate their knowledge, but they also have to prove their clinical reasoning and practical competence.

For those responsible for their assessment, it’s imperative they are confident the exams are valid and robust. Alongside this, they need to ensure they test all syllabus areas and different clinical scenarios.

Add to this the complexity of practical assessments, which are common in medical education, then it’s easy to see why moving to digital exams is a daunting prospect.

It’s for these reasons there’s no ‘one size fits all’. Instead, there are a number of different question types and exam styles that are commonly used depending on which is most appropriate for the situation.

With Speedwell’s eSystem it’s possible to create and run many different exam types quickly and easily. Additionally,  you have the flexibility to run paper exams alongside online exams if you require.

In this article, we examine the exam types available in the eSystem along with their merits and considerations for use in medical education.

Multiple Choice Questions (MCQ)

A staple used for many years in medical education, MCQs are tried and tested. In paper-based exams with pre-printed OMR (Optical Mark Recognition) exam sheets, the marking burden is eased as the sheets are scanned in and marked automatically. Online MCQs are increasingly being used and with the eSystem, they are easy to set up and run. They are also marked automatically within the software, with a full suite of analysis and reports available post-exam.

However, as a question style, they are open to criticism in that candidates could possibly make ‘lucky-guesses’ and do well in an exam when they don’t actually have the required knowledge. Similarly, depending on the distractors, candidates could use logic and reasoning to determine the answer.

 Extended Matching Questions (EMQ)

EMQ’s are a specific type of multiple choice question commonly used in medical education. They allow questions to have multiple variables or scenarios which are all linked to a common set of answers. They have the benefits of MCQ questions but also make it possible to assess diagnostic reasoning in a way that traditional MCQs don’t. And since there are typically more answer options candidates are less likely to be able to guess the correct answer. However, they can be more time consuming and difficult to write due to having to find different question scenarios that fit with the set answers.

EMQs are available with eSystem exam software. Not only can you create an exam, but you can also run it online too if you require since EMQs are available for online delivery.

Single Best Answer (SBA)

Single best answer questions (SBA) are also popular in medical education. With SBAs there’s a single question, with a set of possible answers and the candidate is asked to select the single best answer. Often considered to be superior to single correct answer questions, with SBAs it’s possible to acknowledge that more than one answer may have some relevance. With SBA questions, the candidate must use their clinical knowledge and reasoning to eliminate some answers and select the ONE best answer.

Using the eSystem to run SBA exams means that you get the benefit of automatic marking as well as having analysis and reports at your fingertips.

However, as with other question styles that give a pre-defined set of answers, there are some concerns that SBAs may be subject to cueing. Where candidates could work out the correct answer from the information given in the question.  Read more about this in our blog to SBA or VSA… that is the question.

Short Answer Questions (SAQ)

With eSystem it’s also possible to use short answer questions in your medical exams. These are open-ended questions that require candidates to create their own answer, rather than select from a list. The obvious benefit of this style over MCQs is that the student must know the answer and are not able to guess it.

This type of question requires an examiner to review the answers therefore it’s not possible to mark them automatically. However, with the eSystem, it is possible to mark them online. The intuitive format clearly shows the question text, candidate answer, the model answer and a maximum score all on one screen. Examiners can easily enter candidates’ marks as appropriate, before moving on. And since with this question type the answers are short, it can be a relatively quick process.

Very Short Answer Questions (VSA)

These are similar to short answer questions in that they require the student to create their own free-text answer. The main difference being, as the name suggests, that answers are limited to just 2 or 3 words.

VSAs are increasingly being used in medical education and have been added to the eSystem as a result. They have the key benefit of automatic marking, saving time whilst removing any margin for error in the process. Furthermore, they are not subject to cueing in the same way that SBA questions can be.

When setting up a VSA question in the eSystem, there’s the option to add the model answer alongside any alternative correct answers. With marks being allocated to each one.  Watch our short video using VSAs in exams for more information.

Hot Spot Questions

Hot Spot questions are gaining popularity in medical education. They allow examiners to present the candidate with a picture or image in the question. Making them ideal for testing candidates’ interpretation of an x-ray or scan for example. Typically, the student will be asked to select an area or ‘hot spot’ within the image as their answer.

With the eSystem, it’s simple to add hot spot questions to an exam. And it’s intuitive format makes it easy to mark out the hot spot area on the picture. Watch our video, using hot spot questions in exams to see for yourself.

During exam delivery, candidates can zoom into the image and examine it more closely. Once they identify the area they want to submit as their answer, they simply click it to mark it out.  If they change their mind, they can go back and change their selection.

Hot spot questions are marked automatically by the eSystem. Additionally, post-exam, examiners can review the answers by viewing the heat map report. This report provides a simple visual representation of all of the answers on one image.

Essay Questions

Essay questions are open-ended questions which require students to write an essay as their answer. The obvious benefits being that they offer students ample opportunity to demonstrate their knowledge, skills and reasoning. Conversely, they need to be marked individually by an examiner which not only takes time but could also make them prone to subjectivity.

Whilst it isn’t possible to avoid the need for examiners to mark essay questions, it is possible to mark them online with eSystem.  This means it’s not necessary to export or download the answers for marking. It can all be done within the software. The examiner views the student’s answer, alongside the model answer and can quickly and easily allocate marks as appropriate, before moving on to the next candidate.

OSCE (Online/Offline) Practical Exams

Objective Structured Clinical Exams (OSCE’s) have long been considered the gold standard in assessing practical competence in medical education. Traditionally, they consist of a number of stations each presenting different clinical scenarios. The students then move around each station, with the examiner marking them in turn. However, they are often costly, complicated and time consuming to set-up and run.

With the eSystem exam software, it’s possible to run OSCEs electronically. Using a tablet, the examiner enters marks and feedback for each candidate at the station. The software ensures that all required areas have been filled in before allowing the examiner to move on. It’s also easy to capture and deliver feedback to candidates after the exam.

A common concern about running digital OSCEs is around the reliability of WIFI. With the eSystem, there’s no need to worry about this because they can be run electronically offline. With all data being uploaded back to the eSystem when you’re back online. Ideal for environments such as hospitals where WIFI may not be reliable/or allowed.

Read our case study on how the eSystem revolutionised OSCEs for UCL when they made the decision to move to digital OSCEs.

Mini Multiple Interviews (MMI)

Mini Multiple Interviews are being used by many medical schools as part of their admissions process. They are similar to OSCEs in that typically the candidate will be asked to take part in several short practical assessments. The advantage is that it is possible to evaluate a candidate in a variety of different areas, such as critical thinking, logical reasoning, empathy and so on.

As with OSCEs, with eSystem software, it’s possible to run digital MMI’s either online or offline (if WIFI is limited or not available in the venue). Read how ARU medical School successfully used the eSystem exam software to run their MMI interviews for their first cohort of medical students in 2018.

Flexible Exam Software for Medical Education

We understand the importance of having exam software that enables delivery of the exams and question styles you require, whilst simultaneously giving the flexibility to run assessments in the way that you need.

With Speedwell’s eSystem you get this flexibility. You can create and run exams online, offline or on paper. Alongside this, you’ll benefit from many other features such as in-built statistical and feedback reports. Allowing you the insight and ability to streamline and improve your exam management processes. Ultimately freeing up your time to focus on creating better exams in the future.

Which is why Speedwell has been the first choice for many institutions in medical education for over 30 years.

Talk to the team

If you’d like to find out more about our software or arrange a free personal demonstration of the eSystem, get in touch. Call our sales team on +44 (0) 1223 851703 or email