European Journal of Cardiovascular Medicine

Competency based education has been defined as an outcome-based approach to the design, implementation, assessment and evaluation of a medical education program using an organizing framework of competencies [1]. Assessment is more about integration of the required knowledge, skills and attitudes rather than anyone of them in isolation. The main purpose of assessment in competency-based curriculum is to help the teachers decide if the students have acquired the desired competencies [2]. So, assessment in competency-based curriculum should incorporate integration to the extent feasible while maintaining subject identity.

 The three important characteristics of competency-based curriculum are - teaching and assessment has to be in the context of competencies, discrete assessment of knowledge, skills and attitudes may not always add up to a competency and a high context specificity in assessment [2]. Many competencies like communication, team work, sincerity etc. may not be assessed if done separately or only at summative examination. Therefore, all competencies need to be assessed multiple times and in different contexts. An implication of this is that only one summative or end of year examination is not suited for this purpose. Utility of assessment is traditionally expressed as a notional concept represented by products of validity, reliability, acceptability, feasibility and educational impact [3].

 Competency based assessment requires active participation of the student in the form of self-assessment and reflections which aids in the process of learning. Effective feedback is paramount to helping learners improve. This study is an attempt to analyse the best tool of assessment for the newly introduced curriculum in medical education in India in 2019 all over India.

The aim is to study best assessment method for CBME introduced in India as GMR 2019 regulations by MCI, India. This achieved a uniform pattern of assessment in all over India for first time in Medical Education.

The present study was conducted in GMC [ RIMS], Kadapa, Andhra Pradesh, India. This is done as a mandatory project in ACME course conducted by CMC, Vellore, Tamil Nadu, India. The study was conducted through a questionnaire sent to the students of then 2019 batch by google sheet for which batch new regulations of GMR- 2019 introduced. The institutional ethical committee approval is taken and voluntary participation of students is asked for answering question are. Some questions are framed that they could give their own answers are given along with suggestions.

 The collected data was subjected to statistical analysis by computing the answers. Their opinions on the introduced assessment and what they want to have in new regulations question paper was recorded. Some students expressed freely some suggestions regarding studies, course and assessment

Table 1 :Types of assessment students  want to have

                                                 Table 2: Opinion on need for recreation

Table 3:No.of reading hours you fix per day

Table 4: No.of actual reading hours per day

Fig .1. : AETCOM based assessment makes you  a good doctor to change your technique

Fig .2. : Students feeling every internal is followed by practical is stressful.

Fig.3 :    students feeling internal should be practical.

Table 5:statistical data  on internals

Table 6:statistical data  on internals followed by practicals are stressful

Table 7: statistical data on which first year subject in MBBS degree is stressful

Table 8 :statistical data  on which first year subject in MBBS degree is stressful

Table 9:Types of assessment do you want to have

The study was conducted through a questionnaire sent to the students of then 2019 batch by google forms for which batch new regulations of GMR- 2019 introduced. The institutional ethical committee approval is taken and voluntary participation of students is asked for answering questionare.150 both female and male students participated in the study and gave their valuable opinions.

Assessment is purpose driven. In planning and designing assessments, it is essential to recognize the stakes involved in it. The higher the stake, the greater the implications of the outcome of the assessment. The more sophisticated the assessment strategies, the more appropriate they become for feedback and learning[4]. Multiple assessment methods are necessary to capture all or most aspects of clinical competency and any single method is not sufficient to do the job. For knowledge, concepts, application of knowledge (‘Knows’ and ‘Knows How’ of Miller’s conceptual pyramid for clinical competence) context-based MCQ, extended matching item and short answer questions are appropriate. For ‘Shows How” multi-station OSCE is feasible. For performance-based assessment (‘does’) mini-CEX, DOPS is appropriate.

 Medical education worldwide is embracing the move toward outcome-based education (OBME) [5, 6]. One of the most popular outcome-based approaches being widely adopted by medical schools worldwide is competency-based medical education (CBME) [7]. Formulate the search question [8] as follows: participants: healthcare professionals and healthcare profession students; educational aspect: CBME curricula; outcome: program evaluation practices

The old method of question paper was containing  Essay type questions [either direct or structured] , Short Answer questions , Very short answer questions only. As new regulations are introduced for 2019 batch, assessment pattern also needs to be improvised to meet the needs of developing a global competent Indian Medical Graduate.This study is done to know if there was any need for assessment methods according to students and what type of assessments they were wishing for.The best method they wanted were among Long essay questions ,  structured long essay questions, problem based questions,  short answer questions , very short answer questions ,only diagram based questions, fill in the blanks, multiple choice questions, practical exams OSPE,  VIVA , AETCOM BASED ASSESSMENT and the wished assessment by the students was in this order – MCQ, problem based questions, long essay questions, structured LEQ, very short answer questions , only diagram based questions, short answer questions, AETCOM based assessment, OSPE , viva, fill in the blanks. Among these, some assessments were not in practice up to 2019.  62% of students chose sports or games ,27 % followed by meditation or yoga as their choice of recreation. 1% chose group discussions with other students. Most of the students wanted to study for 4-5 hrs daily but only 1-3 hours of study is happening among most of these students.

There were also requests for SDL sessions which was introduced for first time in that year, study hours and good hostel atmosphere. There was also request for programs which increase interaction with student and teacher and Clinical exposure and problem based questionare. Introduction of multiple-choice questions, problem-based questions, group discussions and self-directed learnings and diagram-based questions were requested.

 The reason for inclusion of multiple-choice questions and fill in the blanks and diagram based questions according to students was that they take less time when compared to the long and lengthy question answers and also better at interpreting the knowledge and understanding of the student. Extended matching questions were also suggested .

Students felt that teaching would be better if performed more frequently on a large scale, not in a manner of spoon feeding but in the sense of stimulating the students mind. Management of time in the exam was felt as an important another challenge for them. 

The students are felt stressful in the new curriculum and stressful subject is Anatomy for boys and physiology for girls which is significant at higher level. The students felt that every internal should be followed by practicals in the new curriculum and not stressful which was not practised earlier.   

The students emphasized the need of study hours and extracurricular activities and they were also reading daily  in the new curriculum in order to reduce stress. Introduction of AETCOM based assessment makes them feel that AETCOM is necessary for changing of attitudes to compete globally as an Indian Medical Graduate from 2019.

A program helps to identify areas of success, challenges, and opportunities for improvement in CBME implementation, leading to a deeper comprehension of CBME strategies and their effectiveness. Implementing CBME demands significant efforts and a wide range of financial, human, time, and infrastructure resources [9]. Despite many challenges , Medical educators are trying  precise in setting evaluation objectives, which entails answering certain questions: who will use the evaluation data; how will the data be used at both the individual and program level; will the evaluation be summative or formative; and what evaluation questions must be answered [10, 11, 1].

 This study analysed the newly introduced curriculum in 2019 and ideas of students who got prepared for the change of curriculum to compete globally as an Indian Medical Graduate. This study also analyses the program and its impact on students by medical educators. In the recent years, assessment pattern is changed accordingly to meet the new curriculum which are mainly discussed in this study. The continuation of study will lead medical educators to know about the views of students about assessment and their ideas.

Conflict Of Interest:   None

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