Background

Assessments in medical education play an indispensable role in fostering competent medical graduates, who are knowledgeable and skilled enough to meet the changing needs of the healthcare practice (1). In fact, based on the performance of medical students in assessments, teachers gain in-depth insights about how much students have learned, how they have learned, in which topics students have performed better, and what areas need more attention to help students attain the intended learning objectives (2). Paper-based assessments have been used for generations to assess students’ cognitive performance in different subject areas taught to them during their training in medical schools, but these types of assessment have their own set of limitations, such as limited scope for interaction, being time-consuming, subjective scoring, questions’ lack of modifiability once printed, paper wastage, concerns pertaining to storage and archiving of papers, and security concerns (1-3).

This calls for alternative options to overcome these limitations (1-3). The purpose of the current article was to explore the scope and merits of electronic question banks, identify their potential challenges in the implementation phase, and offer strategies to overcome them.

Electronic Question Banks: Benefits for Students

Electronic question banks (EQBs) offer multiple benefits for medical students, beginning with easy accessibility at convenient times (4). This means that the learning process does not remain restricted to within the four walls of lecture halls, rather students can take their individual calls and decide when to learn and how to learn (supporting the principle of adult learning). Further, EQBs ensure that students are exposed to a wide range and types of questions of varying difficulty levels, which in turn can fulfill the needs of students with different learning styles, promoting inclusivity (5, 6). As students can have access to EQBs at any time, this becomes a source for the continuous reinforcement and gradual improvement of their knowledge on the subject (7).

Depending on their performance in these assessments, students become motivated to practice self-directed learning, which happens to be a crucial attribute of medical graduates (7).

Because EQBs are conducted using electronic platforms, students are acquainted with digital platforms often used in national entrance exams or certification assessments (4). This would eventually reduce students’ anxiety, which is often attributed to high-stakes assessments (6). At the same time, students even become well-primed and learn the art of managing their time and approach during exams. Moreover, EQBs can be regularly updated, ensuring that students remain in touch with recent developments (8). Further, we can develop a mechanism to provide immediate feedback to students about their performance, helping them strengthen their positives and repair their shortcomings (9). Finally, EQBs help students gradually boost their technological literacy and remain at par with their counterparts across the world (5, 6).

Challenges of EQBs and Potential Solutions (Table1)

Establishing an EQB in a medical college faces some challenges requiring a comprehensive approach to be addressed (2). These challenges can be technological, wherein users may lack access to appropriate technology devices or technical assistance precluding them from using EQBs (4).

Table 1. Challenges and Potential Solutions of Developing EQBs

From the student’s perspective, resistance to change, variability in the learning curve of different students, and lack of student engagement could be other noteworthy concerns (9). Similarly, even teachers can express their reluctance to shift from conventional assessments to EQBs, expressing security and privacy concerns over the content of EQBs or students’ information (10).

Further, with regard to the content of EQBs, concerns include imbalanced questions (both in terms of a tendency toward a specific type of questions like MCQs or in terms of complexity, like a greater number of recall types rather than problem-solving questions), maintenance of the content, especially in the sense of alignment between the questions and recent developments (2, 4, 6). There have been concerns about the lack of measures to sustain quality assurance in EQBs, especially with regard to the accuracy of answers, as well as the relevance and framing of questions (2). There may also be issues such as a lack of standardization of EQBs across different institutions, leading to considerable variations in implementation and processes (7, 8). Finally, the initial setup and infrastructure will warrant lots of financial expenses, and we must think and plan along those lines to ensure that EQBs are effectively implemented (2, 4). There is an immense need to overcome these challenges, and this important task demands a multipronged approach to help educators optimize EQBs (2, 4-7, 9).

Conclusion

In conclusion, EQBs can ensure that medical education is delivered in an innovative manner, which in turn can lead to the graduation of competent healthcare professionals. The need of the hour is to overcome the hurdles interfering with the implementation of EQBs to expand the benefits of this approach for medical students.