Feasibility of an Online Acute Stressor in Preschool Children of Mothers with Depression.

Maternal depression is a risk factor for future mental health problems in offspring, with stress-system function as a candidate vulnerability factor. Here we present initial validation of an online matching-task (MT) paradigm in young children exposed to maternal depression (N = 40), a first in stressor-paradigm research for this age group. Investigations of stress-system reactivity that can be conducted online are an innovative assessment approach, accelerated by the COVID-19 pandemic. Results indicate high feasibility, with a >75% data collection success rate across measures, similar-to or better-than in-person success rates in young children. Overall, the online MT elicited significant heart rate but not cortisol reactivity. Individual differences in child mental health symptoms were a moderator of reactivity to the stressor such that children with lower, but not higher, behavioral problems exhibited the typical pattern of cortisol reactivity to the online MT. Results are aligned with allostatic load models, which suggest downregulation of stress-system reactivity as a result of experiencing adversity and mental health vulnerability. Consistent with in-person research, this suggests that an early phenotype for the emergence of behavior problems may be linked to altered stress-system reactivity. Results hold potential clinical implications for intervention development and the future of online stress-system research. Trial Registration: Clinical Trial Registration: NCT04639557; (Building Regulation in Dual Generations-Telehealth Model [BRIDGE]).

Comparing remote and face-to-face assessments of physical performance in older adults: A reliability study.

INTRODUCTION: Older people often experience a decline in their physical performance. Tests have been approved to evaluate this performance in person. Yet, the constraints associated with in-person assessments (e.g. lack of medical facilities, pandemic lockdown, and contagion risk) are making us contemplate setting up assessments remotely. OBJECTIVES: To determine whether remote physical performance measurements of older adults are reliable and valid compared to face-to-face measurements. METHODS: Forty-five subjects aged 65 and over completed the normal/fast speed test (NWT/FWT), the unipodal balance test (UBT), the normal/fast timed up and go test (NTUG/FTUG), the 5 and 10 rep sit to stand test (5STS and 10STS), the 30 sec chair stand (30CS), the 2 minute step test (2MST) and the flexibility before standing (SAD) once face-to-face and twice remotely, by two different observers. The intraclass correlation coefficients (ICC), the standard errors of measurement (SEM%) and minimum detectable changes (MDC%) were calculated for both intra- and inter-observer conditions, to assess the relative and the absolute reliability. An ICC value exceeding 0.90 indicates a very high reliability, while an ICC between 0.70 and 0.89 signifies a high reliability. In clinical practice, a SEM % of less than 10% is considered acceptable. A smaller MDC % indicates a measurement that is more sensitive to detecting changes. RESULTS: Intra-observer relative reliability was very high (ICC>0.9) for the UBT, NWT, NTUG, FTUG, 5STS, 10STS, 30CS and the SAD; and high (ICC>0.7) for the 2MST and FWS. SEM% values ranged from 0% to 24.03% and MDC from 0% to 9.93%. Inter-observer relative reliability was considered very high (ICC>0.9) for all tests. SEM% values ranged from 0% to 17.68% and MDC from 0% to 7.32%. CONCLUSION: Our findings demonstrate that remote assessments exhibited consistently high to very high levels of intra- and inter-observer relative reliability when compared to face-to-face assessments. Additionally, certain remote evaluations showed acceptable absolute reliability, making them viable alternatives for healthcare professionals when in-person assessments are not feasible in clinical practice.

Application of MPP database and artificial intelligence system in online evaluation of college students' mental health.

Based on MPP database, we have conducted research and investigation on big data processing and analysis, and provided a good solution for big data. However, due to the large data storage requirements in the local file system may not be fully met. Therefore, the storage and management of big data, reliability, availability and scalability are more and more adopted by distributed file system. Therefore, MPP database based on distributed file system has become a research hotspot. In this paper, in the network control, through the control algorithm based on two kinds of artificial intelligence system, through the fuzzy PID controller to reduce the impact of system control performance. The dynamic BP network error correction and predictive PID controller are introduced into the system to reduce the influence. College Students' mental health education is an important part of the current training. Rapid and accurate online evaluation and analysis of College Students' mental health can provide reference for college students and effective help for the follow-up activities and consultation of the school, At the same time, it provides some basis for the balance of psychological scale and the revision of item setting. In this paper, MPP database and artificial intelligence system are introduced into the application of mental health assessment, which can effectively assess the mental health of college students, and thus promote the continuous development of assessment application.

An online tiered screening procedure to identify mental health problems among refugees.

BACKGROUND: Many refugees suffer from mental health problems due to stressful and traumatic events before, during, and after migration. However, refugees are facing a wide variety of barriers, limiting their access to mental health care. Internet-based tools, available in several languages, could be one way to increase the availability of mental health services for refugees. The present study aimed to develop and test a screening tool to screen for clinically relevant symptoms of psychiatric disorders common among refugees (i.e. Depression, Anxiety, Post-traumatic stress disorder, and Insomnia). We, designed, translated, and adapted an internet-based tiered screening procedure suitable for use with the largest refugee populations residing in Sweden. The tool aims to accurately identify symptoms of mental distress (Tier 1), differentiate between symptoms of specific psychiatric disorders (Tier 2), and assess symptom severity (Tier 3). We tested the overall efficiency of using a tiered screening procedure. METHODS: Seven hundred fifty-seven refugees residing in Sweden, speaking any of the languages Arabic, Dari, Farsi, English, or Swedish, completed an online questionnaire following a three-tiered procedure with screening instruments for each tier. In this study, the Tier 3 scales were used as reference standards for clinically relevant symptoms, to evaluate screening efficiency in terms of accuracy and reduction of item burden in previous tiers. RESULTS: The results show that the tiered procedure could reduce the item burden while maintaining high accuracy, with up to 86% correctly assessed symptoms and few false negatives with moderate symptoms and above (at most 9%), and very few with severe symptoms (at most 1.3%). DISCUSSION: This study generated an accurate screening tool that efficiently identifies clinically relevant symptoms of common psychiatric disorders among refugees. Using an adapted online tiered procedure to screen for multiple mental health issues among refugees has the potential to facilitate screening and increase access to mental health services for refugees. We discuss the utility of the screening tool and the necessity of further evaluation.

Not for Room 101.

The emergence of the COVID-19 pandemic in March 2020 disrupted learning and teaching and brought in-person teaching to an abrupt halt, leading to a rapid pivot towards online and technological solutions including in Anatomy where access to cadaveric specimens and labs were halted. But emerging from the pandemic and with the resumption of more in-person teaching, would these technological innovations find the metaphorical "Room 101" or could some of them successfully enhance the anatomy educators' toolkit? In this chapter, two such technological adaptations that we intend to continue to use in our institution are described. Their development and the pedagogy underpinning their successful use will also be described.The first of these is "Live from the Lab" which is a cadaveric demonstration livestreaming session. Teaching Anatomy through demonstration is not a new concept, however, beaming demonstrations of cadaveric material to students in remote locations need consideration of ethics and the Code of Conduct for students and teachers alike which will be described here along with how to set up such a session.Next, the use of an online assessment platform for spotter-type Anatomy assessments will be described along with their benefits. Both adaptations involve online use of images and/or videos of cadaveric material but have proven to be pedagogically useful.

An online case-based teaching and assessment program on clinical history-taking skills and reasoning using simulated patients in response to the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has created unprecedented challenges for medical students and educators worldwide. Groups 1, 2 and 3 of year 3, semester 2 medical students at the Royal College of Surgeons in Ireland (n = 275) had only completed 2, 5 and 7 weeks, respectively, of their scheduled 10-week clinical medicine and surgery attachments, prior to the Irish shutdown of all in-person non-essential activities, including medical student education. METHODS: We developed and delivered an online case-based program, focused on history-taking skills and clinical reasoning, using simulated patients and video technologies. 12 tutorials were delivered over 6 weeks to 35 subgroups of 8 students in line with program learning outcomes. Both simulated patients (n = 36), and tutors (n = 45, from retired clinical professors to newly graduated physicians), were rapidly upskilled in Blackboard Collaborate and Microsoft Teams, and also in the provision of constructive feedback. We evaluated this newly developed program by the following three criteria: student attendance, achieved grades, and student feedback. RESULTS: Attendance at the 12 tutorials was higher amongst group 1 and 2 students (75 and 73%) by comparison with group 3 students (60%) (p = < 0.001). Of the 273 students that sat the Year 3 Semester 2 online long case assessment, 93% were successful. Despite group 1 students having the least prior clinical experience, results were similar to those of groups 2 and 3 (1st honors, 2nd honors, pass, and fail grades for group 1, 39%, 33%, 23% and 6%; group 2, 34%, 41%, 17% and 8%; group 3, 39%, 25%, 28% and 7%) (p = 0.48). An increased attendance rate at tutorials was associated with higher numbers of honors grades (p = < 0.001). Anonymous feedback from the students demonstrated considerable satisfaction with program: > 85% agreed that the online program was interactive and very educational. CONCLUSIONS: Use of online video technology, tutors of varied experience, and simulated patients were demonstrated to replicate patient encounters, and to facilitate the development of clinical skills remotely during the COVID-19 pandemic.

Improving the resident assessment process: application of App-based e-training platform and lean thinking.

BACKGROUND: The assessment system for standardized resident training is crucial for developing competent doctors. However, it is complex, making it difficult to manage. The COVID-19 pandemic has also aggravated the difficulty of assessment. We, therefore, integrated lean thinking with App-based e-training platform to improve the assessment process through Define-Measure-Analyze-Improve-Control (DMAIC) cycles. This was designed to avoid unnecessary activities that generate waste. METHODS: Panels and online surveys were conducted in 2021-2022 to find the main issues that affect resident assessment and the root causes under the frame of waste. An online app was developed. Activities within the process were improved by brainstorming. Online surveys were used to improve the issues, satisfaction, and time spent on assessment using the app. RESULTS: A total of 290 clinical educators in 36 departments responded to the survey, and 153 clinical educators used the online app for assessment. Unplanned delay or cancellation was defined as the main issue. Eleven leading causes accounted for 87.5% of the issues. These were examiner time conflict, student time conflict, insufficient examiners, supervisor time conflict, grade statistics, insufficient exam assistants, reporting results, material archiving, unfamiliarity with the process, uncooperative patients, and feedback. The median rate of unplanned delay or cancellation was lower with use of the app (5% vs 0%, P < 0.001), and satisfaction increased (P < 0.001). The median time saved by the app across the whole assessment process was 60 (interquartile range 60-120) minutes. CONCLUSIONS: Lean thinking integrated with an App-based e-training platform could optimize the process of resident assessment. This could reduce waste and promote teaching and learning in medical education.

How reliable is assessment of children's sentence comprehension using a self-directed app? A comparison of supported versus independent use.

This study reports on the feasibility of using the Test of Complex Syntax- Electronic (TECS-E), as a self-directed app, to measure sentence comprehension in children aged 4 to 5 ½ years old; how testing apps might be adapted for effective independent use; and agreement levels between face-to-face supported computerized and independent computerized testing with this cohort. A pilot phase was completed with 4 to 4;06-year-old children, to determine the appropriate functional app features required to facilitate independent test completion. Following the integration of identified features, children completed the app independently or with adult support (4-4;05 (n = 22) 4;06-4;11 months (n = 55) and 5 to 5;05 (n = 113)) and test re-test reliability was examined. Independent test completion posed problems for children under 5 years but for those over 5, TECS-E is a reliable method to assess children's understanding of complex sentences, when used independently.

Emergency remote teaching of foreign languages at Saudi universities: Teachers' reported challenges, coping strategies and training needs.

Though considerable research has been reported on COVID-19-related distance education, some dimensions of remote foreign language teaching experiences during the pandemic crisis remain to be explored. The study reported in this paper investigated Saudi university foreign language teachers' accumulated experiences and reflective beliefs of emergency remote instruction. The study focused specifically on: a) the general educational challenges the teachers encountered and their attempts to overcome them; b) the teachers' perceived difficulties in remotely teaching and assessing foreign language areas and their strategies for coping with them; and c) their reflective evaluation of remote foreign language teaching after doing it for three academic terms. Questionnaire data was collected from 112 teachers of Arabic and English as foreign languages, and semi-structured interviews were conducted with 14 teachers. The analysis of both data types showed that the participants had a number of general educational and language-teaching-specific challenges in their COVID-19-related remote teaching. The teachers generally viewed the remote assessment of language areas is a more challenging task than teaching them. Reading was rated as the least difficult language area to teach and assess remotely, whereas writing was the most difficult one. The teachers reported using various coping strategies to overcome the educational and language teaching-specific challenges. They perceived their remote teaching experiences positively, but reported their needs for further training in developing better online assessment methods, using different teaching platforms and technological tools, and managing classroom interactions. The paper ends by discussing the results of the study and their implications.

The Geneva Space Cruiser: a fully self-administered online tool to assess prospective memory across the adult lifespan.

The current study aimed to examine whether the Geneva Space Cruiser - a new online adaptation of the Cruiser - represents a valid, reliable and useful tool to assess prospective memory (PM) across the adult lifespan via fully self-administered online testing. Therefore, an adult lifespan sample of 252 adults (19-86 years old) performed the Geneva Space Cruiser in the laboratory and online, at home, and also performed a more traditional laboratory PM task. A second sample of 224 young adults (19-35 years old) participated in a test-retest online assessment of the Geneva Space Cruiser. Bayesian analyses showed that the Geneva Space Cruiser yielded similar results when administered in the laboratory versus online, both in terms of data distribution as well as of key outcome measures (i.e., PM performance and monitoring). Results further showed very good test-retest reliability and acceptable construct validity. Finally, the online tool was sensitive for detecting age-differences similar to those typically observed in laboratory studies. Together, our findings suggest that the Geneva Space Cruiser represents a rather valid, moderately to highly reliable, and generally useful tool to assess PM in online testing across wide ranges of the adult lifespan, with certain limitations for the oldest participants and for women.

Web-Based Independent Versus Laboratory-Based Stop-Signal Task Performance: Within-Subjects Counterbalanced Comparison Study.

BACKGROUND: Considered a facet of behavioral impulsivity, response inhibition facilitates adaptive and goal-directed behavior. It is often assessed using the Stop-Signal Task (SST), which is presented on stand-alone computers under controlled laboratory conditions. Sample size may consequently be a function of cost or time and sample diversity constrained to those willing or able to attend the laboratory. Statistical power and generalizability of results might, in turn, be impacted. Such limitations may potentially be overcome via the implementation of web-based testing. OBJECTIVE: The aim of this study was to investigate if there were differences between variables derived from a web-based SST when it was undertaken independently-that is, outside the laboratory, on any computer, and in the absence of researchers-versus when it was performed under laboratory conditions. METHODS: We programmed a web-based SST in HTML and JavaScript and employed a counterbalanced design. A total of 166 individuals (mean age 19.72, SD 1.85, range 18-36 years; 146/166, 88% female) were recruited. Of them, 79 undertook the independent task prior to visiting the laboratory and 78 completed the independent task following their laboratory visit. The average time between SST testing was 3.72 (SD 2.86) days. Dependent samples and Bayesian paired samples t tests were used to examine differences between laboratory-based and independent SST variables. Correlational analyses were conducted on stop-signal reaction times (SSRT). RESULTS: After exclusions, 123 participants (mean age 19.73, SD 1.97 years) completed the SST both in the laboratory and independently. While participants were less accurate on go trials and exhibited reduced inhibitory control when undertaking the independent-compared to the laboratory-based-SST, there was a positive association between the SSRT of each condition (r=.48; P<.001; 95% CI 0.33-0.61). CONCLUSIONS: Findings suggest a web-based SST, which participants undertake on any computer, at any location, and in the absence of the researcher, is a suitable measure of response inhibition.

Do students effectively learn physiology through distance online instruction? Medical students' perceptions and academic performance.

This an account of student feedback on the distance online tools adopted at the onset of the COVID-19 pandemic for teaching cardiovascular (CVS) physiology to Year 2 medical students within a problem-based learning (PBL) medical curriculum. Students' achievement upon assessment of CVS physiology theory content was also evaluated. Most students were ready for online learning in terms of appropriate equipment and internet connectivity. Most students expressed a preference for face-to-face learning of CVS physiology; however, they relied on recorded videos mainly for learning, instead of real-time attendance of physiology learning activities. Most students also reported a negative experience of distance online learning of CVS physiology during the lockdown, and only a few students expressed connection with their instructor through the physiology learning activities. Students undertaking online learning and examination during the pandemic achieved comparably to the prior year's cohort of PBL students learning in person and undertaking paper-based assessment. This indicates that our medical students preferred asynchronous learning during the pandemic confinement and that they sufficiently achieved their learning outcomes in CVS physiology, displaying resilience in their adaptation to the online learning and examination format.

The effect of implementing mind maps for online learning and assessment on students during COVID-19 pandemic: a cross sectional study.

BACKGROUND: In Saudi Arabia, the sudden shift from conventional (in-person) to online education due to the coronavirus disease 2019 (COVID-19) pandemic affected teaching and assessment methods. This research aimed to assess the effectiveness of mind maps in this regard, measure students' reactions to certain educational environment-related changes caused by the pandemic, and identify skills that students perceived they gained through mind mapping. METHODS: This study employed a non-intervention (cross sectional) design. Participants were King Abdulaziz University students from two medical physics courses (second and fourth level). Data were collected twice (after the first and last mind mapping assignments), and responses were analyzed using a paired t-test. Overall student results were compared against overall student performance in the previous term using chi-squares test hypothesis testing. The data were collected and analyzed using SPSS software. RESULTS: The results of the paired t-test showed no significant differences between students' mean satisfaction in both surveys. Nevertheless, students' responses revealed their satisfaction with using mind maps. Moreover, students believed that they gained skills like organizing and planning, decision making, and critical thinking from the mind map assignments. The chi-squares test (Chi-square = 4.29 < [Formula: see text] = 9.48 and p-value = 0.36 > 0.05) showed no differences in students' grade distribution between the two terms of 2020 (pre- and post-COVID-19 pandemic) despite the change in assessment style post-pandemic commencement. CONCLUSIONS: Mind mapping can be adapted as an online teaching and assessment method. Additionally, student support and education institution-level effective communication can reduce stress during challenging times.

Introducing ACTFAiREST2 to implement online assessments amid COVID-19: a case study from a low resource setting.

BACKGROUND: Amid COVID-19, soon after the closure of academic institutions, academia was compelled to implement teaching and assessments virtually. The situation was not the same for all countries. This transition was much more challenging in low-resource settings like Pakistan, where the students were geographically distant with minimal connectivity. A private university in Pakistan instituted a systematic approach for ensuring quality assurance and reliability before launching online assessments amid the COVID-19. The purpose of this study was to reflect on the phased transition to online/remote assessments to facilitate continuous student learning through distance modalities during the pandemic. METHOD: To assist faculty in re-designing their assessments, a workshop was conducted which was based on the modified Walker's nine principles. The principles coded as "ACTFAiREST2" were introduced to ensure that the faculty understands and adapts these principles in designing online assessments. The faculty modified and re-designed their course assessments, from face to face to online modality and submitted their proposals to the Curriculum Committee (CC). To guide the process of approving modified and re-designed assessments, a checklist was adapted. All the pre and -post workshop assessment proposals were analyzed using a content analysis approach to ensure the alignment of course learning outcomes with the assessments. RESULTS: A total of 45 undergraduate courses' assessment proposals were approved by the CC after deliberations ensuring their applicability in a virtual environment. From the analysis of the course outlines and assessment proposals submitted to the CC, faculty made four key changes to their assessment tasks in the light of ACT FAiREST2 principles (a) alternative to performance exams; (b) alternative to knowledge exams; (c) change in the mode of assessment administration; and (d) minimizing the overall assessment load. CONCLUSION: This transition provided an impetus for the faculty from a low resource setting to build momentum towards improved and innovative ways of online teaching and assessments for future nursing education to adapt to the new normal situation. This development will serve as a resource in similar contexts with planned and evidence-based approaches for enhancing faculty readiness and preparedness for online/remote assessments.

An online hazard prediction test demonstrates differences in the ability to identify hazardous situations between different driving groups.

Previous research has found that the traditional approach to measuring hazard perception, as used by the UK Government, does not necessarily transfer well to other countries. The speeded response times of a hazard perception test were susceptible to threshold bias, differentiating drivers according to cultural background more than driving experience. An alternative method - the hazard prediction test - appears to mitigate these problems when used across different countries. The current study applies the hazard prediction methodology to a new cultural context (Israel), delivered via an online platform. A further innovation was to include both hazardous and non-hazardous trials allowing measures of criterion and sensitivity parameters of the Signal Detection Theory to be calculated.In total, 74 participants (43 experienced and 31 novices) watched 26 hazard prediction clips that had been filmed in Tel Aviv (Israel), 13 of which contained cues to genuine hazards. Each hazardous clip was occluded prior to the hazardous situation fully materialising, though with sufficient evidence that any participant who was looking in the right place at the right time would be able to correctly identify the unfolding hazard. Participants were first asked to identify whether there was a hazard (a binary decision), and then to predict how the traffic situation was going to develop by choosing one of four options provided after each video.As hypothesised, experienced drivers outperformed novices in the multiple-choice prediction question, provided that they had correctly identified that the clip contained a hazard in the first question. Novices were poor at selecting the correct multiple-choice option, regardless of whether they correctly identified that the clip contained a hazard. Both driving experience and hazard sensitivity significantly predicted multiple-choice accuracy, though criterion did not. The newly developed online test was successful in differentiating between experienced and novice driver groups for accuracy in prediction. These results support the roll-out of the hazard prediction methodology across different countries. Practitioner summary: This study provides new insights into how to develop an online hazard prediction test suitable for international export. The results suggest that this newly developed test is successful in differentiating between experienced and novice drivers. This raises the possibilit y of assessing and training drivers on a global scale.

Final-year medical student Psychiatry and Addiction Medicine synchronous summative tele-assessments during a COVID-19 Delta-variant stay-at-home lockdown.

OBJECTIVE: We describe the planning, process and evaluation of final-year Psychiatry and Addiction Medicine summative assessments in a four-year graduate medical degree program, during a COVID-19 Delta-variant public health stay-at-home lockdown. CONCLUSIONS: We conducted separate written and clinical synchronous (real-time simultaneous) tele-assessments. We used online assessment technology with students, examiners and simulated patients, all in different physical locations. Medical students' examination performance showed a good range. This was comparable to other discipline stations, and performance in previous years. There was no differential performance of students through the day of the assessments.

The Work for Environmental Protection Task: A consequential web-based procedure for studying pro-environmental behavior.

Some human behaviors have serious societal consequences, but these consequences tend to be neglected in online research on societally relevant behaviors. For example, human activities contribute to climate change and biodiversity loss, but pro-environmental behavior is often studied using inconsequential self-reports and hypothetical scenarios. Such measures can easily be administered online, but suffer from severe validity problems. To address these problems, we developed a multi-trial web-based procedure for the study of consequential pro-environmental behavior. On the Work for Environmental Protection Task (WEPT), participants can choose to exert voluntary extra efforts screening numerical stimuli in exchange for donations to an environmental organization. They thus have the opportunity to produce actual environmental benefits at actual behavioral costs (i.e., to show actual pro-environmental behavior). In a preregistered validation study (N = 209), we found WEPT performance to systematically vary with these consequences, that is, the implemented costs and benefits were large enough for participants to effectively take them into account. In addition, aggregated WEPT performance was found to be highly reliable and to be correlated to self-reports and objective observations of other pro-environmental behaviors and conceptually related measures. These findings support the validity of the WEPT as an online procedure for the study of actual pro-environmental behavior. We discuss how the WEPT can advance the experimental analysis of pro-environmental behavior, help to address problems of common-method variance in individual difference research, and be adapted for the consequential study of other societally relevant behaviors.

Remote Assessment of Veterinary Clinical Skills Courses During the COVID-19 Pandemic.

In spring 2020, the COVID-19 pandemic forced educators to adjust the delivery and assessment of curriculum. While didactic courses moved online, laboratory courses were not amenable to this shift. In particular, assessment of clinical skills courses through common methods including objective structured clinical examinations (OSCEs) became inadvisable. This article describes decisions made for first-, second-, and third-year veterinary students (n = 368) with respect to clinical skills at one US college. This includes the remote completion of a surgical skills curriculum using instructional videos and models and the delaying of laboratory sessions deemed impossible to deliver remotely. First- and third-year students were subsequently assessed using modified remote OSCEs. Second-year students were assessed using the standard surgical skills examination, video-recorded. All first- and third-year students successfully passed their OSCE upon either first attempt or remediation. Two second-year students failed their remediation examination and were offered additional faculty tutoring and another remediation attempt at the start of the fall semester. The remediation rate on the surgical skills examination was not different from that of previous years. One incident of suspected academic dishonesty occurred in the first-year OSCE. Students learned surgical skills successfully at home by practicing on models and receiving feedback of their skills on video recordings. While disappointing, one case of academic dishonesty among the 368 total students tested was not surprising. Remote assessment using modified OSCEs and surgical skills exams appears feasible and fair when in-person testing is not possible.

Blended programmatic assessment for competency based curricula.

The uncertainty in all spheres of higher education due to the COVID-19 pandemic has had an unprecedented impact on teaching-learning and assessments in medical colleges across the globe. The conventional ways of assessment are now neither possible nor practical for certifying medical graduates. This has necessitated thoughtful considerations in making adjustments to the assessment system, with most institutions transitioning to online assessments that so far have remained underutilized. Programmatic assessment encourages the deliberate and longitudinal use of diverse assessment methods to maximize learning and assessment and at present can be utilized optimally as it ensures the collection of multiple low-stake assessment data which can be aggregated for high-stake pass/fail decisions by making use of every opportunity for formative feedback to improve performance. Though efforts have been made to introduce programmatic assessment in the competency-based undergraduate curriculum, transitioning to online assessment can be a potential opportunity if the basic tenets of programmatic assessment, choice of online assessment tools, strategies, good practices of online assessments and challenges are understood and explored explicitly for designing and implementing online assessments. This paper explores the possibility of introducing online assessment with face-to-face assessment and structuring a blended programmatic assessment in competency-based medical education.

Remote versus on-site proctored exam: comparing student results in a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has profoundly affected assessment practices in medical education necessitating distancing from the traditional classroom. However, safeguarding academic integrity is of particular importance for high-stakes medical exams. We utilised remote proctoring to administer safely and reliably a proficiency-test for admission to the Advanced Master of General Practice (AMGP). We compared exam results of the remote proctored exam group to those of the on-site proctored exam group. METHODS: A cross-sectional design was adopted with candidates applying for admission to the AMGP. We developed and applied a proctoring software operating on three levels to register suspicious events: recording actions, analysing behaviour, and live supervision. We performed a Mann-Whitney U test to compare exam results from the remote proctored to the on-site proctored group. To get more insight into candidates' perceptions about proctoring, a post-test questionnaire was administered. An exploratory factor analysis was performed to explore quantitative data, while qualitative data were thematically analysed. RESULTS: In total, 472 (79%) candidates took the proficiency-test using the proctoring software, while 121 (20%) were on-site with live supervision. The results indicated that the proctoring type does not influence exam results. Out of 472 candidates, 304 filled in the post-test questionnaire. Two factors were extracted from the analysis and identified as candidates' appreciation of proctoring and as emotional distress because of proctoring. Four themes were identified in the thematic analysis providing more insight on candidates' emotional well-being. CONCLUSIONS: A comparison of exam results revealed that remote proctoring could be a viable solution for administering high-stakes medical exams. With regards to candidates' educational experience, remote proctoring was met with mixed feelings. Potential privacy issues and increased test anxiety should be taken into consideration when choosing a proctoring protocol. Future research should explore generalizability of these results utilising other proctoring systems in medical education and in other educational settings.