Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : JC10 - JC14 Full Version

Evaluation of Community Medicine Postgraduate Theory Examination to Measure the Content and Cognitive Domain Coverage- A Retrospective Analysis

Published: March 1, 2022 | DOI:
M Rajalakshmi, Vinayagamoorthy Venugopal, Amol R Dongre

1. Assistant Professor, Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. 2. Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India. 3. Professor, Department of Community Medicine and Medical Education, Pramukhswami Medical College, (PSMC), Karamsad, Gujarat, India

Correspondence Address :
Vinayagamoorthy Venugopal,
Assistant Professor, Department of Community and Family Medicine, All India
Institute of Medical Sciences, Deoghar, Jharkhand, India.


Introduction: Assessment is a critical step in learning process. Postgraduate theory examination ideally should assess higher levels of cognition. In order to maintain high standard of public health the postgraduates of the specialty should be certified properly using the appropriate assessment methods. Since the assessment drives learning, ideally it should be aimed at judging a learner’s attainment of curriculum outcomes.

Aim: To evaluate the postgraduate theory exam question papers from 2014 to 2018 in Community Medicine (CM) of various South Indian Universities and to measure the actual content coverage and cognitive domain coverage as per Bloom’s taxonomy.

Materials and Methods: The present retrospective analytical study was conducted from April 2019 to July 2019 to assess the question papers from 2014-2018 in community medicine. Sixty theory exam question papers (20 per University) of last 5 years of three South Indian Universities namely Pondicherry (PU), Tamil Nadu (TN), and Kerala (KR) of CM subject were analysed for content coverage and to categorise the level of knowledge assessed as per Bloom’s taxonomy. The significance of difference between the data of various years was tested using Chi-square test.

Results: Questions testing higher cognitive domain was found only in 15%, 3.75% and 2.5% of PU, TN and KR Universities, respectively. Epidemiology of communicable and non communicable diseases was the content that received maximum coverage of total marks, 25%, 21.25% and 18.5% in PU, TN and KR Universities respectively. Certain topics were not covered in many papers. There was no statistical difference in distribution of marks among various Universities in South India.

Conclusion: Findings of this study may be used to redefine the distribution of contents and cognitive domain tested across universities ensuring the validity and reliability of the assessment.


Assessment, Bloom’s taxonomy, Blueprinting

The Department of CM is a branch of healthcare that aims to develop a well-rounded and holistic medical professional, who will demonstrate knowledge and competence with compassion in dealing with primary healthcare, desire for lifelong learning, evidence-based practice, interdisciplinary teamwork, professional and ethical behaviour in practice in order to improve and sustain the health of the population (1),(2). In order to maintain high standard of public health the postgraduates of the specialty should be certified properly using the appropriate assessment methods. Since the assessment drives learning, ideally it should be aimed at judging a learner’s attainment of curriculum outcomes (3).

The summative assessment for postgraduate in CM across various Indian Universities has written theory examination and clinical examination. Long Essay Question (LEQ) and Short Essay Question (SEQ) are the type of assessment tools of the written exam (4),(5). Ideally postgraduate theory exam needs to test higher level of cognitive domain namely critical thinking, evaluation and synthesis skills. Due weightage has to be given to all contents of the curriculum that ensures validity of the test paper. However, there are drawbacks in setting theory papers namely subjectivity in setting papers, loss of uniformity, lower cognitive domains predominantly assessed, no prevalidation by peer reviewers, and specific learning objectives not clearly defined (6). The evaluation of examination question papers is hence crucial in educational institutes since examination helps to evaluate student’s achievement and proficiency in specific course.

In this study, an attempt was made to evaluate the level of assessment of postgraduate CM question papers of selected South Indian Universities namely Puducherry University (PU), Tamil Nadu-Dr. MGR University (TNMU) and Kerala University of Health Science (KUHS) for the levels of knowledge as well as weightage given to various topics which helps to give evidence-based suggestions to improve the validity of the theory exam.

Material and Methods

The present retrospective analytical study carried out in the department of CM, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), that trains and certifies undergraduate and postgraduate students, located at rural Puducherry. Postgraduate examination was conducted at the end of three years of Doctor of Medicine (MD) course. PU conducts two examinations annually that is one examination in the month of March-April and other examination in the month of October-November. The theory question papers of PU, TNMU, KUHS were publicly available in their respective websites after examination. Total time period of study from data collection to analysis and interpretation was for four months during the months of April and July 2019. Question papers from 2014 to 2018 in CM were reviewed by the first and second authors of the study who were guided by the third author. Total of sixty MD degree theory exam question papers (20 per University) of last five years from PU, TNMU, KUHS were included for content analysis.

Theory question papers of CM postgraduation theory examination from three selected South Indian Universities (PU, TNMU, KUHS) were the samples. The study variables included name of university, year of examination, type of assessment tool, number and marks of the tools, contents of the curriculum assessed, domain of the cognition assessed.

Study Procedure

The question papers were reviewed, and data extraction sheet was prepared. Question papers were retrieved from respective university websites and from college libraries. The time spent for reviewing each question paper was 10-15 minutes. The parameters which were extracted from the question paper were categorisation of essay questions as per Bloom’s taxonomical domains and weightage given to topics in various universities (7). Classification of levels of Bloom’s taxonomical domain was based on commonly used action verbs. The verbs used in Level-1 Bloom’s taxonomical domain include “define, identify, explain, describe, summarise, interpret, classify, compare and contrast”. Level 2 includes “solve, relate, apply, construct, develop, plan, utilise”. Level 3 includes “analyse, categorise, classify, compare, contrast, distinguish, divide, determine, interpret, criticise, compile, imagine, predict, and propose”. Any controversy in classifying the verb or topics was intervened and facilitated by the second author.

Details of each question paper: Four theory papers (I, II, III, IV), each with maximum mark of 100 were conducted in all the selected Universities. Duration of theory examination of all Universities was three hours. However, type of question varied within universities. In Pondicherry University, there were two LEQs, each carried 25 marks and five SEQs, each carried 10 marks. In Tamil Nadu Dr MGR University, there were two LEQs, each carried 15 marks and seven SEQs, each carried 10 marks. In Kerala University there was one LEQ for 20 marks and eight SEQs, each carried 10 marks.

Contents of theory examination question paper remain same in all Universities. Topics covered in theory paper-I include epidemiology, behavioural sciences, population sciences, demography, environmental health and research methodology and biostatistics. Paper-II includes epidemiology, prevention and control of communicable and non communicable diseases, health education, and behaviour change communication. Healthcare of special groups and nutrition were covered in paper-III. Paper-IV covers health services, health administration, primary healthcare, national health programmes, international health and health legislation (8).

Content representation in each university: Total number of theory examination papers reviewed from 2014-2018 in PU, TNMU, KUHS were four (Paper I, Paper II, Paper III, Paper IV) in each year. All four papers were selected from each year and each University. Marks allotted for each LEQ (25, 15, 20) and each SEQ (10, 7, 10) in Pondicherry, Tamil Nadu and Kerala respectively. Total marks in each paper were 100 in all universities.

Statistical Analysis

The software used for data analysis was Statistical Package for Social Sciences (SPSS) version 24.0. Description of categorical variables was expressed as frequencies and percentages. The significance of difference between the data of various years was tested using Chi-square test.


Total of 60 MD degree theory exam question papers (20 per University) of last five years were analysed for understanding the comprehensiveness of topics and to categorise the level of knowledge as per Bloom’s taxonomy. Among all the three Universities, a total of 100 LEQ and 460 SEQ were reviewed.

Categorisation as per Bloom’s taxonomical domains: More than half [290 marks (72.5%), 370 marks (92.5%), 360 marks (90%)] of the essay questions tested the remembering and understanding skills (Level 1 of Bloom’s taxonomical domain) of the students in PU, TNMU, KUHS respectively. Level 2 (applied type of question) accounts for [50 marks (12.5%), 15 marks (3.75%) and 30 marks (7.5%)] in various universities. Level 3 (creating, evaluating and analysing) type of questions accounts for [60 marks (15%), 15 marks (3.75%) and 10 marks (2.5%)] in PU, TNMU, KUHS, respectively. There was a significant difference in distribution of level 1 and level 2 Bloom’s taxonomical domain among the three universities using Chi-square test, which shows blueprinting was not followed properly (p-value=0.032) (Table/Fig 1).

Weightage to topics in PG Community Medicine (CM) examination: In total, there were four papers in PG CM examination in all universities. Total marks allotted for each paper was 100 in all the Universities. Average marks allotted in each University (PU, TNMU, KUHS) from 2014-2018 were given in (Table/Fig 2). Epidemiology of communicable and non communicable diseases had maximum average marks [100 (25%), 85 (21.25%) and 74 (18.5%)] allotted in PU, TNMU, KUHS respectively. Certain topics which were less covered or not covered in some question papers were international health and health legislation, mental health, disaster management, man and medicine, genetic health, communication for health education and behaviour change communication. There was no statistical difference in distribution of marks among various universities of South India.

Comparison of weightage given to topics in various universities each year: It was observed in (Table/Fig 3) that there was significant difference (p-value 0.001, 0.005, 0.001, 0.001 and 0.008) in weightage given to topics such as demography and family planning, epidemiology of communicable and non communicable diseases, communication for health education and behaviour change communication, healthcare of special groups, healthcare services and primary healthcare in each year in Pondicherry University. In TN Dr. MGR University topics such as healthcare of special groups, nutrition, healthcare service, primary healthcare showed significant difference (p-value 0.001, 0.010 and 0.001) in weightage over the years. Environment and health, healthcare of special groups, nutrition, health planning and management and recent advances and updates were found to be significant (p-value 0.001, 0.001, 0.041, 0.001 and 0.026) in KUHS. This shows that blueprinting was not followed in last five years of examination in all the three universities.


Content analysis of theory exam question papers revealed that questions testing higher cognitive domain were found only in 15%, 3.75% and 2.5% of PU, TN and KR Universities respectively. Epidemiology of communicable and non communicable diseases was the content that received maximum coverage of total marks, 25%, 21.25% and 18.5% in PU, TN and KR Universities respectively.

It was observed that majority (72.5%, 92.5%, 90%) of essay questions tested the Level-1 of Bloom’s taxonomical domain in postgraduate CM examination in all the Universities (PU, TNMU, KUHS) respectively. Similar to the current study’s finding, previous studies done also expressed that the lower order questions were asked more than higher order questions (Table/Fig 4) (9),(10),(11),(12),(13). A good and reasonable postgraduate examination paper must consist of various difficulty levels to accommodate the different capabilities of students. Therefore, there is a crucial need to construct a balanced and high-quality exam, which satisfies higher cognitive levels. There has to be a system that automatically handles the classification of questions in papers before finalising it in accordance with Bloom’s taxonomy. It is high time to make use of preplanned software program to auto check the papers based on the examination type.

In the present study, it was found that non communicable and communicable diseases chapter were given more weightage and many topics namely international health and health legislation, mental health, disaster management, man and medicine, genetic health, communication for health education and behaviour change communication were ignored in most of the universities. Validity is an important characteristic of good assessment and construct under-representation is one of the major validity threats in medical education. Under-representation is under-sampling or biased sampling of the curriculum or course content (11),(12),(14). Blueprinting is a guiding map which specifies the assessment program and curriculum over a specified period of time (15). Blue printing helps to reduce the two major threats to validity such as construct under-representation (CU) and construct irrelevance variance (CV) (16),(17),(18),(19),(20),(21). Few of the previous studies that evaluated question papers revealed that blue printing though existed was not followed in their specialties (11),(16). It is recommended that a system should be developed for centralised moderation of question papers at national level to avoid variation in percentage of questions asked on each topic among different colleges (22),(23),(24).

It was clear that the weightage given to higher cognitive domains was negligible in the summative written exam. However, the formative assessment might have tested higher cognitive domains but they could not be evaluated and that was one of the limitations. The content coverage was not uniform across universities and also many chapters were ignored and under-represented. One might argue that as it was postgraduate examination students should be prepared to answer any variations in contents asked in the test paper but there have to be an acceptable range of variation. As there was no standard recommendation about these variations our evaluation could not account for it.


The results cannot be generalised across nation as only three South Indian University question papers were evaluated.


It was evident that the theory test papers testing the higher cognitive domains were negligible across all three universities evaluated. The content under representation and lack of uniformity of content coverage across universities was another issue identified. Findings of this study may be used to redefine the distribution of contents and cognitive domain tested across universities ensuring the validity and reliability of the assessment. Measures must be taken during system increasing moderation of university professional question papers to look into the identified issues in setting theory examination question paper for postgraduates.


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DOI and Others

DOI: 10.7860/JCDR/2022/51597.16108

Date of Submission: Jul 27, 2021
Date of Peer Review: Nov 26, 2021
Date of Acceptance: Jan 10, 2022
Date of Publishing: Mar 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jul 28, 2021
• Manual Googling: Jan 08, 2022
• iThenticate Software: Jan 20, 2022 (6%)

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