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

Users Online : 166414

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
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.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
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.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
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.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
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.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



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)
E-mail: drrajendrak1@rediffmail.com
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.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

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
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : JE01 - JE07 Full Version

Effectiveness of the Structured and Conventional Methods of Viva Examination in Medical Education: A Systematic Review and Meta-analysis


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57445.16977
K Anbarasi, JV Karunakaran, Latha Ravichandran, B Arthi

1. Professor, Department of Dental Education, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. 2. Professor and Head, Department of Conservative Dentistry and Endodontics, JKK Nataraja Dental College, Komarapalayam, Tamil Nadu, India. 3. Dean, Medical Education Unit Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. 4. Reader, Department of Public Health Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. K Anbarasi,
Professor, Department of Dental Education, Unit Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
E-mail: anbarasi815@gmail.com

Abstract

Introduction: Oral examination (viva voce) is one of the common assessment methods for medical students. Literature shows that Conventional Oral Examination (COE), is a widely adopted method and uses a consolidated scoring system. There came an alternative method, Structured Oral Examination (SOE) that uses the recommended rating scale (prevalidated questions and markings). The emergence of a new method raised the research question of whether the conventional or structured oral examination is effective in assessing medical students.

Aim: To evaluate the effectiveness of traditional and structured viva-voce examination across the specialties in medical education.

Materials and Methods: A systematic review was conducted on 18 peer-reviewed articles about conventional and structured oral examination among medical students. Medical Education Research Study Quality Instrument (MERSQI) was used to assess the quality of evidence.

Results: The level of evidence was moderate where the MERSQI score ranges from 7.5 to 15.5 for the 18 articles included in the review process. SOE overcomes COE by assessing students’ cognitive skills, communication skills, behaviour, and attitude whereas COE principally assesses the recall knowledge. Analytical and reasoning power remains the predominant domain in SOE. With psychometric properties like good reliability, sensitivity, and acceptability, SOE remains the best strategy for the evaluation of medical students. Pooled results in the forest plot showed no difference in the viva voce marks between COE and SOE with a mean difference of 0.46 (p=0.53).

Conclusion: The review analysis revealed that there is no difference in the mean marks scored by COE and SOE. However, a SOE will allow examiners to assess the medical students’ learning achievement with no partiality, stress, and anxiety compared to COE.

Keywords

Assessment, Dental education, Structured oral exam, Unstructured oral exam, Viva-voce

The knowledge and skills of medical students have been assessed using written and oral examinations since 1950. An oral examination (viva-voce) is an interview between a candidate and one or more examiners holding an important place in a medical examination (1). The oral examination is a way of assessing the candidates’ ability to understand and express the ideas in particular topics and judging how deep they understand them (2).

The conventional or traditional or unstructured oral examination is an interview or discussion between examiner(s) and student in the absence of patients (3). This COE mainly focuses on the professional aspects of medical subjects like practice-oriented knowledge, mental sharpness, positive verbal communication, and subtle decision making (4),(5). In this method, each student receives different questions about the content addressed, the difficulty of the question, and different levels of prompting or help. It has been claimed that this oral examination format is not uniform, too subjective, and is more prone to errors (6),(7).

SOE is recently used in the assessment of medical education, including basic medical subjects. SOE assesses the knowledge, skills, and attitude of the students using a set of predetermined questions (8). It is well planned in content and competencies to be assessed in a specific duration and is supported by a checklist. Though SOE is well framed, it increases apprehension among the students (difficulty level of questions, problem solving type of questions, direct feedback) and reluctance among the faculty members (SOE demands detailed planning, pre validated well-structured questions, scoring criteria, resources, and manpower) in terms of implementation (9). It is the need of the hour to decide whether COE or SOE will help in a successful medical student’s examination.

This systematic review aimed to evaluate the effectiveness of the COE and SOE in all disciplines of medical education and consolidate the results based on students’ test scores.

Material and Methods

The present study was a systematic review and a meta-analysis. There was no language restriction placed, and articles published from 2010 to March 2019 were included. This time frame was selected since the structured viva examination entered its major application in medical education in the previous decade (10). The study was conducted from August 2021 to February 2022. This review work on published literature did not require Ethical approval and informed consent.

Search strategy: The databases such as MEDLINE, Cochrane, and Google scholar were used for the search. Keywords of published articles and MeSH terms were the search terms. Search criteria using MeSh terms had been built. These terms were refined using keywords of published articles. The search terms were connected by Boolean Operators ‘AND’, ‘OR’, and ‘NOT’ to find all relevant articles. Search terms used were oral examination, assessment tool, viva, viva-voce, interactive exam, structured, traditional, medical education, medical students, and dental students, reliability.

Inclusion criteria: Articles published in peer-reviewed journals with comparative analysis of SOE and COE in medical and dental education were included in this review.

Exclusion criteria: Oral examination of medical and dental education at the undergraduate level had been included, excluding nurses, physical therapists, pharmacologists, and other healthcare professionals. The Objectively Structured Clinical Examination (OSCE), multiple mini-interviews types of assessment, and narrative or literature reviews describing the importance of structured oral examination were excluded from the review.

Selection process: The retrieved articles from the database search and hand search were screened for the title. Duplicates were excluded. Three researchers read the abstracts and full text of selected articles separately and then discussed their findings. The review process continued after the agreement between the researchers. In case of any conflict of interest, all researchers read the articles again for further discussion and decision.

Data extraction: A data extraction spreadsheet was developed using Microsoft Excel®. This sheet was divided into study identification (author, year), study population and settings (number of participants, subject), study design (intervention, comparison), study method and measurement, study outcomes, and study citation parts. The data extraction sheet was pilot tested with five articles. After making necessary corrections to the sheet, it was applied to all the selected studies. A double review of the abstracts and full-text articles was conducted.

Quality Assessment: MERSQI scale (11),(12) was used for the quality assessment as it assesses the methodological rigor of articles. MERSQI tool consists of six domains which include study design, sampling, type of data, validity of evaluation instrument, data analysis, outcomes. The scoring is based on the 10 items within the six domains ranging from 0 to score 3 for each domain. Thus, the maximum score will be 18 for an article (Table/Fig 1).

The scale is comprehensive with its list of 10 review items and also has evidence for its validity. This scale adopts Kirkpatrick’s four-level model (13) to approach the effectiveness construct. The first level (reaction) focuses on the participants’ perceptions of the intervention, the second level (learning) evaluates knowledge, skills, and attitudinal change, and the third level measures changes in behaviour. The fourth level (results) focuses on the Organisation’s benefits because of the intervention.

Statistical Analysis

Descriptive statistics such as percentages were used to analyse the data based on MERSQI domain perspectives. MERSQI score for each article based on all sections was calculated. The total number and percentage of articles for each MERSQI domain were also calculated. Two reviewers conducted a meta-analysis using RevMan 5.4 (Cochrane Collaboration, Copenhagen, Denmark) to yield outcomes. Mean±Standard Deviation (SD) was chosen for expressing the results of continuous outcome (mean viva voce marks). I2 test was used to test the heterogeneity. We selected the random effect model to merge data if I2 > 40%; otherwise, a fixed-effect model was used. The 95% Confidence Interval (CI) was adopted in this review.

Results

After the initial search through PubMed, Cochrane Library, Google Scholar, and hand search. Using the search terms and MeSH terms, 63 relevant articles were obtained. During the first stage of screening, 58 articles remained after removing five duplicates. Then, 38 articles were removed subsequently by screening titles and abstracts. After assessing the full texts, two articles were excluded for not fulfilling the inclusion criteria. Eighteen articles (14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(25),(26),(27),(28),(29),(30),(31) were finally included in qualitative synthesis and eight articles were included in quantitative synthesis (15),(17),(21),(22),(23),(28),(30),(31) (Table/Fig 2).

Qualitative assessment: Most of the SOE to study its effectiveness was administered at only one institution (94.4%). These study articles (14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30),(31) reported that structured viva-voce had positive effects on the overall experience and student satisfaction compared to traditional viva-voce. However, the level of scientific evidence and effectiveness varied among the studies. The MERSQI scale helped us to identify the quality of evidence. This scale reported that the quality of evidence of all included articles was moderate (Table/Fig 1).

Out of 18 articles, only two articles used Randomised Controlled Trials (RCT) (11.1%) to test the effectiveness of SOE. The study design used in most of the articles was a single group with pretest and post-test (55.6%) followed by a non randomised two groups study (27.7%). Single group pretest and post-test study design got the highest MERSQI score of 15, followed by a non randomised two groups and RCT study design with a score of 10 and 6, respectively. The single group cross-sectional study design got the least MERSQI score of 1.

When assessed for the outcomes, eight articles assessed both the mean viva voce marks and students’ perception (15),(16),(17),(21),(23),(26),(28),(31). Two studies (18),(19) assessed the student’s perception alone, and one study assessed both student and teachers' perception (25). Three studies assessed viva voce marks, and the perception of both students and teachers (22),(24),(30). Three studies analysed the structured viva voce questionnaire and conducted perception survey among the participants (19),(20),(27) and one study (14) explored the reliability of structured viva voce and mean marks.

To evaluate the students’ perception regarding SOE, 12 studies (66.7%) used open-ended and closed-ended questionnaires. The closed-ended questionnaire was collected as students’ feedback based on a 2-point (yes or no) and a 5-point (strongly agree to strongly disagree) Likert scale. Most of the studies (66.7%, N=12) assessed the outcome subjectively and objectively. Also, about 77.8% (N=14) of the test instruments had internal validity tests. The authors of 16 articles (88.8%) used appropriate statistical tests according to MERSQI. Similarly, 66.7% of the studies used inferential statistics besides descriptive statistics. All studies included in this review had an excellent response rate of 75%.

The MERSQI score that can be obtained by a study ranged from 5 to 18 points. According to (Table/Fig 3), the highest score for an article was 18 and the lowest score was 7.5. All the studies (100%) framed the SOE as question set cards or question template. The questions in the question sets were from must know (core) and nice to know (non-core) areas. These questions were set with increasing grades of difficulty from easy to very difficult and the questions used were recall, analytical and reasoning power types.

The participants of all studies were undergraduate medical and dental students. The structured viva voce questions were developed from the following specialties: Community medicine, physiology, pathology, microbiology, biochemistry, pharmacology, periodontology, molecular biology, integrated basic science, forensic medicine, and anatomy. Almost all the studies (83.3%, N=15) (15),(16),(17),(18),(19),(20),(21),(22),(23),(26),(27),(28),(29),(30),(31) compared structured viva voce against traditional viva voce, and one study measured the reliability of structured viva voce and one study reported sensitivity and specificity of structured viva voce (14),(18).

The structured viva voce strategy was stated explicitly as “recall, analytical and reasoning power” and “must know, good to know, and nice to know” types in 14 articles (77.7%) (15),(16),(17),(18),(19),(20),(21),(22),(24),(25),26],(27),(30),(31). The remaining four articles (14),(23),(28),(29) have not mentioned the strategy. Of 13 articles that assessed the viva voce marks, three articles (16.6%) reported that the marks obtained by the students were higher in traditional viva voce than in structured viva voce. Almost 78% of the participants in all studies felt that SOE can be introduced in the formative assessment. Eleven articles (61.1%) (14),(15),(17),(20),(21),(22),(25),(26),(27),(29),(30) had mentioned the time frame allotted for structured viva examination which ranged from 5 to 15 minutes, whereas no time frame had been mentioned for traditional viva examination.

Meta-analysis: Eight studies compared the mean viva voce marks. The forest plot was produced according to the mean viva voce marks of the conventional and structured oral examination. The results of the meta-analysis showed no significant difference (p=0.53) in the mean viva voce marks with the conventional and structured oral examination (MD, 0.46; 95% CI, -0.99 to 1.92) (Table/Fig 4). A random-effect model was adopted because of high heterogeneity with a total sample of 81.

Discussion

A systematic review was planned to find out whether structured viva voce or traditional viva voce is effective in terms of assessment scores, perception, and reliability in the evaluation of medical students. In consonance with the structured viva voce scheme, 77.7% of researchers followed recall, analytical and reasoning power domains for viva voce. This finding makes us think that formative assessment in medical education focuses on these three domains rather than any other additional domains. Viva voce is the most effective concept for the evaluation of clinical reasoning skills, an essential component of medical practice, and requires psychometric properties in terms of reliability and validity (32),(33).

Based on this review results, there was no significant difference in the marks scored by the medical and dental students using COE and SOE. However, structured viva voce eliminates inappropriate bias by careful selection and training of examiners, use of more formal structured questions, and application of this structure to assess the candidate making this concept a reliable and valid one. It has been suggested that rating candidates separately in three fields: recall, analytical, and problem-solving will improve their reliability (34). Providing training sessions for examiners to promote scoring consistency and conducting mock examinations for implementation integrity will make this concept most effective (35).

Of two articles that assessed the reliability of structured viva voce, one compared the reliability of the system by administering the 7th day and 14th day after a one-month lecture (14). Another one compared the inter-rater and internal consistency reliability between structured and traditional viva voce (15). These reviews reflect that structured viva voce has good reliability among students and examiners. Besides reliability and validity, the acceptability of structured viva voce among students and teachers was also assessed in all studies. Students expressed that structured viva voce was better than traditional viva voce based on certain criteria assessed by the closed-ended questionnaire. The criteria were that structured viva voce had a well-organised system, covered most of the topics in the syllabus, questions were from all levels, allotted time was adequate, and questions were comprehensive. In an open-ended questionnaire, students and teachers in all studies felt that structured viva voce had no partiality, no cross-questions, encourages deep learning, is transparent and fair, but requires training.

16.6% of the articles in this review reported that mean viva voce marks in the SOE are less when compared to COE. The reason was that structuring exposes students to all types of questions from easy to difficult levels whereas traditional viva voce may make students answer several easy or several difficult level questions (16). 78% of 1,311 students from all studies have reported that SOE covered a wide range of topics, was less stressful, not exhausting, and positively influenced the learning patterns. It has been suggested that structured viva voce examination can be improved by increasing the number of examiners. Although a moderate level of evidence has been reported according to the MERSQI scale, the feasibility and acceptability of a change in the formative assessment among the students and faculty for structured viva examinations have increased (17).

Limitation(s)

The limitation of this review was related to the MERSQI outcome domains. The scale is good for assessing evidence on effectiveness, but it makes no differentiation between knowledge and skills. Future work in this domain may develop this feature of the MERSQI scale. Also, the MERSQI scale does not consider the statistical power of the studies included, which is necessary to establish the levels of evidence in a well-organised manner. All the included articles have the limitation of being done the trial for the Short-term and done on a single topic in a single specialty. High-quality studies with crossover randomised controlled trials comparing the conventional and structured oral examination will help to derive a more convincing inference.

Conclusion

This review and meta-analysis showed no difference in the mean viva voce marks scored by the students in a COE and SOE. Though there is general acceptability for structured viva voce, future research based on learning domains (cognitive, psychomotor, affective, and communication) is needed to assess the effectiveness of structured viva voce in assessing the progress of learning.

References

1.
Anderson J, Roberts FJ. A New Look at Medical Education. London: Pitman Medical; 1965.
2.
Joughin G. A short guide to oral assessment. 2010.
3.
Cox KR. How to improve oral examinations. Med J Aust. 1978;2(10):176-77. Doi: https://doi.org/10.5694/j.1326-5377.1978.tb131652.x. PMID: 739931. [crossref] [PubMed]
4.
Guilford JP. Psychometric Methods. NY: McGraw-HilL; 1954.
5.
Weingarten MA, Polliack MR, Tabenkin H, Kahan E. Variations among examiners in family medicine residency board oral examinations. Med Educ. 2000;34(1):13-17. Doi: https://doi.org/10.1046/j.1365-2923.2000.00408.x. PMID: 10607273. [crossref] [PubMed]
6.
Roberts C, Esmail A, Sarangi S, Southgate L, Wakeford R, Wass V, et al. Oral examinations- equal opportunities, ethnicity, and fairness in the MRCGP Commentary: Oral exams - get them right or don’t bother. BMJ. 2000;320(7321):370-75. Doi: https://doi.org/10.1136/bmj.320.7231.370. PMID: 10657339. [crossref] [PubMed]
7.
de Silva V, Hanwella R, Ponnamperuma G. The validity of oral assessment (viva) that assesses specific and unique competencies in a post-graduate psychiatry examination. Sri Lanka Journal of Psychiatry. 2013;3(2):16-19. Doi: https://doi.org/10.4038/sljpsyc.v3i2.5133. [crossref]
8.
Thomas CS, Mellsop G, Callender K, Crawshaw J, Ellis PM, Hall A, et al. The oral examination: A study of academic and non-academic factors. Med Educ. 1993;27(5):433-39. Doi: https://doi.org/10.1111/j.1365-2923.1993.tb00297.x. PMID: 8208147. [crossref] [PubMed]
9.
Rahman G. Appropriateness of using oral examination as an assessment method in medical or dental education. J Educ Ethics Dent. 2011;1(2):46. Doi: https://doi.org/10.4103/0974-7761.103674. [crossref]
10.
Wu E, Larson S, Chacko-Stacey A, Lynch JC, Hart E, Siddighi S, et al. The value of oral examinations and the role it plays in medical student education. Res Square. 2022. https://assets.researchsquare.com/files/rs-246762/v1/29e1e4c4-e5e1-4b3b-a294-6e6547f56885.pdf?c=1652953791.
11.
Reed DA, Beckman TJ, Wright SM, Levine RB, Kern DE, Cook DA. Predictive validity evidence for medical education research study quality instrument scores: Quality of submissions to JGIM’s Medical Education Special Issue. J Gen Intern Med. 2008;23(7):903-07. Doi: https://doi.org/10.1007/s11606-008-0664-3. PMID: 18612715. [crossref] [PubMed]
12.
Reed DA, Beckman TJ, Wright SM. An assessment of the methodologic quality of medical education research studies published in The American Journal of Surgery. Am J Surg. 2009;198(3):442-44. Doi: https://doi.org/10.1016/j.amjsurg.2009.01.024. PMID: 19716888. [crossref] [PubMed]
13.
Kirkpatrick DL. Implementing the four levels: A practical guide for effective evaluation of training programs: Easyread super large 24pt edition. ReadHowYouWant.com; 2009.
14.
Ganji KK. Evaluation of reliability in structured viva voce as a formative assessment of dental students. J Dent Educ. 2017;81(5):590-96. Doi: https://doi.org/10.21815/JDE.016.017. PMID: 28461636. [crossref] [PubMed]
15.
Sule PA, Ubale MR, Kartikeyan S, Belurkar DD, Kulkarni VV. Comparative study of objectively structured versus traditional viva-voce in microbiology amongst second-year MBBS students. IOSR J Res Method Educ. 2017;7(3):15-18. Doi: https://doi.org/10.9790/7388-0703041518. [crossref]
16.
Rokade SA, Kate DR. Structuring the unstructured: New dimension in viva assessment for Anatomy. Int J Anat Res. 2017;5:3976-82. Doi: https://doi.org/10.16965/ijar.2017.233. [crossref]
17.
Patidar A, Chaturvedi JN. Introduction of structured oral examination in formative assessment of pharmacology for 2nd professional MBBS students. Int J Basic Clin Pharmacol. 2019;8(2):253-58. Doi: https://doi.org/10.18203/2319-2003.ijbcp20190143. [crossref]
18.
Shah HK, Vaz FS, Motghare DD. Structured oral examination: From subjectivity to objectivity-An experience in community medicine. J Educational Res Med Teach. 2013;1(1):25-27.
19.
Shenwai MR, Patil KB. Introduction of structured oral examination as a novel assessment tool to first year medical students in physiology. J Clin Diag Res. 2013;7(11):2544. Doi: https://doi.org/10.7860/JCDR/2013/7350.3606. PMID: 24392396. [crossref] [PubMed]
20.
Gor SK, Budh D, Athanikar BM. Comparison of conventional viva examination with objective structured viva in second year pathology students. Int J Med Sci Public Health. 2014;3(5):537-39. Doi: https://doi.org/10.5455/ijmsph.2014.250220142. [crossref]
21.
Puppalwar PV, Rawekar A, Chalak A, Dhok A, Khapre M. Introduction of objectively structured viva-voce in formative assessment of medical and dental undergraduates in biochemistry. J Res in Med Educ Ethics. 2014;4(3):321-25. Doi: https://doi.org/10.5455/ijmsph.2014.250220142. [crossref]
22.
Khilnani AK, Charan J, Thaddanee R, Pathak RR, Makwana S, Khilnani G. Structured oral examination in pharmacology for undergraduate medical students: Factors influencing its implementation. Indian J Pharmacol. 2015;47(5):546. Doi: https://doi.org/10.4103/0253-7613.165182. PMID: 26600646. [crossref] [PubMed]
23.
Shaikh ST. Objective structured viva examination versus traditional viva examination in evaluation of medical students. Anat Physiol. 2015;5(175):2161-0940. Doi: https://doi.org/10.4172/2161-0940.1000175. [crossref]
24.
Vankudre AJ, Almale B, Patil M, Patil AM. Structured oral examination as an assessment tool for third year Indian MBBS undergraduates in community medicine. Community Medicine. MVP J Med Sci. 2016;3(1):33-36. Doi: https://doi.org/10.18311/mvpjms/2016/v3/i1/687. [crossref]
25.
Dangre-Mudey G, Damke S, Tankhiwale N, Mudey A. Assessment of perception for objectively structured viva voce amongst undergraduate medical students and teaching faculties in a medical college of central India. Int J Res Med Sci. 2016;4(7):2951-54. Doi: https://doi.org/10.18203/2320-6012.ijrms20161983. [crossref]
26.
Dhasmana DC, Bala S, Sharma R, Sharma T, Kohli S, Aggarwal N, et al. Introducing structured viva voce examination in medical undergraduate pharmacology: A pilot study. Indian J Pharmacol. 2016;48(Suppl 1):S52. Doi: https://doi.org/10.4103/0253-7613.193308. PMID: 28031609. [crossref] [PubMed]
27.
Ponnudhali D, Bhandary S, Jones E. Structured oral examination-A valid and reliable assessment tool for first year mbbs students. National J Basic Med Sci. 2016;7(2):99-105.
28.
Bagga IS, Singh A, Chawl H, Goel S, Gohal P. Assessment of objective structured viva examination (OSVE) as a tool for formative assessment of undergraduate medical students in forensic medicine. Sch J App Med Sci. 2016;4:3859-62.
29.
D’Souza UJ, Abdullah AF, Mustapha ZA. Standardized viva-voce examination: Year 1 medical degree programme in an integrated undergraduate medical curriculum in a Malaysian University. Manipal J Med Sci. 2016;1(2):07.
30.
Bhadre R, Sathe A, Bhalkar M, Mosamkar S. Comparison of objective structured viva voce with traditional viva voce. Int J Healthc Biomed Res. 2016;5:62-67.
31.
Waseem N, Iqbal K. Importance of structured viva as an assessment tool in anatomy. J Univ Med Dent Coll. 2016;7(2):29-34.
32.
Orrock P, Grace S, Vaughan B, Coutts R. Developing a viva exam to assess clinical reasoning in pre-registration osteopathy students. BMC Med Educ. 2014;14(1):01-09. Doi: https://doi.org/10.1186/1472-6920-14-193. PMID: 25238784. [crossref] [PubMed]
33.
Thorndike RL. Applied psychometrics. Houghton Mifflin; 1982.
34.
Wass V, Wakeford R, Neighbour R, Van der Vleuten C. Achieving acceptable reliability in oral examinations: An analysis of the Royal College of General Practitioners membership examination’s oral component. Med Educ. 2003;37(2):126-31. Doi: https://doi.org/10.1046/j.1365-2923.2003.01417.x. PMID: 12558883. [crossref] [PubMed]
35.
Tutton PJ, Glasgow EF. Reliability and predictive capacity of examinations in anatomy and improvement in the reliability of viva voce (oral) examinations by the use of a structured rating system. Clin Anat. 1989;2(1):29-34. Doi: https://doi.org/10.1002/ca.980020105. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/57445.16977

Date of Submission: Apr 30, 2022
Date of Peer Review: May 28, 2022
Date of Acceptance: Jul 22, 2022
Date of Publishing: Sep 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 05, 2022
• Manual Googling: Jul 20, 2022
• iThenticate Software: Aug 26, 2022 (12%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com