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JIIMC 2022 Vol. 17, No.2 Perception about Structured Versus Traditional Viva ORIGINAL
ARTICLE Perception of MBBS Students About Structured Versus Traditional Viva Examination Formats Fareeha Naseer Syed, Attia Sheikh, Syed Atif Hussain Andrabi ABSTRACT Objective: To explore the perception and views of undergraduate medical students about the significance of structured versus traditional viva formats. Study Design: It was qualitative exploratory research Place and Duration of Study: The study was conducted in Pathology department of CMH Multan Institute of Medical Sciences from December 2019 to August 2020. Materials and Methods: Four sets of focused group discussions were carried out, each group comprising of 8 students of fourth year MBBS who had undertaken both structured and traditional viva examinations in the subject of Pathology. The students who did not appear in the exam and those who did not volunteer for the study were excluded from the study. The interviews were audio recorded followed by transcription and manual thematic analysis. The students identified their preferences for the type of viva which gave an umbrella of themes. The subthemes were then identified to find out the exact reasons of their preferences. Results: The results of the study yielded five themes and sub themes. The main themes were attitude towards exams, exams preparation, time management, student teacher relationship and relevancy of content of viva. The students suggested that viva exam of all subjects should be structured to maximize uniformity of content coverage, time management and attitude improvement for both faculty and students. Conclusion: The students were Overwhelmingly satisfied with structured viva as compared to traditional viva format. They emphasized structured viva as their preferred assessment method as traditional viva does not truly reflect a student's competence. Key Words: Assessment Methods, Perception, Structured, Students, Traditional Viva. Introduction more teacher centered, time consuming, variable, The rapidly evolving medical education system has examiner biased, difficult , not interactive, with made the assessment of medical students a tense atmosphere during exam.6All these demerits challenging task. There have been a number of ways make both the validity and reliability of this method by which students can be assessed but viva voce has questionable 7 , 8 . In order to overcome these always been an integral part of students' difficulties a much reliable approach was much evaluation1,2. Traditional viva voce has long been needed and it was provided by structured viva 3 used as a summative assessment tool . Though it has format. It has been introduced in various medical some potential strengths like greater compliance universities globally 9,10,11. This modified format helps and flexibility both on part of students and teachers 4 in eliminating many flaws including the element of 5 ,this method also has some serious flaws in it . It is bias and gives an equal and fair chance to every 1 student. Department of Pathology/Department of Medical Education2 A lot of research has been done and methods of CMH Institute of Medical Sciences, Multan 3 Department of Radiology structured exam devised. Students desire the Combined Military Hospital, Multan needed change in assessment methods. Hashim R et Correspondence: al. confirmed in their study that 98% of their students Dr. Fareeha Naseer Syed were satisfied with the structured viva format 9. Assistant Professor Department of Pathology Though many quantitative and some qualitative data CMH Institute of Medical Sciences, Multan endorse the efficacy of structured format but E-mail: [email protected] literature review shows very little work done in this Received: November 15, 2021; Revised: June 10, 2022 area ethnographically. Ethnographic research is one Accepted: June 13, 2022 of the best and unique ways to explain students' 129 JIIMC 2022 Vol. 17, No.2 Perception about Structured Versus Traditional Viva perception about viva examination whereby the with increasing difficulty level as per the Bloom's researcher documents the culture, perspectives and taxonomy of educational objectives of cognitive 12,13,14 practices of people in a particular setting . domain, i.e, easy, moderate and hard. Each student Detailed informal or conversational interviews allow was given an equal time. There were four pools of to probe their issues in a more naturalistic manner. A questions, one pool of ten questions to be used each more recent form of ethnography, the Focused day with equal marks distribution for each Ethnography (FE), investigates a specific issue among batch(Table I). small groups of people instead of whole Table I: AN EXAMPLE OF A POOL OF 10 QUESTIONS FOR communities, for example, students of a medical STRUCTURED VIVA (TOTAL MARKS:10; TIME:10 min) college15.Because, the scope of FE is narrow, the researcher generally has better and more knowledge about the topic under study and does not need immersion in cultural practices and engagement in long-term fieldwork. Thus, FE is more feasible for busy medical educators who are curious and want to 16,17,18 explore outcomes in their own setting . With this background knowledge, we decided to carry out a qualitative research project in Pathology department of CMH Institute of Medical Sciences Multan. We wanted to explore what our students feel about the viva examination systems being followed in our setting and convince our faculty that our students are aware and desirous of a much- needed change in that system. Our students volunteered to both structured and traditional viva formats followed by recording their perceptions and views about the two formats via focused group interviews. Materials and Methods This qualitative, focused ethnographic study was conducted from December 2019 to August 2020 at CMH Multan Institute of Medical Sciences, Multan, Pakistan. After taking approval from institutional ethics review board the sample was collected using purposive sampling technique from among fourth year medical students who had undertaken their viva voce in the department of Pathology at CIMS Multan at the end of second modular examination. Those students who did not appear in the exam and those who did not volunteer were excluded from the study. There were 100 students, who were divided into four batches of 25 students each. Viva was conducted on 4 consecutive days. Each student had to take both structured and traditional viva examinations by two The traditional viva examination was conducted separate examiners. The students were briefed conventionally with examiner asking 10 random but about the new viva format beforehand. relevant questions and with the same time limit. For structured viva, questions with keys were Maximum 10 marks were awarded to this part of prepared mutually agreed by all the faculty members exam too. 130 JIIMC 2022 Vol. 17, No.2 Perception about Structured Versus Traditional Viva In order to control bias it was assured that the viva Table II: Medical Students' Perception About Traditional questions for the structured examination prepared and Structured Viva Examinations were kept in complete secrecy; only the examiner knew about those at the time of the exam. The students who had taken the structured viva were Exams kept separate from rest of the examinees with strict compliance to exam protocols. Everyday a separate pool of questions was used. Same couple of examiners conducted the viva on all the four days to remove teacher-teacher bias. After taking informed consent the focused group interviews were taken at the end of viva each day from those students who volunteered. Each group interview lasted for about 60minutes. The questions used for focused group interview were finalized after being validated by experts in the field of medical education. The opinions of the students were both audio recorded as well as noted down by the Preparation moderator. The audio recordings were later transcribed verbatim. Thematic analysis was conducted. In the first stage day wise coding was done which produced four sets of codes (D1-D4). Every individual in a group was further given a lettered code from A to H. In the second stage these codes were arranged and then evaluated into Management themes and subthemes. Results Of the hundred students , four groups of students (32%), each comprised of 8 students, volunteered for focused group interviews. Results of the study revealed five major themes and subthemes after consensus of the researchers. (Table II). The first theme was “Attitude towards exams”. Most Relationship of the students felt that during traditional viva there was generally an aura of fear and anxiety. Viva is a test of communication skills and not everyone is good at it. Many students could not answer because of anxiety or shyness despite of knowing the answer. Their self-confidence was boosted with structured viva format. According to one student, “I've never felt so confident in any viva examination before. Structured viva is far better way to express myself. It was just like a quiz show where I was answering and scoring.” (D1-F). In traditional viva students felt the examiner's bias when he changed difficulty level of question from easy to hard for some students and vice versa, “I think I had a better connection with my examiner taking structured viva. I didn't feel nervous. 131 JIIMC 2022 Vol. 17, No.2 Perception about Structured Versus Traditional Viva But in traditional viva it was not the same. We never the students believed the questions were relevant, bonded. I wasn't given a chance.” (D4- B) focused and according to their syllabus and content. The second theme was “Exam preparation”. However, for traditional viva some students Although uniform coverage of every topic in a large complained that they were asked out of syllabus group is an uphill task. However, the results of our questions as their viva was drifted sideways. “I think study showed that majority of the students were structured viva was more relevant than traditional satisfied with the structured viva exam. All the viva as it covered the important topics without question asked were sufficient to cover the relevant wasting time on unnecessary details.”. (D4- G) topic and the required learning outcomes were met. Discussion One of the students said “It will really help in final Our study is unique as no one has used a focused exam preparation as it covers all the aspects of the ethnographic technique to take into account syllabus. There was no drifting sideways. I think students' views about both traditional and structured viva should be the preferred method for structured viva examination formats. Majority of our assessment.” (D2-H).This was not the case with students favored the structured format of viva while the traditional viva. The examiner usually stuck with highlighting the issues of traditional format. one or two questions of his choice. Traditional viva examination system has now been The third theme was “equal distribution of time”. obsolete in many parts of the world because of its Students felt that time distribution was more high degree of subjectivity, bias and poor validity.19,20 uniform during structured viva than traditional viva Such imperfections can be eliminated by the use of though overall duration of both exams was same. In structured viva format. Structuring can be traditional viva the time was lost more on some challenging, as it requires a large Q bank with valid questions than others.“Previously my viva used to keys, frequent updates , difficulty levels according to linger for as long as half an hour. It was a relief that Miller's pyramid must be ensured, and it all requires a this exam finished in time. Since it was time bound so dedicated faculty, space and time.20,21 Majority of the it will also help me in time management in my final studies conducted now reveal that both students and exams” (D3-C). faculty believe that structured viva owns a The fourth theme that emerged was “ Student- satisfactory level is terms of the efficacy of teacher relationship”. Examiner's approach to assessment22,23. present difficult questions to different students The main objective of our study was to determine the might have shown bias. Most of the students felt that perceptions and views of our undergraduate gender bias was not felt at all during structured viva students about structured versus traditional viva but during traditional viva some of them formats. About 99% of our students expressed that experienced it. One of the students who experienced the questions asked in structured viva were relevant, gender bias during traditional viva mentioned that in syllabus was uniformly covered, and it helped in a reserved manner, “I felt that the examiner equal time management. Dangre-Mudey G et al. also disapproved of me irrespective of what answers I confirmed similar findings in their study where 52% gave during traditional viva examination. It was a of their students agreed on uniformity of covered prolonged exam which I wished to end early. syllabus and 56% students agreed on equal time However, during structured viva there was no such distribution among students in structured viva. feeling.”(D2- C). Another student was very much Most of our students (almost 98%) believed that unhappy of the favoritism shown by the examiner, examiner in structured viva was more friendly, “I'm sure that my colleague was given extra unbiased and did not ask repetitive questions, attention. It happened during traditional viva when however, during traditional viva the examiner was the examiner didn't have any pool of questions to ask usually moody, focused on some topics and students. from and he simply was asking his favorite questions Such findings are mirrored by another study from only some students” (D3-A) conducted by Shah HK et al. where 75% of the The final theme was “relevance of content of viva students favored structured viva for the same questions”. For structured viva examination, most of reasons. 132 JIIMC 2022 Vol. 17, No.2 Perception about Structured Versus Traditional Viva The medical education research has been moving evaluation of students' perception. Turk J Surg 2018; 34: 9- towards a more interpretivist approach and focused 12. 2. Dangre-Mudey G, Damke S, Tankhiwale N, MudeyA. ethnography has provided a more pragmatic way to Assessment of perception for objectively structured viva execute this17,18. 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