P-34 Performance and integrity across proctored physical, unproctored online, and proctored online formats in the UWI Final MBBS Medicine & Therapeutics written examination
Author(s):
K Krishnamurthy, A Kumar, D Cohall, M H Campbell, K Connell, M Emmanual, N Seecheran, E Morris, J PaulCharles, M A A Majumder
Type Of Study:
- Analytical Study
- Observational Study
Year of Presentation:
2026
Objective: This study compared performance and integrity
indices across three successive modalities of The University
of the West Indies Final MBBS Medicine & Therapeutics
written paper
Methods: Institutional records for every candidate in 2019 (proctored physical, n=508), 2020 (un-proctored online, n=529) and 2021 (physically onsite proctored online, n=361) were analysed retrospectively (N=1 398). Mean scores, score dispersion, categorical outcomes, Cronbach’s alpha, and item-difficulty indices were contrasted with oneway ANOVA, χ² tests, and odds ratios.
Results: Examination modality significantly influenced performance. The mean (± SD) scores were highest in the unproctored online exam (2020: 68.4 ± 6.5), followed by proctored physical exam (2019: 64.2 ± 7.2) and proctored online (2021: 60.5 ± 7.3). The difference in the mean score of the three modalities was highly significant (p<0.0001). Pass rates peaked in 2020 (92%) versus 2019 (81%) and 2021 (70%). The odds of failing the examination in 2021 were more than five times higher than in 2020 (OR=5.652). Reliability (Cronbach’s α) highest in 2019 (0.813) and 2021 (0.770) but very low in 2020 (0.307). Odds of failing in 2021 were 5.65 times higher than 2020.
Conclusion: Examination modality strongly impacted on performance and reliability. Unproctored online exams led to grade inflation, reduced variability, and low reliability, while proctored formats—physical or virtual—improved assessment rigor, fairness, and psychometric integrity, emphasizing the need for robust proctoring in high-stakes medical assessments.