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Year : 2021  |  Volume : 34  |  Issue : 2  |  Page : 77-79

All eyes on me: Remote online assessments for health professional programs during a pandemic

Division of Clinical and Administrative Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA

Date of Submission25-May-2021
Date of Decision21-Dec-2021
Date of Acceptance08-Sep-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Fahamina Ahmed
1 Drexel Drive, New Orleans, LA 70125, LA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1357-6283.332953


Background: Due to the unprecedented COVID-19 pandemic, learning institutions were faced with many challenges while transitioning their in-person courses to an online format for teaching, learning, and testing. One of these challenges included the continuation of assessments in a safe but secure manner. Discussion: Professional health programs may need to implement new policies to ensure a fair, safe testing process that maintains exam integrity during remote assessments. We concluded that transitioning to remote assessments for health professional schools posed many challenges. Further studies may elaborate the effectiveness and limitations of the various approaches used for remote assessments by professional health programs during the pandemic.

Keywords: COVID-19, education, health professional programs, online learning, proctored exam, remote assessments

How to cite this article:
Ahmed F, Borghol A. All eyes on me: Remote online assessments for health professional programs during a pandemic. Educ Health 2021;34:77-9

How to cite this URL:
Ahmed F, Borghol A. All eyes on me: Remote online assessments for health professional programs during a pandemic. Educ Health [serial online] 2021 [cited 2022 Jan 22];34:77-9. Available from:

  Background Top

Online or distance learning courses have been a part of our higher education system for quite some time now. The dynamics of online learning provided students an opportunity to manage their work-life balance based on their personal schedule and responsibilities. The online learning courses were developed and planned thoroughly for this education system. Although online education methods can be convenient, the true implications of these methods, if developed rapidly, with the lack of proper planning, for all courses in a pharmacy curriculum have not been studied.

In March 2020, the emergence of the COVID-19 pandemic forced many universities, including professional health institutions, to switch all their traditional in-person educational courses to an online format, probably without the training and preparation needed to effectively manage all the aspects of their courses. This unprecedented situation left uncertainties, with administrators thinking of ways to continue learning while utilizing various available virtual electronic systems. As we continued to provide virtual instruction through these methods, the additional inherent challenge of administering assessments in a safe, effective manner came along with it. Health education programs that have regular, high stakes assessments, and large class sizes may not use online assessment formats regularly. Therefore, the number of students and number of assessments were the challenge for our health program.

  Discussion Top

Although innovation of online distance learning has advanced educational delivery, it is not void of technical problems. Just like other businesses, corporations, and health-care systems, administrators at universities were left with expedited planning and decision-making on implementing remote learning and assessments. The International Association of Universities published a survey report on the impact of COVID-19 on higher education worldwide.[1] In the Americas, 69% of universities planned on carrying out examinations, with 51% using new measures.[1] Some institutions may have had monitoring systems in place or as an option integrated in their electronic assessment software. Other institutions may have researched these services to find out that they were not part of their planned budget. In addition, some may have switched from paper and pencil examinations to electronic remote assessment, using methods never implemented before. While electronic assessments have many advantages, (e.g., immediate feedback, faster method for assessment, and linking of curriculum outcomes), they inherently pose challenges.[2] Professional health schools likely had to come up with creative methods to assess the students adequately and safely while maintaining the goals and integrity of the assessments.

Similar to the administration and faculty, students needed to adapt to these changes while still dealing with all of the other challenges that presented with the pandemic. A study conducted by Elsalem et al. evaluated stress and behavioral changes with remote online exams experienced by students studying medical sciences during the COVID-19 pandemic.[3] This study indicated that about one-third of students reported stress. The main factors identified were exam duration, technical problems, inadequate material coverage, exam environment at home, and student dishonesty.[3] Similarly, Jaap et al. found that the majority of students surveyed preferred computer laboratory proctored examinations compared to unproctored remote assessments.[4] Proctored remote examinations pose challenges such as being more stressful for students, possibly affecting their performance. These challenges included efficient software and hardware requirements for students and instructors using personal equipment, Internet connection reliability, and personal and cultural reasons students may not agree to being watched on camera.[5] Going through online testimonies of students who have used online proctoring systems, the notion seems to be that students felt anxiety and were “creeped” out by someone watching them. During an in-person exam, you have someone walking around and “looking” over your shoulder but in a familiar place usually with a familiar proctor. Even though remote proctoring may not affect student performance, students have expressed negative impressions predominantly due to privacy, environmental, and psychological factors while using this mandatory tool.[6] Students may not feel comfortable with being monitored, but it may be a necessary tool to maintain the integrity of an online exam that has to be administered remotely.

If there is not a virtual monitoring system in place, can you guarantee the integrity of your assessment? Programs were left with so many questions, but with little time to answer them during the stay at home order. Students have been remote with all resources at their fingertips, but they have also entered a professional health program with a dedication to integrity and professionalism. Moreover, there is a lack of sufficient objective data that indicates there is more overall cheating during remote assessments when compared to in person.[7] From the student's perspective, every student had a different situation. Some students may have lost their quiet space due to children, spouses, or parents all working from home compared to sitting in a quiet classroom testing environment. A study conducted by Weiner and Hertz revealed that online remote kiosk proctored high stake exams were similar to proctored test centers when comparing examinee scores and ratings of testing conditions, therefore providing an option for some students who may not be able to take them in their homes.[8] Alternative assessments methods discussed such as quizzes, open-book take-home assessments, and presentations may not be options for large class sizes like the ones in certain health professional programs.[5] These concerns along with the vagueness of the integrity and subjective nature of the alerts from these monitoring systems pose a challenge to implement effective policies.

There are specific changes that can be made to online assessments to minimize cheating and collaboration with peers if the option of an online proctoring system is not available. These adjustments can include minimizing testing time, prohibiting backward navigation to previous questions, randomizing questions and options, using higher order critical thinking questions, and having a back-up assessment for people who experience technical difficulties while trying to take the remote assessment.[7],[9] When making a decision to use online assessment, some other features that should be considered include authentication of the user, accessibility for students with disabilities, and secure electronic methods. To ease anxiety and stress felt by students during proctored remote assessments, institutions can utilize mock remote proctoring sessions and human resources during testing.[10] The use of mock exams for practice can help ease some anxiety associated with the new assessment modality and proctoring methods. These standards are by no means perfect, but give programs a creative starting point and direction to implement remote assessments effectively with minimal impact on student's academic performance during an unprecedented situation.

  Conclusion Top

Objective and subjective data need to be collected to assess the efficacy of the different approaches used by professional health institutions. Educational systems may need to explore the ideas of reassessing some of the lessons taught during this period to assure efficiency of the different strategies enforced. Looking ahead at what might be the challenge for some time, programs may need to invest in researching online assessment options for unexpected circumstances. In conclusion, whatever remote online assessment strategy is used, it may not present without any challenges.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Marinoni G, Land H, Jensen T. The Impact of Covid-19 on Higher Education Around the World. IAU Global Survey Report. International Universities Bureau; 2020.  Back to cited text no. 1
Alruwais N, Wills G, Wald M. Advantages and challenges of using E-assessment. Int J Inform Educ Technol 2018;8:34-7.  Back to cited text no. 2
Elsalem L, Al-Azzam N, Jum'ah AA, Obeidat N, Sindiani AM, Kheirallah KA. Stress and behavioral changes with remote E-exams during the Covid-19 pandemic: A cross-sectional study among undergraduates of medical sciences. Ann Med Surg (Lond) 2020;60:271-9.  Back to cited text no. 3
Jaap A, Dewar A, Duncan C, Fairhurst K, Hope D, Kluth D. Effect of remote online exam delivery on student experience and performance in applied knowledge tests. BMC Med Educ 2021;21:86.  Back to cited text no. 4
Guangul FM, Suhail AH, Khalit MI, Khidhir BA. Challenges of remote assessment in higher education in the context of COVID-19: A case study of Middle East College. Educ Assess Eval Account 2020;32:519-35.  Back to cited text no. 5
Kharbat FF, Abu Daabes AS. E-proctored exams during the COVID-19 pandemic: A close understanding. Educ Inf Technol (Dordr) 2021;1-17.   Back to cited text no. 6
Beck V. Testing a model to predict online cheating-Much ado about nothing. Act Learn High Educ 2014;15:65-75.  Back to cited text no. 7
Weiner J, Hertz G. A comparative study of online remote proctored versus onsite proctored high-stakes exams. J Appl Test Technol 2017;18:13-20.  Back to cited text no. 8
Elzainy A, El Sadik A, Al Abdulmonem W. Experience of e-learning and online assessment during the COVID-19 pandemic at the College of Medicine, Qassim University. J Taibah Univ Med Sci 2020;15:456-62.  Back to cited text no. 9
Hall EA, Spivey C, Kendrex H, Havrda DE. Effects of Remote Proctoring on Composite Examination Performance Among Student Pharmacists. Am J Pharm Educ 2021;85. doi: 10.5688/ajpe8410.  Back to cited text no. 10


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