Remote E-exams during Covid-19 pandemic: A cross-sectional study of students' preferences and academic dishonesty in faculties of medical sciences.

BACKGROUND: Since the emergence of coronavirus disease 2019 (Covid-19), distance education has been extensively implemented in all educational institutes and remote electronic exams (E-exams) have been adopted as a primary mode of assessment.
OBJECTIVES: This cross-sectional study aimed to evaluate the experience of students at faculties of Medicine, Dentistry, Pharmacy, Nursing and Applied Medical Sciences at Jordan University of Science and Technology regarding remote E-exams preferences and academic dishonesty during the pandemic.
MATERIALS AND METHODS: The survey composed of 16 questions, prepared using Google forms and distributed through students' E-learning platforms. The survey explored factors affecting students' preference for remote E-exams, methods for course assessment/evaluation, factors related to students' exam dishonesty/misconduct during remote E-exams and measures that can be considered to reduce this behavior. Data were analyzed using descriptive, cross tabulation and Chi-square tests.
RESULTS: Among 730 students, approximately only one third preferred remote E-exams. This was significantly (P < 0.05) associated with academic major, efforts/time for remote E-exam preparation, questions appropriateness with study material, and academic achievements (students Grade Point Average (GPA), curriculum objectives). Combining both exams and quizzes was the most preferred method of assessment (30%), while submission of reports or short written assignments were the least preferred ones. Exam dishonesty/misconduct appears as one of the major challenges with remote E-exams. The main measures considered by students to reduce exam dishonesty included substituting the exam with other forms of assessment, using different exam forms, the use of online proctoring solutions and considering compulsory pass/fail grades.
CONCLUSION: Results suggested less preference of remote E-exams among students at medical faculties. Findings from this study are highly valuable to plan for academic strategies to overcome difficulties and challenges of remote E-exams. These might include improvement for the distance teaching methodologies, rearrangement of assessment options, modification of the academic curriculum to fit the current situation, and adopting certain measures to prevent exam dishonesty and maintain academic integrity.

Introduction

Coronavirus disease 19 (Covid-19) was declared officially by the World Health organization (WHO) as pandemic on March 11, 2020 [1]. Covid-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). This new virus is very contagious, transmitted mainly by aerosols from coughing and sneezing and has rapidly spread worldwide. Among infected patients, 70% are asymptomatic or have very mild symptoms, while the remaining 30% exhibit a wide range of symptoms that can be life threating [2].

Most countries attempted restrictive measures to achieve containment of the disease. Those measures included the prevention of social contacts, the ban of movements within the national territory, the closure of all non-essential activities, and suspension of all educational activities [3].

Most universities worldwide have either suspended or canceled their campus events such as classroom lectures, conferences, workshops, and sports. Faculty members transitioned their teaching to distance online teaching [[4], [5], [6]]. However, online learning cannot achieve the required intended learning outcomes if students do not have internet access due to technical or economic issues [7]. The absence of face-to-face interaction between the students and the instructor as well as the lack of traditional classroom socialization are amongst the issues encountered with higher education students [4,8,9].

Upon the abrupt transition to distance online education, many challenges have been observed by educational institutions. In particular, students assessment and the way for exam conduction appeared as major concerns [10]. Electronic examinations (E-exams) are considered as integral element in distance education systems [11]. In-campus E-exams have long been utilized by educational institutes as a students' assessment tool [12]. Remote E-exams were adopted by most educational institutes during the pandemic. However, many difficulties were recognized including the possible technical problems related to internet connectivity/E-exam platforms and impracticality of such exams to assess clinical skills [10,13]. In addition, concerns regarding the academic dishonesty have been recently raised [14]. With all difficulties and challenges, remote E-exams were linked to students' stress with negative impact on students’ behaviors and dietary habits [15].

Different assessment methods were applied during distance assessment include synchronous and asynchronous methods of assessment, assignments, assessment portfolios, multiple choice questions, open book exams, and oral exams [16]. However, the possible exam dishonesty behaviors among students necessitate the application of certain measures to maintain the academic integrity. These include proctoring solutions, re-arrangement of the E-exams structure (using different forms, one way exams, reduce number of questions/page, reduce time limits), and changing the mode of assessment (oral exams, substituting exams with other forms of assessment) [10]. Preparing and adopting such measures in all subjects will require additional costs, efforts and time. Likewise, the grading and evaluation problems might arise with remote E-exams particularly with practical/clinical courses. Further, new strategies and/or technologies must be applied for anti-plagiarism and avoiding dishonesty [17].

Here in Jordan University of Science and Technology (JUST), distance online teaching has been applied as mode of learning shortly after the announcement of Covid-19 pandemic. The students experience has revealed the preference for the traditional classroom teaching methods more than the online teaching [4]. The remote E-exams were also considered as the main assessment method during the pandemic. Since it was the first experience of our students to this type of exams, it was described as being more stressful compared with in-campus exams [15]. Accordingly, the aim of this cross sectional study was to investigate, using an electronic survey, the factors affected the medical sciences students’ experience with remote E-exams and various aspects associated with exam preferences and academic dishonesty in such mode of assessment.

Material and methods

Ethical statement

This study was approved by the Deanship of Research and the Institutional Review Board at JUST (IRB number: 12/135/2020). The study was registered with the Research Registry (researchregistry6092, https://www.researchregistry.com/browse-the-registry#home/?view_2_search=researchregistry6092&view_2_page=1) in accordance with the declaration of Helsinki and conducted in agreement with the guidelines of Strengthening the reporting of cohort studies in surgery (STROCSS) 2019 [18].

Study design

An initial questionnaire was prepared by four faculty members who are actively involved in educating students at various faculties of medical sciences (Medicine, Dentistry, Pharmacy, Nursing and Applied Medical Sciences) in JUST. Initially, the questionnaire was piloted on 30 students and was then finalized and approved. Questionnaire was prepared using Google Forms and a link was sent to medical sciences undergraduates via their E-learning accounts. A follow up reminder was sent after three and six days. The questionnaire was collected after the final exam period of the summer semester.

The survey contained 16 questions that collected students' demographics (academic major and gender) and aimed to assess the students' experience of remote E-exams, with the main focus on (1) determining factors affecting the students' preference of remote E-exams compared with in-campus exams and defining students' preference regarding methods for course assessment and evaluation (2) identifying factors related to students’ exam dishonesty/misconduct during remote E-exams and measures that can be considered to reduce this behavior.

Students were asked about 11 factors that might contribute to students' preference of E-exams. These include exam related factors such as efforts/time needed for preparation, whether exam questions were appropriate with study material, exam structure (navigation, number of questions/page, type of exam) and exam dishonesty. Other factors also include the students’ academic achievement (expected Grade Point Average (GPA), actual GPA and achievement of curriculum goals). Students were also asked about their preferred methods of course assessment and evaluation including exams, quizzes, reports, and short assignments. In addition, students were asked about eight possible measures that can be considered to reduce exam dishonesty. These include proctoring solutions, modifications of exam structure (using different forms, one way exams, reduce number of questions/page, reduce time limits), change the mode of assessment (oral exams, substituting exams with other forms of assessment) and to consider the grade as compulsory pass/fail rather than actual grades.

Statistical analysis

Statistical packages Minitab version 17.0 was used to analyze the data. Descriptive statistics were used to report students' demographics, course assessment and evaluation preference, and possible measures to curb exam dishonesty. Cross tabulation and Chi-square test were performed to identify any association between students' preference of remote E-exams and demographic factors as well as association with exam related factors and students' academic achievement. The association between exam dishonesty/misconduct during remote E-exams with students’ gender and exam related factors was also analyzed using Chi-square test.

Results

Students’ demographics

In this study, 730 students from faculties of medical sciences agreed to participate and have completed the survey. More than half of respondents were from Faculty of Medicine (53.70%), while the least participation was from Faculty of Applied Medical Sciences (Table 1). The majority of participants (63.15%) were females. Participants’ demographics of are shown in Table 1.

Table 1

Students’ demographic characteristics.

Variable	Number of Students	Percent
Academic Major
Medicine	392	53.70
Dentistry	110	15.07
Pharmacy	84	11.51
Nursing	106	14.52
Applied Medical Sciences	38	5.21
Total	730	100
Gender
Female	461	63.15
Male	269	36.85
Total	730	100

Students’ preference for E-exams

Students were asked whether they prefer the in-campus or remote E-exams (Table 2). The majority of respondents (498; 68.22%) preferred in-campus E-exams, while around one third of students (232; 31.78%) preferred the remote E-exams. This was found to be significantly associated with the students' academic major (P = 0.007). More than one third of students from Faculties of Medicine and Applied Medical Sciences (36.22% and 36.84%, respectively) preferred remote E-exams, compared with only less than fifth of students at Faculty of Pharmacy (17.86%). However, exam preference was not found to be associated with students’ gender (P = 0.161).

Table 2

Students’ preference to E-exams.

Variable	Student's E-exam preference		P-value
	Campus E-exams (%)	Remote E-exams (%)
Academic Major
Medicine	63.78	36.22	0.007
Dentistry	68.18	31.82
Pharmacy	82.14	17.86
Nursing	75.47	24.53
Applied Medical Sciences	63.16	36.84
Gender
Female	70.07	29.93	0.161
Male	65.06	34.94
Total	100	100

Factors related to students’ preference of E-exams

Students were asked about factors that might contribute to students' preference of E-exams (Table 3). Those include exam related factors such as efforts/time needed for preparation, whether exam questions were appropriate with study material, exam structure (navigation, number of questions/page, type of exam) and exam dishonesty. Other factors also include the students’ academic achievement (expected GPA, actual GPA and achievement of curriculum goals).

Table 3

Factors that might affect students’ preference of E-exams.

Variable	Total (%)	Student's E-exam preference		P-value
		Campus E-exams (%)	Remote E-exams (%)
Exam related factors
Efforts and time				0.000
More than regular exams	49.86%	57.03%	34.48%
Less than regular exams	21.92%	20.68%	24.57%
No difference	28.22%	22.29%	40.95%
Total	100%	100%	100%
Exam questions appropriate with theory material				0.001
Yes	34.66%	30.92%	42.67%
No	53.15%	58.03%	42.67%
Not applicable	12.19%	11.04%	14.66%
Exam questions appropriate with Lab material				0.000
Yes	28.63%	25.30%	35.78%
No	35.34%	39.96%	25.43%
Not applicable	36.03%	34.74%	38.79%
Exam questions appropriate with clinical material				0.004
Yes	22.05%	19.28%	28.02%
No	32.74%	36.14%	25.43%
Not applicable	45.21%	44.58%	46.55%
Exam navigation				0.336
One way	4.52%	4.02%	5.60%
Two ways (free)	95.48%	95.98%	94.40%
Number of questions/page				0.812
1/page	19.32%	19.68%	18.53%
5/page	50.41%	49.60%	52.16%
10/page	30.27%	30.72%	29.31%
Type of exam				0.106
Regular exam	71.92%	70.08%	75.86%
Open book	28.08%	29.92%	24.14%
Exam dishonesty				0.009
No exam dishonesty	55.07%	51.20%	63.36%
Help from friends	20.41%	22.09%	16.81%
Search for answers from all possible sources	24.52%	26.71%	19.83%
Academic achievements factors
Expected GPA				0.068
Higher	50.96%	53.41%	45.69%
Lower	16.44%	16.67%	15.95%
No change	32.60%	29.92%	38.36%
Actual GPA				0.000
Higher	30.41%	25.90%	40.09%
Lower	32.88%	41.57%	14.22%
No change	36.71%	32.53%	45.69%
Achievement of curriculum objectives				0.000
Yes	37.67%	27.31%	59.91%
No	62.33%	72.69%	40.09%

Students’ preference of E-exams and exam related factors

Around half of all respondents (49.86%) reported that more efforts and time were spent in preparation for remote E-exams compared with in-campus exams. This was found to significantly affect the students' preference of E-exams. Majority of students who preferred remote E-exams reported that similar efforts/time were needed for exam preparation (40.95%) as for in-campus exams, while the majority of students who preferred the in-campus exams reported that more preparation was needed for the remote E-exams (57.03%). Regarding the students' response about whether the questions were appropriate with study material, the percentages of students who reported that questions were not appropriate with study material were higher for all material types including theory (53.15%), lab (35.34%) and clinical (32.74%) than percentages of students who agreed that questions were appropriate. This was found to be statistically significant (P ≤ 0.004) and affect the students' preference of E-exams, with most students who considered questions as not appropriate with study material preferred the in-campus exams. Regarding the exam structure, almost all students (95.48%) preferred the free navigation between questions, half of students preferred five questions/page and more than two thirds (71.92%) preferred regular exams rather than open book exams. However, all of the aforementioned exam structure related factors were not found to affect the students' preference of E-exams (P > 0.05). Students were asked whether they have had exam misconduct and dishonesty during the remote E-exams. More than half of the students (55.07%) reported no exam dishonesty or misconduct, while the other half reported that they seeked assistance from friends (20.41%) or all other possible sources (24.52%). Of note, this was found to be significantly related to the students’ preference for E-exams. Among students who preferred remote E-exams, 63.36% reported no exam misconduct and dishonesty compared with 51.20% of students who preferred the in-campus exams. This might be attributed to the observation that higher percentage of students who preferred remote E-exams considered that exam questions were appropriate with study material and thus they were less likely to behave in dishonest way to answer exam questions. In comparison, higher percentages of students who preferred in-campus exams reported that remote E-exam questions were not appropriate with study material, and thus they might have behaved in dishonest way to be able to answer exam questions.

Students' preference of E-exams and students’ academic achievements

Factors related to students' academic achievements were evaluated whether they might affect the students' preference for E-exams. Among all students, 50.96% expected that their GPA will be higher with remote E-exams while 16.44% expected a lower GPA. However, upon being assessed with remote E-exams, only 30.41% of students had higher GPA, while 36.71% reported no GPA change and 32.88% got lower GPA. Of note, around 62.33% of all students reported that upon being assessed with remote E-exams, they have not achieved the objectives of their curriculum. It was found that both the actual GPA and achievement of curriculum objectives to be significantly associated with the students’ preference for E-exams. Among students who preferred the in-campus exams, 41.57% reported that GPA was lower than usual and 72.69% considered that they have not achieved the curriculum objectives. In comparison, 40.09% of students who preferred the remote E-exams reported that their GPA was increased and 59.91% reported that they have achieved the goals and objectives of their curriculum.

Course assessment and evaluation

Since most students reported that remote E-exams need more efforts and time for preparation, considering other ways for assessment and evaluation might reduce these challenges with remote E-exams. Students were asked about their preference for methods of course assessment and evaluation. Students were allowed to choose more than way of assessment. As shown in Fig. 1, the majority of students chose combining both exams and quizzes as mode of assessment, while all other choices that included writing reports were the least selected.

Fig. 1

Students' preference of course assessment and evaluation methods.

Factors affecting exam dishonesty in remote E-exam

Students were asked about the exam dishonesty during the remote E-exams. Possible factors that might be underlying this behavior include students' gender and exam related factors (efforts/time needed for preparation, exam questions appropriate with study material). Those were assessed using Chi-square analysis (Table 4). There was no significant difference between male and female students regarding the exam misconduct. However, exam related factors such as efforts/time needed for preparation were found to be significantly associated with student's E-exam dishonesty. Although the majority of students reported that they spent more efforts/time for remote E-exam preparation, the percentages of students who spent less efforts/time for exam preparation were higher among students who have exam dishonesty with help from friends (34.23%) or search from all possible resources (28.49%). In addition, the appropriateness of theory and clinical exam questions with study material was found to be significantly associated with student dishonesty.

Table 4

Factors related to E-exam dishonesty.

Variable	Student's E-exam dishonesty			P-value
	No Exam dishonesty	Help from friends	Search from all possible sources
Gender				0.271
Female	64.93%	64.43%	58.10%
Male	35.07%	35.57%	41.90%
Total	100%	100%	100%
Efforts/Time needed				0.000
More than regular exams	51.00%	45.64%	50.84%
Less than regular exams	14.43%	34.23%	28.49%
No difference	34.58%	20.13%	20.67%
Total	100%	100%	100%
Exam questions appropriate with theory material				0.025
Yes	38.31%	34.90%	26.26%
No	50.75%	48.99%	62.01%
Not applicable	10.95%	16.11%	11.73%
Total	100%	100%	100%
Exam questions appropriate with Lab material				0.673
Yes	29.35%	31.54%	24.58%
No	35.57%	32.89%	36.87%
Not applicable	35.07%	35.57%	38.55%
Total	100%	100%	100%%
Exam questions appropriate with clinical material				0.000
Yes	22.89%	30.87%	12.85%
No	28.11%	34.90%	41.34%
Not applicable	49.00%	34.23%	45.81%
Total	100%	100%	100%

Possible measures to reduce exam dishonesty

Students were asked about possible measures that can be considered to reduce exam dishonesty. These include proctoring solutions, modifications of exam structure (using different forms, one way exams, reduce number of questions/page, reduce time limits), change the mode of assessment (oral exams, substituting exams with other forms of assessment) and to consider the grade as compulsory pass/fail rather than actual grades. As shown in Fig. 2, the main measures considered by students included substituting the exam with other forms of assessment, using different exam forms, the use of online proctoring solutions and considering compulsory pass/fail grades. These measures were chosen by 40.8%, 34%, 27.3% and 24.7% of students, respectively. Modifications on exam structure such as one way exams, reduce number of questions/page and reduce time limits were only chosen by 10.4%, 14.8% and 6.6% of students, respectively. Conducting oral exams was considered by only 6.8% of students as a measure to reduce exam dishonesty.

Fig. 2

Possible measures preferred by students to reduce exam dishonesty.

Discussion

The higher education system around the world has implemented the online teaching as an approach for distance learning shortly after the announcement of Covid-19 pandemic. In addition, E-exams were conducted from distance and considered as a primary mode of assessment for students' academic progress during the pandemic. Although E−exams were well documented to be approved by many educational institutes including JUST years before the pandemic, they were mainly conducted in-campus [19,20]. Therefore, considering remote E-exams has raised valuable concerns for educational institutions, faculties and students [21]. Accordingly, in this cross-sectional study among students at faculties of Medical Sciences in JUST, the students' perception about the experience of remote E-exams was evaluated. Factors that might affect students’ preference of remote E-exams versus in-campus were assessed. In addition, exam dishonesty/misconduct was investigated as one of the major drawbacks of remote E-exams.

In this study, remote E-exams were less preferred among two thirds of students compared with in-campus E-exams. This is the first time for students at JUST to be exclusively taught by online learning and assessed by remote E-exams [4,15]. The unfamiliarity of educators and students and the lack of essential requirements in the E-exam platforms might have contributed to this response. Stress factors related to remote E-exams might also have negatively affected the students’ preference of remote E-exams [11,22,23].

In this study the majority of students reported that more efforts/time are needed to prepare for remote E-exams compared with in-campus. This was found to be significantly associated with students’ inclination toward in-campus exams. The needed efforts/time might be related to the diversity of teaching methods and the variable study materials/resources used during the distance education. Here in JUST, lectures were given in a hybrid method including Synchronous (online live classes) and Asynchronous (pre-recorded) learning [4,9]. The latter involved the use of narrated power point, recorded videos, PDF handouts and slides [4]. Therefore, students might have spent more efforts to study for remote E-exams from all sources collectively.

In this study, higher percentage of all respondents reported that questions were not appropriate with course’ study material including theory, laboratory and clinical components. This was found to significantly affect the students’ preference and might be related to the challenges encountered during distance education [24]. The optimal online course delivery necessitates the adoption of audio/video-designed classes as well as optimization of delivery methods and teaching materials [25]. In addition, robust infrastructure/platforms and well-skilled technology support teams are considered as essential elements for the success of online education [26]. The abrupt shift to distance education and assessment due to the COVID-19 pandemic revealed many challenges for educators such as inadequacies in their online curriculum teaching experience, training, and support from educational technology teams [24,26]. Further, the practical and clinical contents cannot be optimally provided without a supervised interactive experience [27].This is a major concern in Faculties of Medical Sciences with a strong professional orientation or practical components that are difficult to be assessed and validated by remote E-exams [10,26]. Considering the aforementioned factors might have contributed to the note of inappropriateness of exam questions with study material.

Factors related to students' academic achievements were also found to significantly affect the students' preference for E-exams. Around 62.33% of all students reported that upon being assessed with remote E-exams, they have not achieved the objectives of their curriculum. Previous studies also reported that one of the major challenges with remote education during the pandemic was the ability to maintain and guarantee curriculum delivery integrity, its assessment, educational outcome achievement, and curriculum objective fulfillment [26,28,29]. Instructors were asked abruptly to initiate online teaching without a previous preparation [30]. Students had also to cope with sudden changes in teaching methods, despite the possible connectivity problems, resources constraints, and variations in knowledge and skills related to online learning [31,32]. Student's GPA might contribute to students' preference of remote E-exams. Half of students surveyed in this study expected to have higher GPA with remote E-exams. However, upon being assessed only one third of students have higher GPA, and thus might significantly contributed to students' preference of E-exams. Further, a large part of practical objectives in the curricula of Faculties of Medical Sciences that were difficult to be provided using online tools had put students at these faculties at highly challenging situations [26]. Based on aforementioned observations, educational administrators have to carefully balance between students' safety, educational standard, and their responsibility toward the community in graduating skilled and safe health care providers [24,26,33].

The second main part of this survey concerned with exam dishonesty/misconduct as a major challenge with remote E-exams [[34], [35], [36]]. Students during in-campus E-exams receive similar exam invigilation. However, in remote E-exams students will take the exam from home [14]. In this study, around 40% of students reported that they seeked assistance from friends or all other possible sources. This was found to be significantly associated with student's efforts/time spent for exam preparation and the appropriateness of theory and clinical exam questions with study material. Recent studies also have revealed exam dishonesty as an obstacle related to remote E-exams [35,37].

Considering all these observations, many educational institutions have recommended several measures to prevent academic dishonesty [36]. In this study, the main measures considered by students included substituting the exam with other forms of assessment, using different exam forms, the use of online proctoring solutions and considering compulsory pass/fail grades.

Student authentication checking systems might influence the assessment process [38,39]. Online proctoring relies on many technological tools to prevent or reduce exam dishonesty [10]. Many educational institutions have applied online proctoring systems as being effective measures for the supervision of remote E-exams [40,41]. Recent study comparing non-proctored and proctored online exam scores revealed significant differences in exam average between the two sections and supported the necessity for proctored exams [41]. However, such systems require financial and human supports. In addition, a negative impact on students mental health and well-being was recently raised as a concern with the use of online proctoring systems [42], and therefore, educational institutions have recommended other measures to prevent academic dishonesty [37,43].

Substituting the exam with other forms of assessment could include asking students to write an essay on a controversial issue, analyze and interpret data, or solve a real-world problem [10,44]. Although cheating cannot be totally eliminated, educators can design questions for which students need to reflect on their personal situation or their own experience with the course [44]. However, this might be more suited to assess students’ mastery of the course content and capacity to think at higher cognitive levels [10]. Further, it will be impractical to apply such assessment method for bigger classes where students number might exceed 200.

Administering different sets of exam questions to different students in E-exams reduces the risk of student interaction with each other. This was adopted by many universities during the pandemic [37]. However, additional investment is needed from exam developers to design large panel of questions. In addition, the questions should be with the same level of difficulty to ensure the reliability and fairness Further, it has limited value with other forms of cheating such as searching for answers from the Internet [10].

Strict E-exams duration is another solution to limit dishonest behaviors. However, it was only chosen by 6.6% of surveyed students. It can reduce dishonesty when the time for cheating competes with the time needed to answer exam questions [10]. The exam durations are set to allow the highest performing students just to have enough time to complete the test within the given time limits, while average students would only be able to answer between 60 and 80% of exam questions [10]. It is also important to ensure a fair treatment of students as they do not always take their exams under the same conditions. If all requirements are met, limited exams duration can be an effective way to reduce academic dishonesty without the need of proctoring technologies [10]. However, the major drawback will be on students with special needs who cannot take the privilege of extra time for their exams since the online exam settings cannot be changed.

The mode of navigation between questions might be considered as a measure to reduce exam dishonesty. Recent studies reported the mode of navigation as students’ concern and the one-way exams not allowing students to access the previous questions is not a favorable mode [11,15]. However, it might be valuable if the same questions set will be used combined with shuffling in the order of questions and choices. In our study only 10%of students considered one-way exams to reduce exam cheating.

Conducting oral exams was considered by only 6.8% of students as a measure to reduce exam dishonesty. E-exams can be redesigned as synchronous oral exams. Oral exams provide other advantages such as limiting the risk of technical failure and ensuring that assessment and grading can, where appropriate, be adjusted to students’ individual situations and constraints [10,43]. This was considered as one of the best solutions to reduce dishonesty by other educational institutions [37,43]. However, given the large number of students as in Faculties of Medical Sciences, oral exams need a significant time investment from faculty members [43].

Here in JUST, most faculties adopted the use of different exam forms, limit the exam duration and applying one way navigation mode to reduce the students’ dishonest behaviors.

This study was conducted in a single institution, and therefore the lack of generalizability of the findings might be a limitation. In addition, the study was conducted at the early phase of the pandemic where most faculty members have minimal experience in distance education and most students have a first-time experience for distance education and E-exams. Further, most students were under the stress of the pandemic and its associated lifestyle changes.

Conclusion

In this cross-sectional study, approximately only one third of students from Faculties of Medical Sciences preferred the remote E-exams as a mode of assessment during the Covid-19 pandemic. This was found to be significantly associated with more efforts/time needed for exam preparation, inappropriateness of exam questions with study material and students‘ academic achievements. Findings from this study are highly valuable to plan for academic strategies that will help in overcoming difficulties of remote E-exams. These might include improvement for distance teaching methodologies, rearrangement of assessment options and modification of the academic curriculum to fit the current situation.

Exam dishonesty/misconduct appears as one of the major challenges with remote E-exams that negatively affects the academic integrity and was significantly associated with efforts/time spent for exam preparation and inappropriateness of exam questions with study materials. Considering the experience of other worldwide educational institutes and based on the recommendations of exam committees at faculties of medical sciences in JUST, most faculties adopted the use of different exam forms, limit the exam duration and applying one way navigation mode to reduce the students’ dishonest behaviors.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Declaration of competing interest

Authors declare no conflict or competing interest.