Online vs. Paper-Based Examination: A Quasi-Experimental Study Comparing Two Examinations Formats in the Integrated Cardiovascular Module at FRPMC.

Abstract: Background: Medical education has rapidly shifted from traditional paper-based exams to online assessments, especially after the COVID-19 pandemic. This changes the trend from paper based examination towards online examination. This study investigates the effectiveness of online versus paper-based exams among faculty and students at Fazaia Ruth Pfau Medical College (FRPMC), Karachi. Methods: A quasi-experimental study was conducted from December 2025 to January 2026 at Fazaia Ruth Pfau Medical College (FRPMC), Karachi. The study included 223 first-year (Batch 2025) and second-year MBBS students (Batch 2024) who had completed the cardiovascular module and appeared at the end of module examination. Participants were allocated into two groups based on examination format: paper-based and online. Both examination formats comprised 80 multiple-choice questions covering basic science subjects and were administered within a 90-minute time frame. The paper-based examination was conducted in a supervised, controlled environment, whereas the online examination was administered through the Learning Management System (LMS-Moodle). Students’ academic performance in both formats was evaluated by comparing mean examination scores. In addition, students’ perceptions regarding the effectiveness of the examination formats were assessed using a structured, closed-ended 19-item questionnaire. The questionnaire was distributed via Google Forms, LMS-Moodle, and WhatsApp, achieving a 100% response rate. Faculty perceptions were explored through open-ended questions administered to 25 faculty members involved in the assessment process. Quantitative data were analyzed using SPSS version 26. Descriptive statistics were used to summarize the findings, and the reliability of the questionnaire was evaluated using Cronbach’s alpha. Conclusion: In conclusion, students prefer more paper-based exams and feel more confident and less stressed with paper-based exams, while faculty appreciate the efficiency and fairness of online assessments. These findings imply the need for a balanced strategy that respects students’ comfort while simultaneously supporting the practicality and accuracy valued by faculty.