Acceptability and Effectiveness of Image-based Multiple-choice Questions as a Formative Assessment Method in Anatomy for Phase-I MBBS Students: A Mixed-methods Study

Abstract Background: Assessment in anatomy education requires focus on visual understanding and practical medical applications. The evaluation of essential clinical reasoning abilities through visualization and higher-order cognitive and visual-spatial skills remains unaddressed by traditional text-based MCQs. Image-Based MCQ (IB-MCQs) is more authentic evaluation approach which is aligned with competency-based assessment. The present study evaluated the feasibility, perception and effectiveness of IB-MCQs as a formative assessment tool for Phase-I MBBS students in Anatomy through different platforms. Methodology: The study was conducted after ethical approval and used a mixed-methods approach. The assessment included 250 students who completed traditional MCQs and IB-MCQs through different platforms which included large screens and smart TVs and Google Forms, LMS. Statistical analysis used: The research used quantitative methods to analyze performance results while students and faculty members provided qualitative feedback about feasibility, usability and educational value. Results: Students achieved better results in IB-MCQs when using large-screen and Smart-TV platforms according to statistical analysis ( p < 0.001, Cohen’s d = 0.8–1.1) which suggests better visualization abilities and conceptual knowledge. The performance of students decreased when they used mobile devices because of technical issues with the interface. The majority of students (87%) preferred IB-MCQs as assessment method because they found it more engaging and helpful for spatial learning. Conclusions: IB-MCQs enables students to learn visually while thinking critically develop application skills and analytical thinking abilities however, their effectiveness may be influenced by the testing platform, technical infrastructure, and logistics.