Document Type : Original Article


Pakistan Health Research Council, Head office, Islamabad, Pakistan


 Background: The study aimed to describe the procedures implemented by medical colleges in Pakistan to assure quality in their assessment system.
Method: A qualitative study was conducted from March 2015-December 2017 in medical colleges of Pakistan using grounded theory design. The medical colleges were selected by using non-probability convenient sampling technique. Out of the total 93 PMDC (Pakistan Medical and Dental Council) recognized medical colleges, 49 were selected from all four provinces of Pakistan as well as Azad Kashmir. An open-ended questionnaire was filled by one faculty member from each participating medical college after obtaining informed consent. Data was analyzed using SPSS version 21 (IBM).
Results: Majority participants appreciated their institution’s assessment policy and wished improvement in terms of comparability to national organization’s assessment systems. For about 1/3rd of participants developing standardized tools, their grading (e.g. SEQs), and faculty’s unwillingness to devote time for quality MCQ were the challenges. Recommendations by > 1/3rd to overcome barriers included one assessment per year, improvement in teaching methods, standardized assessment, and structured viva exams. In >1/2 institutions no audit of assessment process was conducted. Around 1/3rd confirmed audit was an irregular unplanned activity and no report published. Around 1/4th of participants highlighted that a formal audit report stemmed in improving teaching & examination methods.
Conclusions: Overall Quality Assurance (QA) procedures in assessment system in Pakistan were poorly implemented. Lack of QA and Monitoring & Evaluation (M&E), feedback mechanism, benchmarks for assessors, and formal auditing was noted. Student’s involvement, & semester system was recommended.


1.         Joshi MA. Quality assurance in medical education. Indian J Pharmacol. 2012;44(3):285.
2.         Sallis E. Total quality management in education: Routledge; 2014.
3.         Mishra S. Quality assurance in higher education: An introduction: National Assessment and Accreditation Council, India; 2007.
4.         Anaper C, Nihan S, Ulucay D, Cabuk A. Accreditation of Online and Distance Learning Programs: Online GIS Education Program Experience. Turkish Online Journal of Distance Education. 2013;14(1):231-44.
5.         Colby J WM. Defining Quality in Education. United Nations Children's Fund NY, NY, USA; June 2000.
6.         LCME accreditation guidelines for new and developing medical schools May 2006 [cited 2020 17 September]. Available from: https://www.flbog.edu/wp-content/uploads/0017_0088_0736_11.pdf.
7.         Şandru IMD. Dimensions of quality in higher education-some insights into quality-based performance measurement. Synergy. 2008(2):31-40.
8.         Rose K. Project Quality Management: Why, what and how: Plantation, Florida : J. Ross Publishing, 2014. ©2014. Available from: https://books.google.com.sa/books?id=b5F08Z0QRosC&pg=PA69&lpg=PA69.
9.         Kalolo JF. Improving the quality of science education in Tanzanian junior secondary schools: The stakeholders' perspectives, issues, and promising practices. 2014.
10.       Outcomes and standards for undergraduate medical education: Tomorrow’s Doctors. General Medical Council. 2009 Available from: http://www.ub.edu/medicina_unitateducaciomedica/documentos/TomorrowsDoctors_2009.pdf.
11.       Epstein RM. Assessment in medical education. New England journal of medicine. 2007;356(4):387-96.
12.       Hodges B. Assessment in the post-psychometric era: learning to love the subjective and collective. Med Teach. 2013;35(7):564-8.
13.       Raupach T, Brown J, Anders S, Hasenfuss G, Harendza S. Summative assessments are more powerful drivers of student learning than resource intensive teaching formats. BMC med. 2013;11(1):61.
14.       Ivankova NV, Creswell JW, Stick SL. Using mixed-methods sequential explanatory design: From theory to practice. Field methods. 2006;18(1):3-20.
15.       Pakistan Medical & Dental Council. Recognized Medical Dental Colleges in Pakistan. 2014 [cited 2020 13 september ]. Available from: http://www.pmdc.org.pk/AboutUs/RecognizedMedicalDentalColleges/tabid/109/Default.aspx.
16.       Marshall B, Cardon P, Poddar A, Fontenot R. Does sample size matter in qualitative research?: A review of qualitative interviews in IS research. Journal of computer information systems. 2013;54(1):11-22.
17.       Fiaz M, Rani F, Saqlain M, Mahmood A, Shaiq PA, Naqvi S, et al. Identification of Population Specific Risk Phenotypes Contributing Towards Development of Metabolic Syndrome. Pak J Zool. 2016;48(4).
18.       Downing SM. Selected-Response Item Formats in Test Development.  Handbook of test development. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 2006. p. 287-301.
19.       Shrivastava S. A study on academic appraisal program: An innovation towards quality assurance in undergraduate medical education: Datta Meghe Institute of Medical Sciences; 2015.
20.       RaJ GA. Quality Assurance in Medical Education at GMC -1998-2008. In: Proceedings of 10th biennial INQAAHE. 2009.
21.       Memon MA, Joughin GR, Memon B. Oral assessment and postgraduate medical examinations: establishing conditions for validity, reliability and fairness. Adv Health Sci Educ Theory Pract. 2010;15(2):277-89.
22.       Moghaddam AK, Khankeh HR, Shariati M, Norcini J, Jalili M. Educational impact of assessment on medical students’ learning at Tehran University of Medical Sciences: a qualitative study. BMJ open. 2019;9(7):e031014.
23.       Griewatz J, Simon M, Lammerding-Koeppel M. Competency-based teacher training: A systematic revision of a proven programme in medical didactics. GMS J Med Educ. 2017;34(4).
24.       Harden RM. Outcome-based education: the future is today. Med teach. 2007;29(7):625-9.
25.       Chong L, Taylor S, Haywood M, Adelstein B-A, Shulruf B. The sights and insights of examiners in objective structured clinical examinations. J Educ Eval Health Prof. 2017;14.
26.       Cobb KA, Brown G, Jaarsma DA, Hammond RA. The educational impact of assessment: a comparison of DOPS and MCQs. Med teach. 2013;35(11):e1598-e607.
27.       Segers M, Martens R, Van den Bossche P. Understanding how a case-based assessment instrument influences student teachers’ learning approaches. Teach Teach Educ. 2008;24(7):1751-64.
28.       Al Kadri HM, Al-Moamary MS, Elzubair M, Magzoub ME, AlMutairi A, Roberts C, et al. Exploring factors affecting undergraduate medical students’ study strategies in the clinical years: a qualitative study. Advances in health sciences education. 2011;16(5):553-67.
29.       Al Kadri HM, Al-Moamary MS, van der Vleuten C. Students' and teachers' perceptions of clinical assessment program: A qualitative study in a PBL curriculum. BMC res notes. 2009;2(1):263.
30.       Khan JJS, Biggs JS, Tabasum S, Iqbal M. Assessment in medical education in Pakistan: evaluating evaluation. Biomedica. 2012;28(1):88-94.
31.       Palmer EJ, Duggan P, Devitt PG, Russell R. The modified essay question: its exit from the exit examination? Med Teach. 2010;32(7):e300-e7.
32.       Rush BR, Rankin DC, White BJ. The impact of item-writing flaws and item complexity on examination item difficulty and discrimination value. BMC med educ. 2016;16(1):1-10.
33.       Shipton EE, Bate F, Garrick R, Steketee C, Visser EJ. Pain medicine content, teaching and assessment in medical school curricula in Australia and New Zealand. BMC med educ. 2018;18(1):110.
34.       Al-Rubaish AM, Al-Umran KU, Wosornu L. An audit of assessment tools in a medical school in eastern Saudi Arabia. J Family Community Med. 2005;12(2):101.
35.       Okeke TC, Anyaehie BU, Ugwu EO, Agu PU, Orizu I, Adiri C, et al. An Audit of Medical Students’ Performance in 2nd MBBS Physiology Examination in a Medical School in Nigeria: A 7-Year Review. American Journal of Clinical Medicine. 2013;1(2):28-31.