Remote versus on-site proctored exam: comparing student results in a cross-sectional study.

Background: The COVID-19 pandemic has profoundly affected assessment practices in medical education necessitating distancing from the traditional classroom. However, safeguarding academic integrity is of particular importance for high-stakes medical exams. We utilised remote proctoring to administer safely and reliably a proficiency-test for admission to the Advanced Master of General Practice (AMGP). We compared exam results of the remote proctored exam group to those of the on-site proctored exam group.

Methods: A cross-sectional design was adopted with candidates applying for admission to the AMGP. We developed and applied a proctoring software operating on three levels to register suspicious events: recording actions, analysing behaviour, and live supervision. We performed a Mann-Whitney U test to compare exam results from the remote proctored to the on-site proctored group. To get more insight into candidates' perceptions about proctoring, a post-test questionnaire was administered. An exploratory factor analysis was performed to explore quantitative data, while qualitative data were thematically analysed.

Results: In total, 472 (79%) candidates took the proficiency-test using the proctoring software, while 121 (20%) were on-site with live supervision. The results indicated that the proctoring type does not influence exam results. Out of 472 candidates, 304 filled in the post-test questionnaire. Two factors were extracted from the analysis and identified as candidates' appreciation of proctoring and as emotional distress because of proctoring. Four themes were identified in the thematic analysis providing more insight on candidates' emotional well-being.

Conclusions: A comparison of exam results revealed that remote proctoring could be a viable solution for administering high-stakes medical exams. With regards to candidates' educational experience, remote proctoring was met with mixed feelings. Potential privacy issues and increased test anxiety should be taken into consideration when choosing a proctoring protocol. Future research should explore generalizability of these results utilising other proctoring systems in medical education and in other educational settings.