# Examiner workload comparison: three structured oral examination formats for the European diploma in anaesthesiology and intensive care

## TL;DR

This study compares examiner workload across three formats of a medical exam and finds that online exams do not consistently reduce workload, while hybrid exams offer some benefits.

## Contribution

The study provides new insights into how different exam formats affect examiner workload in medical certification.

## Key findings

- Online exams had higher workload than hybrid but not face-to-face exams.
- Mental demands, temporal demands, and effort were the main contributors to workload.
- Hybrid exams showed a minor but significant reduction in workload compared to others.

## Abstract

The COVID-19 pandemic triggered transformations in academic medicine, rapidly adopting remote teaching and online assessments. Whilst virtual environments show promise in evaluating medical knowledge, their impact on examiner workload is unclear. This study explores examiner’s workload during different European Diploma in Anaesthesiology and Intensive Care Part 2 Structured Oral Examinations formats. We hypothesise that online exams result in lower examiner’s workload than traditional face-to-face methods. We also investigate workload structure and its correlation with examiner characteristics and marking performance. In 2023, examiner’s workload for three examination formats (face-to-face, hybrid, online) using the NASA TLX instrument was prospectively evaluated. The impact of examiner demographics, candidate scoring agreement, and examination scores on workload was analysed. The overall NASA TLX score from 215 workload measurements in 142 examiners was high at 59.61 ± 14.13. The online examination had a statistically higher workload (61.65 ± 12.84) than hybrid but not face-to-face. Primary contributors to workload were mental and temporal demands, and effort. Online exams were associated with elevated frustration. Male examiners and those spending more time on exam preparation experienced a higher workload. Multiple diploma specialties and familiarity with European Diploma in Anaesthesiology and Intensive Care exams were protective against high workload. Perceived workload did not impact marking agreement or examination scores across all formats. Examiners experience high workload. Online exams are not systematically associated with decreased workload, likely due to frustration. Despite workload differences, no impact on examiner’s performance or examination scores was found. The hybrid examination mode, combining face-to-face and online, was associated with a minor but statistically significant workload reduction. This hybrid approach may offer a more balanced and efficient examination process while maintaining integrity, cost savings, and increased accessibility for candidates.