Implementation of Image-Based Objective Questions As An Assessment Tool in Anatomy in Phase I MBBS Students
Keywords:
Image-based objective questions (IBOQs); Anatomy education, Formative assessment; Visual learning; Clinical reasoning; Student perception; Faculty perception; Online assessment.Abstract
Background: Image-based objective questions (IBOQs) have emerged as a promising assessment strategy in anatomy by promoting visual interpretation, spatial understanding, and clinical application. However, evidence regarding their educational effectiveness and stakeholder acceptability remains limited.
Objectives: To evaluate students' and teachers' perceptions of image-based assessments, compare student performance across two image-based examinations, and assess the feasibility of integrating IBOQs into formative assessment for Phase I MBBS students.
Methods: A quasi-experimental study was conducted among Phase I MBBS students using routine formative assessments administered through Google Forms. Two examination sessions comprising text-based and image-based objective questions were conducted after an orientation session. Student performance was analysed using paired and independent t-tests, while perceptions of students and faculty were explored using Likert-scale questionnaires, thematic analysis of open-ended responses, and focus group discussions.
Results: Students scored significantly higher in text-based than image-based examinations in both assessment sessions. However, among the 86 students who completed both image-based assessments, mean scores improved significantly from 13.02 to 14.49 (t = −3.20, p = 0.0019), indicating adaptation to the assessment format. Qualitative findings revealed that IBOQs enhanced spatial understanding, clinical reasoning, integration of theory with dissection, and student engagement. Both students and faculty recommended gradual integration of image-based questions alongside conventional assessments while highlighting the need for structured practice, high-quality image banks, and appropriate digital infrastructure.
Conclusion: Repeated exposure to image-based formative assessments significantly improved student performance and promoted deeper, clinically relevant learning. IBOQs should complement, rather than replace, conventional text-based assessments to strengthen competency-based anatomy education.
