{"paper_id":"2acd104b-6fbf-419c-8d93-b693658f52e1","body_text":"Enhancing medical assessment strategies: A comparative study between structured, traditional and Hybrid viva-voce assessment. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing medical assessment strategies: A comparative study between structured, traditional and Hybrid viva-voce assessment. Kavita Rasalkar, Sulekha Sinha, Sunita Tripathy, Bikramaditya Mukherjee, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5669110/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Jun, 2025 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Medical students' skills and knowledge have traditionally been assessed through written and oral examinations (viva-voce). Structured viva-voce is an objective structured method to orally assess students. As an assessment tool it was used informally since 1989, however it was publicized by describing it separately by Oakley and Hencken in 2005. Hybrid method is combination of both structured and traditions viva-voce methods This study aims to assess the methods for inter-examiner consistency to minimize variations in scoring during viva-voce. It further investigates medical students' perceptions regarding the fairness, transparency, and overall experience of the assessment formats: structured viva-voce, traditional viva-voce, and hybrid method. By examining these perspectives, the study seeks to provide insights into optimizing viva-voce methods for improved reliability and student satisfaction. Methods: Oral assessment was scheduled. Validated structured viva-voce cards, based on Bloom’s taxonomy and expert-reviewed, were prepared. Each student underwent a 5-minute structured viva using two different card sets, followed by a 5-minute traditional viva conducted by both examiners. A hybrid format included combining both methods. Feedback was obtained through a mixed questionnaire with quantitative (Likert scale) and qualitative (open-ended) items on the examination methods. Results and conclusion: The study evaluated variation in scoring between 2 examiners for three viva-voce formats: structured, traditional, and hybrid (a combination of both traditional and structured) among 151 students with 53.6% females and 46.3% males. The Wilcoxon signed rank test revealed significant inter-examiner variability in structured viva-voce and Set 2 of traditional viva-voce (p < 0.05), while the hybrid method showed better consistency between examiners. Pearson correlation and reliability analyses indicated that the hybrid viva-voce demonstrated higher inter-examiner consistency, correlation coefficients, and reliability (ICC and Cronbach’s α = 0.663) compared to structured and traditional formats, suggesting it may be a more effective assessment method. Feedback revealed that 56% of students preferred the hybrid format for its balance of objectivity and flexibility. While structured viva-voces excelled in fairness and coverage, traditional viva-voces were appreciated for flexibility but suffered from inconsistency. Overall, the hybrid format emerged as the effective assessment method, offering enhanced reliability and student satisfaction by addressing the shortcomings of both individual formats. These findings suggest the potential of hybrid viva-voce in fostering a consistent and comprehensive evaluation framework. Structured Viva voce Traditional Viva voce Hybrid viva-voce Formative Assessment summative assessment Examiner Evaluator Students’ performance Examination inter examiner consistency mitigation of Bais Medical education Biochemistry Oral examination competency NMC CBME 2019 Figures Figure 1 Figure 2 Figure 3 Background Competency-Based Medical Education (CBME) implemented in Indian medical colleges since 2019 has defined core competencies, certifiable skills, and practical instructions. Three formative assessments, along with continuous internal assessments, have been recommended, but the assessment pattern is left to university discretion (1). Universities have specified mark distribution for each component, but no specific instructions are provided to ensure uniformity in student evaluation. The effects of assessment practices are far more potent than any other aspects of learning (2). Assessments influence and control students more deeply than teachers often realize(3). “Students can, with difficulty, escape from the effects of poor teaching, they cannot (by definition, if they want to graduate) escape the effects of poor assessment.” (4) As medical educators we need to confront the ways of assessments which has the potential to cause anxiety due to bias. Skills and knowledge of students in medical college have been traditionally assessed by written and oral examinations. Oral examinations has been recorded in use since 1815 as an “examination conducted by speech” having named as viva-voce which seems to be derived from Latin “by or with living voice”. Viva-voce examinations (1) remain an integral part of assessments of students performance. It is interviewing the student by one or more examiners to assess depth and clarity of subject knowledge, along with his decision making and presentation skills(5,6). Oral examinations play a vital role in assessing competencies that are difficult to evaluate through written tests or Objective Structured Practical Examination (OSPE) sessions. They provide an opportunity to gauge students' depth of understanding, communication skills, and response efficiency in real-time.(7) Viva-Voce offers better sensitivity in both positive and negative predictability of students understanding (8). However, viva-voce assessments can be subjected to inter-examiner variation.(9,10) Structured and standardized oral examination could reasonably prevent errors in viva-voce caused due to halo effect, lack of central tendency, leniency, students confidence, impression of previous candidates and judgement clustering around mid-ranges (8).Structured viva-voce was used informally since 1989, however it was publicized by describing it separately as an assessment tool by Oakley and Hencken in 2005(5,9,11–13). Structured viva lacks open discussions and requires high planning(14). The hybrid method includes structured and traditional viva voce together. This method attempts to overcome the disadvantages of both the methods. This study aims to assess methods for inter-examiner consistency and variation in different viva-voce assessment methods. It further investigates medical students' perceptions regarding the fairness, transparency, and overall experience of three assessment formats: structured viva-voce, traditional viva-voce, and a hybrid method. By examining these perspectives, the study seeks to provide insights into optimizing viva-voce methods for improved reliability and student satisfaction. Methods Ethical consideration: The study adhered to the Declaration of Helsinki. The study was approved by the Institution Ethics Committee (IEC-DHR Registration EC/NEW/INST/2022/2810) of Manipal Tata Medical College Jamshedpur. (Ethics approval number: MTMC/IEC/2024/67) Study design: The study was a comparative observational cross sectional study design. Participants: The study participants were the phase 1 medical students 2023-24 batch of National Medical Commission (NMC) approved medical college. All 151 students studying in Manipal tata medical college Jamshedpur in Ist year MBBS were enrolled in the study with 81 females and 75 male students. Overall, six competent faculty members were involved in the study. All the faculty members were serving as Assistant Professors and above as per NMC norms for Manipal Tata Medical College. Four competent Biochemistry faculty members were in charge of conducting the viva-voce examination, and the other two were planners of the study. Setting of the study: This study was conducted in the department of Biochemistry during the III sessional examination of Ist MBBS students as a part of formative assessments. All the Biochemistry competencies as per the NMC -CBME curriculum 2019 were covered for the assessment. The planners trained four biochemistry faculty examiners to conduct the session. Isolated viva-voce rooms were set up for four examiners, which were labeled as Examiners 1 & 2 (S1 E1 & S1E2) of set 1 and Examiners 1 & 2 (S2 E1 & S2 E2) of set 2. No mobile phones or other gadgets were allowed in the exam hall. To curb inter-student communication, viva-voce rooms were arranged in a one-way manner so that each student left the department after completing the viva-voce. Even during the session, strict discipline was maintained, and no students were allowed to communicate with any other students. Instrument: Preparation: Structured viva-voce cards were planned and specifically prepared for this study by two competent biochemistry faculty, and it was discussed and finalized with four other biochemistry faculty who were also examiners. Planners got the pattern validated by experts in biochemistry. Competent external Biochemistry experts in grade Associate Professors and above, not associated with the study, were consulted for content validation. A structured questionnaire, as outlined in Table 1, was developed using Google Forms. The experts were requested to assess the relevance of each question using a 5-point Likert scale ranging from \"strongly disagree\" to \"strongly agree.\" The Content Validity Index (CVI) was subsequently calculated, with a CVI value of ≥0.7 considered acceptable for inclusion. Structured viva-voce cards were used to evaluate students' Biochemistry knowledge. Each 10-mark card included eight questions of increasing complexity based on Bloom's taxonomy. Domain 1 (Knowledge) and Domain 2 (Comprehension) had two 1-mark questions each, while Domain 3 (Application & Analysis) had four(Table 1). To ensure anonymity of the cards, the cards were unmarked. The questions included were as follows: (Table 1) Sl no Question Marking Remarks Domain CVI 1 Reference values of TWO parameters 1mark Clinically important parameter covered under practical Recall 1 2 Biochemical defect of any TWO condition 1 mark (enzyme/vitamin/mineral deficiency or excess/ genetic defect 1 3 Describe the functions of 1 mark Any ONE biomolecule-Phosphofructokinase, Glucagon, cholesterol Understand 1 4 Give reasons for any clinical feature of any disease 1 mark Example: haemolysis in sickle cell anaemia 1 5 Describe the mechanism of action of any ONE drug 1 Mark Statin, 5 fluorouracil, methotrexate Analysis and apply 1 6 Diagnostic significance of a biochemical test 1 Mark HbA1c, Lipase, Troponin, CKMB 1 7 Explain the biochemical causes/etiopathogenesis of any disease 2 marks Any ONE explanation question. Cause of cataract in galactosemia, anaemia in glucose-6 phosphate deficiency 1 8 Justify 2 marks Any ONE Justification question example-Oxidized Low-density lipoprotein is atherogenic, prolong starvation causes ketoacidosis 1 Process: The students were explained regarding the examination process, and consent was obtained; all students voluntarily consented to participate in the study. Each student was instructed to complete assessments of both structured and traditional (5 minutes each =10 minutes) from examiner 1 and examiner 2 sequentially. Hence, each student was assessed for 10 minutes with examiner 1 and 10 minutes with examiner 2, for a total of 20 minutes of viva voce. All involved faculty strictly maintained time for each session. Structured Viva-voce Session: Of the 20 different viva cards prepared each examiner received ten different viva-voce cards without any identification, kept upside down on their table. Each student randomly selected a viva-voce card by lottery system, and answered the questions mentioned in the viva-voce card in the first 5 minutes as a part of structured viva-voce. As per the expert’s opinion, on average the allotted time was sufficient to complete the assessment. Traditional Viva-voce Session: - In the next 5-minute session with each examiner, each student faced a traditional viva-voce examination. The faculty randomly asked questions related to the viva-voce topic without a predetermined structure and marked the students accordingly. Hybrid method: The marks obtained by students for structured and traditional viva-voce examinations were summed up to get the scores of the hybrid method. Feedback: Following the viva-voce session, students and faculty were asked to provide feedback on their perception of the assessment methods in Microsoft forms. Quantitative feedback was obtained using Likert scaling covering aspects such as fairness, examiner consistency, student engagement, opportunity for reflection, questioning quality, content coverage and overall effectiveness with the assessment process. Qualitative feedback using open-ended questions was also gathered to gain insights into their experiences. The qualitative feedback was analyzed using content analysis to identify key themes. Responses were coded based on frequently mentioned words and recurring ideas. The primary categories included advantages and disadvantages of assessment methods. Statistical analysis: Descriptive statistics and a comparison of means between structured, traditional, and hybrid between examiner 1 and examiner 2 were done. Since the data was skewed, the Wilcoxon signed-rank test was used to analyze paired differences in scores given by two different examiners to the same student. Intraclass Correlation Coefficient (ICC) & Cronbach α (10) was done to evaluate the reliability of measurements. Internal consistency of each viva format was assessed using Cronbach’s alpha across cases. Inter-examiner agreement was evaluated using the intraclass correlation coefficient (ICC). It was calculated based on scores independently assigned by two examiners to the same group of students across the three viva formats. Although raters did not score students simultaneously, ICC was used to provide an estimate of the consistency in scoring patterns between the two raters for each format. Linear regression to explore relationships between variables and Pearson correlation to assess the strength and direction of associations. Quantitative feedback using Likert scales to gauge participant responses. The p value of <0.01 was considered as statistically significant. Jamovi 2022 version 2.3 was used for statistical analysis (15). The content analysis method was performed for qualitative data obtained in feedback. Coding was performed manually by grouping similar responses, ensuring clarity and consistency in interpretation. This allowed for a structured analysis of perceptions regarding the effectiveness, fairness, and limitations of each viva format Results Table No 2: Demographic Results Examiners Set 1 N (%) Examiner Set 2 N (%) Total (N) Females 41 (27.1%) 40 (26.5%) 81(53.6%) Males 34 (22.5%) 36(23.8%) 70(46.3%) Total 75 (49.7%) 76 (50.3%) 151 N= number of students A total of 151 students participated in the study, comprising 81 females and 70 males. Male and female students were distributed approximately equally among the four examiners to ensure balanced representation (Table 2). Quantitative results: Table 3 Descriptive scores among examiner 1 and examiner 2 using the different evaluation methods: Viva-voce Type Examiner N Min Max Mean + SD Statistics P value by paired t test P value by Wilcoxon Signed rank test Structured S1E1 75 0 9 6.29 + 1.66 2.3 0.032 0.034* S1E2 76 2 9 5.96 + 1.27 S2E1 76 2.5 9 5.95 + 1.39 1.79 0.077 0.067 S2E2 76 1.5 9.5 6.74 + 1.98 E1 151 0 9 6.26 + 1.97 2.83 0.005* 0.005* E2 151 1.5 9.5 5.78 + 1.92 Traditional S1E1 75 0 10 6.12 + 2.17 1.79 0.219 0.047* S1E2 76 2 10 5.55 + 1.6 S2E1 76 2 9 6.39 + 1.75 -3.89 <0.001* <0.001** S2E2 76 1.5 10 6 + 2.19 E1 151 0 10 6.12 + 1.54 -1.54 0.125 0.220 E2 151 1.5 10 6.35 + 1.7 Hybrid S1E1 75 0 19 12.3 + 3.68 2.5 0.016 0.002* S1E2 76 4.5 19 11.5 + 2.62 S2E1 76 6 17 12.3 + 2.91 -1.34 0.182 0.3 S2E2 76 4 19.5 12.7 + 3.6 E1 151 0 19 12.3 + 3.31 0.646 0.519 0.213 E2 151 4 19.5 12.1 + 3.2 SD: standard deviation; Min: minimum value; Max: maximum value; S1E1: Set 1 Examiner 1; S1E2: Set 1 Examiner 2; S2E1: Set 2 Examiner 1; S2E2: Set 2 Examiner 2. P: statistical significance between examiners (p <0.01). Table 3 presents the descriptive statistics for student scores awarded by Examiners 1 and 2 across three assessment formats: structured viva-voce, traditional viva-voce, and the hybrid method. Both the structured and traditional viva-voce formats exhibited inter-examiner variation with the Wilcoxon signed rank test. A p-value of <0.05 was considered statistically significant and <0.01 as highly statistically significant. For set 1 and overall, of structured viva-voce, Set 1& 2 of traditional viva-voce, set 1 of hybrid method the p-value was statistically significant, indicating notable inter-examiner variability in these formats. Traditional viva showed a highly statistically significant difference of <0.001. Table 4 linear regression: Viva-voce Type Examiner R value R2 Estm t Value P value Structured Set 1 0.148 0.021 -0.566 -1.83 0.069 Set 2 0.098 0.0099 -0.395 -1.23 0.221 Together 0.424 0.180 0.434 5.73 <0.001* Traditional Set 1 0.11 0.122 -0.36 -1.36 0.177 Set 2 0.225 0.0504 0.784 2.81 0.006* Together 0.458 0.210 0.413 6.26 <0.001* Hybrid Set 1 0.127 0.016 -0.809 -1.56 0.120 Set 2 0.0717 0.00513 0.467 0.880 0.380 Together 0.496 0.246 0.513 6.99 <0.001* R value: correlation coefficient, R2: Estm: Estimate (regression coefficient), t-Value:test statistic value P: statistical significance between examiners (p <0.01). Table 4 illustrates the findings of linear regression analysis performed on the scores assigned by Examiners 1 and 2 for structured, traditional, and hybrid viva-voce formats. Statistically significant associations were observed between the examiners’ scores across all three formats. The correlation coefficients indicated moderate correlation, with values of 0.424 for structured viva-voce and 0.458 for traditional viva-voce. The strongest association was observed in hybrid mode, with a correlation coefficient of 0.496. This suggests that the hybrid format facilitates better alignment between examiners’ scorings. While structured viva-voce allows for a more detailed evaluation, inter-examiner variability persists. Table 5: Correlation Matrix and Reliability Analysis Pearsons Correlation Cronbach’s α ICC Viva-voce Type Examiner R value P value Structured Set 1 0.159 0.170 0.460 0.442 Set 2 0.545 <0.001 0.694 0.646 Together 0.424 <0.001 0.595 0.511 Traditional Set 1 0.421 <0.001 0.568 0.542 Set 2 0.537 <0.001 0.671 0.576 Together 0.458 <0.001 0.626 0.551 Hybrid Set 1 0.393 <0.001 0.602 0.551 Set 2 0.587 <0.001 0.729* 0.685 Together 0.496 <0.001 0.663 0.591 R value: correlation coefficient, P: statistical significance between examiners (p <0.01). Pearson correlation analyses were performed to further assess the relationship between scores assigned by Examiners 1 and 2 across the three viva-voce formats ( Table 5 ). Statistically significant associations were observed for the structured, traditional, and hybrid modes, except set 1 of structured viva-voce. Internal consistency, as an indicator of reliability, was measured using Cronbach’s alpha. A Cronbach alpha value greater than 0.7 is acceptable, greater than 0.8 is considered good and above 0.9 is excellent reliability (10,16). Reliability analysis using Cronbach’s α in this study showed low reliability of 0.595 for structured viva-voce and moderate reliability for traditional (0.626) and hybrid viva-voce method (0.663) ( Table 5). Only hybrid viva-voce Cronbach α reached the threshold value of >0.7. In comparison, the hybrid viva-voce consistently demonstrated higher correlation coefficients and reliability than the structured and traditional formats, suggesting that it may be a more effective assessment method or that examiners’ grading aligns more closely in this format. One-way random interclass correlation coefficient (ICC) (<0.5 poor, 0.5-0.75 moderate, >0.75 good reliability) was slightly higher for hybrid when compared to structured or traditional viva-voce, indicating higher inter rater(inter-examiner) consistency and reliability ( Table 5) . These findings highlight the potential of the hybrid viva voce in reducing inter-examiner variability while ensuring consistent and comprehensive evaluation. Feedback analysis: The students' feedback was taken as the quantitative Likert scaling and open-ended qualitative questions. In the study, 16% of students expressed a preference for the traditional viva-voce format, while 28% favored the structured viva-voce and the majority of students (56%) preferred a hybrid approach that combined elements of both assessment methods (Figure 2). Quantitative feedback was collected using a Likert scale to evaluate structured and traditional viva-voce formats across various parameters. A significantly higher percentage of students rated the structured viva voce positively compared to the traditional viva voce, particularly in aspects such as content coverage and clarity of objectives (Figure 3). Table 6: Qualitative feedback analysis Strengths Limitations Structured viva-voce Objectivity and fairness: Helps consistent and unbiased marking. Consistency of questions helps students to prepare and perform better. Questions from all topics, hence better coverage of topics. Consistency on questioning by all examiners Helps build student confidence by focusing on well-defined topics Completes in equal time frame for all Higher preparation time for faculty Rigid & less flexible: Low scope for exploring topics beyond the listed questions Unprepared students lose marks easily Provides efficacy but is not ideal for assessing deeper understanding Traditional viva-voce Flexibility: Encourages underprepared students to answer questions Encourages prepared students to assess depth of Knowledge; broader preparation is encouraged. Lower chances of cheating Completes in a shorter time frame Unpredictable hence causes anxiety among students Examiner variability: Inconsistency in covering broader range of topics Students worry about examiner-specific questions (Pet Questions) Option to change questions can cause an uneven assessment process Lack of structure causes unfairness Qualitative feedback was also analyzed from open-ended questions regarding the perceived advantages and disadvantages of both formats. Students highlighted that the structured viva voce's primary advantages were its objectivity and fairness, although its rigidity was identified as a drawback. Conversely, the traditional viva-voce was appreciated for its flexibility, but students noted examiner-to-examiner variability as a significant disadvantage (Table 6 ). The feedback from the faculty revealed the strengths of the method, as consistency in questioning patterns, and limitations, such as the higher preparation time for conducting the assessment sessions. Fairness was the most common word used for structured viva and flexibility was the most common word for traditional viva. Discussion In this study, viva-voce assessment methods were analyzed to evaluate inter-examiner consistency, variation, and check transparency and fairness in the scoring system. The qualitative and quantitative data obtained from the study were complementary to each other. Quantitative data were analyzed through descriptive statistics, correlation analysis, reliability analysis, and Likert scale for feedback, while qualitative insights were gathered through open-ended feedback questions from students and faculty. Structured viva-voce, as supported by examiners in this study and consistent with findings by Gor et al. (17), has the potential to reduce scoring bias through carefully selecting questions targeting the cognitive domains of Bloom's taxonomy, including knowledge, comprehension, application, and analysis. However, our findings revealed similar mean values as seen in study by Shaikh et al (18), low consistency in scoring between examiners for both structured and traditional viva-voce, with statistically significant differences in scores across different sets of examiners. These results align with those reported by Khilnani et al (19). In contrast, the hybrid mode of assessment demonstrated statistically significant differences in scoring between two examiners evaluating the same student only in set 1, highlighting its potential for improved consistency. However, the reduction in variation and improved reliability due to averaging the scores for both structured and traditional assessments cannot be overlooked. Further studies involving the randomization of students into different groups and a detailed comparison of scoring differences between examiners could provide clearer insights. As observed by Gor et al. (17), correlation analysis in this study showed statistically significant associations across all three assessment methods: structured, traditional, and hybrid modes. However, unlike the findings of Suwarna et al. (16,20), reliability analysis in our study showed low reliability, primarily attributed to scoring variations with set 1 examiners. While our study focuses on psychometric indicators such as Cronbach’s alpha and ICC to assess interrater reliability, we acknowledge that validity encompasses more than statistical consistency. Addressing the variations through intensive examiner training in assessment strategies, calibration sessions to standardize questions, along with mock practice sessions for students could enhance reliability and effectiveness in the future as suggested by Kane (6,17,21) The absence of examiner scripting by design in traditional viva is a known threat to scoring and generalization validity. In contrast, structured and hybrid formats, by using prompts and rubrics, better support consistent interpretation and use of scores. Quantitative feedback analysis using a Likert scale demonstrated a clear preference for structured viva-voce and the hybrid mode over the traditional assessment method. Structured viva-voce received favorable ratings across all measured parameters compared to traditional viva-voce, aligning with findings from Shenwai et al (22). Content analysis for qualitative feedback data revealed distinct perceptions of traditional and structured viva-voce methods among students and faculty. Students viewed the traditional viva-voce as flexible, with lower chances of cheating, and quicker to complete. However, they highlighted significant drawbacks, including unpredictability, higher examiner variability, and pressure to anticipate faculty-specific \"pet\" questions. The option for examiners to change questions at a student’s request was noted to have the potential for biased marking and unfair assessments. In contrast, the structured viva-voce was appreciated for its objectivity, fairness, predictability, and focus on well-defined topics, enabling students to prepare effectively and achieve higher satisfaction due to broader topic coverage. However, students noted its rigidity, which could be discouraging for weaker candidates, and its inability to assess deeper understanding. “Equality for all students irrespective of any teacher” “No feeling of only certain specific questions to be asked by each of the faculties.” Were few of the comments regarding structured viva & “Teacher can decide what level of questions to ask from whom” “Low chances of cheating” “Flexibility” were the comments for traditional viva. The examiners opined that structured viva voce required more preparation time, which could be a deterrent. Nevertheless, they emphasized that if standardized could enable unbiased, systematic assessment fostering critical evaluation of students' knowledge and skills. To the best of our knowledge, no prior studies have specifically evaluated the effectiveness of the hybrid mode of assessment. Our findings reveal that the hybrid mode offers statistically significant advantages, including superior inter-examiner consistency, reduced bias, and better correlation. Notably, it emerged as the preferred assessment method among students. This innovative approach combines the structured evaluation of a standardized viva with the flexibility of the traditional method, ensuring unbiased assessments while allowing for a deeper analysis of students' understanding and covering a broader range of topics. Additionally, the hybrid mode mitigates anxiety and fear associated with examiner-related variations in scoring by fostering transparency and fairness. Its ability to blend objectivity with adaptability makes it a promising model for comprehensive and equitable evaluation in medical education. Limitations of the study: The study's findings may be influenced by the single centric, specific context and the chosen subject, limiting their generalizability to all medical education settings. Additionally, the longer preparation time required for faculty may restrict the widespread adoption of this method. However, once established, the standardized structured viva material can be utilized consistently in subsequent assessments. Students underwent assessments by two different examiners, thereby prolonging their evaluation time. Since neither randomization nor a crossover design was implemented, and both viva techniques were conducted in quick succession, faculty scoring may have been influenced by prior responses. Two examiners observing and scoring a single examination process could have given a better understanding of interrater consistency. While the hybrid mode appeared to be well-received by advanced learners—allowing them to answer structured viva questions rapidly while elaborating on concepts in the traditional viva—the observed statistical significance may have been influenced by the larger sample size rather than a true advantage of the method. Faculty feedback was collected through Microsoft forms, but better documentation could be achieved through recorded interview sessions for in-depth discussion. Lastly, improving the design of viva cards and providing intensive examiner training could enhance consistency and reliability in scoring across different evaluators. Conclusions Overall, the hybrid format emerged as the most effective assessment method, offering enhanced reliability and student satisfaction by addressing the shortcomings of both individual formats. These findings suggest the potential of hybrid viva-voce in fostering a consistent and comprehensive evaluation framework. It can be implemented in medical colleges by integrating structured with traditional assessments, ensuring standardization, reducing examiner variation, and enhancing comprehensive evaluation of students' clinical reasoning and knowledge. The well-structured questionnaire can improve inter-rater reliability. Further studies are warranted to support the hybrid model as an effective and reliable viva-voce assessment method. We shall plan to collaborate with other institutions to adopt a multicentric and multidisciplinary approach.\" Declarations Financial support : Nil Conflict of Interest: There was no conflict of interest. Acknowledgements: I acknowledge all my students for voluntarily participating in our study. I am thankful to Mr. Krishna Mohan Tiwari, Mrs. Kavita Verma, Mrs. Veena Devi, Ms. Nilima Ojha & Mr. Anthony for their contribution to my study. Lastly, I thank the institution for supporting my study. Clinical Trail Number: Not applicable Ethics approval and consent to participate: The study adhered to “Declaration of Helsinki”. The study was approved by Institution Ethics Committee (IEC-DHR Registration EC/NEW/INST/2022/2810) of Manipal Tata medical College Jamshedpur. (Ethics approval number: MTMC/IEC/2024/67). Consent from all the participants were received. Consent for publication: Not applicable. Availability of data and materials: We have submitted all the available data, its statistical analysis and material associated with this study Competing interests: I declare that any of the authors of this study have no competing interests associated with the study or its results. Funding : No funding was obtained. Authors' contributions Sl no Author names Contributions 1 Dr Kavita Rasalkar Conception and designing of the study, analysis and interpretation of the data, preparation of manuscript for publication. 2 Dr Sulekha Sinha Designing of the study, Interpretation of data, revised the draft critically, approved the version to be published. Revisions done as per reviewers suggestion. 3 Dr Sunita Tripathy Conduction of study and Data acquisition 4 Dr Bikramaditya Mukherjee Conduction of study and Data acquisition 5 Dr Nagamma Takkella Conduction of study and Data acquisition 6 Dr Elvis Vishal Dadel Conduction of study and Data acquisition 7 Mr Monit Sundriyal Data tabulation in excel 8 Ms Swetanka Prasad Cross checking of tabulated data Acknowledgements: I acknowledge all the students for voluntarily participating in the study. I am thankful to Mr. Krishna Mohan Tiwari, Mrs. Kavita Verma, Mrs. Veena Devi, Ms. Nilima Ojha & Mr. Anthony for their contribution to the study. Lastly, I thank the institution for supporting the study. Authors' information Dr Kavita Rasalkar, Professor and Head, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India Dr Sulekha Sinha, Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India Dr Sunita Tripathy, Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India Dr Bikramaditya Mukherjee, Associate Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India Dr Nagamma Takkella, Assistant Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India Dr Elvis Vishal Dadel, Assistant Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India Mr Monit Sundriyal, Tutor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India Ms Swetanka Prasad, Tutor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India References UG-Curriculum-Vol-I.pdf [Internet]. 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J Clin Diagn Res [Internet]. 2022 [cited 2024 Jul 27]; Available from: https://www.jcdr.net//article_fulltext.asp?issn=0973-709x&year=2022&volume=16&issue=9&page=JE01&issn=0973-709x&id=16977 Anurag Agarwal, Bipin Batra, AK Sood. Evolutionary trends in radiology assessment: The importance of the learning cycle and its assessment in radiology. Silva V de, Hanwella R, Ponnamperuma G. The validity of oral assessment (viva) that assesses specific and unique competencies in a post-graduate psychiatry examination. Sri Lanka J Psychiatry [Internet]. 2013 Jan 13 [cited 2024 Dec 16];3(2). Available from: https://sljpsyc.sljol.info/articles/10.4038/sljpsyc.v3i2.5133 Imran M, Doshi C, Kharadi D. Structured and unstructured viva voce assessment: A double-blind, randomized, comparative evaluation of medical students. Int J Health Sci. 2019;13(2). Abuzied AIH, Nabag WOM. Structured viva validity, reliability, and acceptability as an assessment tool in health professions education: a systematic review and meta-analysis. BMC Med Educ. 2023 Jul 25;23(1):531. Tutton PJM, Glasgow EF. Reliability and predictive capacity of examinations in anatomy and improvement in the reliability of viva voce (oral) examinations by the use of a structured rating system. Clin Anat. 1989;2(1):29–34. Thomas CS, Mellsop G, Callender K, Crawshaw J, Ellis PM, Hall A, et al. The oral examination: a study of academic and non-academic factors. Med Educ. 1993 Sep;27(5):433–9. Oakley B, Hencken C. Oral examination assessment practices: effectiveness and change within a first year undergraduate cohort. J Hosp Leis Sport Tour Educ. 2005 Apr;4(1):3–14. Ahsan M, Mallick A. A Study to Assess the Reliability of Structured Viva Examination over Traditional Viva Examination among 2nd‑Year Pharmacology Students. J Datta Meghe Inst Med Sci Univ. 2022 Nov 5;17:589–94. jamovi - open statistical software for the desktop and cloud [Internet]. [cited 2024 Apr 17]. Available from: https://www.jamovi.org/ Suwarna Madhukumar, Pavithra M B, Amrita Ns. Conventional Viva and Structured Viva — Comparison and Perception of Students. Indian J Public Health Res Dev. 2022 Apr 12;13(2):167–72. Gor S, Budh D, Athanikar B. Comparison of conventional viva examination with objective structured viva in second year pathology students. Int J Med Sci Public Health. 2014;3(5):537. Shaikh ST. Objective Structured Viva Examination Versus Traditional Viva Examination in Evaluation of Medical Students. Anat Physiol [Internet]. 2015 [cited 2024 Jul 27];05(03). Available from: https://www.omicsonline.org/open-access/objective-structured-viva-examination-versus-traditional-viva-examination-inevaluation-of-medical-students-2161-0940-1000175.php?aid=53387 Khilnani AK, Charan J, Thaddanee R, Pathak RR, Makwana S, Khilnani G. Structured oral examination in pharmacology for undergraduate medical students: Factors influencing its implementation. Indian J Pharmacol. 2015 Oct;47(5):546. Ganji KK. Evaluation of Reliability in Structured Viva Voce As a Formative Assessment of Dental Students. J Dent Educ. 2017 May;81(5):590–6. Sireci S. On Validity Theory and Test Validation. Educ Res. 2007 Nov 1;36. Shenwai MR, B. Patil K. Introduction of Structured Oral Examination as A Novel Assessment tool to First Year Medical Students in Physiology. J Clin Diagn Res JCDR. 2013 Nov;7(11):2544–7. Additional Declarations No competing interests reported. Supplementary Files Theoryvivamarksfinal.xlsx Structuredvivaforvalidation.pdf Statisticalanalysis.docx Feedback.xlsx Cite Share Download PDF Status: Published Journal Publication published 04 Jun, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 30 Apr, 2025 Reviews received at journal 28 Apr, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviews received at journal 23 Apr, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviews received at journal 22 Apr, 2025 Reviewers agreed at journal 20 Apr, 2025 Reviewers invited by journal 18 Apr, 2025 Submission checks completed at journal 16 Apr, 2025 First submitted to journal 11 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5669110\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":445407580,\"identity\":\"54297293-1fac-46fe-bb03-0bd74bc7308b\",\"order_by\":0,\"name\":\"Kavita 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viva-voce assessment.\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eCompetency-Based Medical Education (CBME) implemented in Indian medical colleges since 2019 has defined core competencies, certifiable skills, and practical instructions. Three formative assessments, along with continuous internal assessments, have been recommended, but the assessment pattern is left to university discretion\\u0026nbsp;(1). \\u0026nbsp;\\u0026nbsp;Universities have specified mark distribution for each component, but no specific instructions are provided to ensure uniformity in student evaluation.\\u003c/p\\u003e\\n\\u003cp\\u003eThe effects of assessment practices are far more potent than any other aspects of learning\\u0026nbsp;(2).\\u0026nbsp;Assessments influence and control students more deeply than teachers often realize(3). \\u0026ldquo;Students can, with difficulty, escape from the effects of poor teaching, they cannot (by definition, if they want to graduate) escape the effects of poor assessment.\\u0026rdquo;\\u0026nbsp;(4)\\u0026nbsp;As medical educators we need to confront the ways of assessments which has the potential to cause anxiety due to bias.\\u003c/p\\u003e\\n\\u003cp\\u003eSkills and knowledge of students in medical college have been traditionally assessed by written and oral examinations. Oral examinations has been recorded in use since 1815 as an \\u0026ldquo;examination conducted by speech\\u0026rdquo; having named as viva-voce which seems to be derived from Latin \\u0026ldquo;by or with living voice\\u0026rdquo;. Viva-voce examinations (1) remain an integral part of assessments of students performance. It is interviewing the student by one or more examiners to assess depth and clarity of subject knowledge, along with his decision making and presentation skills(5,6).\\u0026nbsp;Oral examinations play a vital role in assessing competencies that are difficult to evaluate through written tests or Objective Structured Practical Examination (OSPE) sessions. They provide an opportunity to gauge students\\u0026apos; depth of understanding, communication skills, and response efficiency in real-time.(7)\\u0026nbsp;Viva-Voce offers better sensitivity in both positive and negative predictability of students understanding\\u0026nbsp;(8). However, viva-voce\\u0026nbsp;assessments can be subjected to inter-examiner variation.(9,10)\\u0026nbsp;Structured and standardized oral examination could reasonably prevent errors in viva-voce caused due to halo effect, lack of central tendency, leniency, students confidence, impression of previous candidates and judgement clustering around mid-ranges\\u0026nbsp;(8).Structured viva-voce was used informally since 1989, however it was publicized by describing it separately as an assessment tool by Oakley and Hencken in 2005(5,9,11\\u0026ndash;13). Structured viva lacks open discussions and requires high planning(14). The hybrid method includes structured and traditional viva voce together. This method attempts to overcome the disadvantages of both the methods.\\u003c/p\\u003e\\n\\u003cp\\u003eThis study aims to assess methods for inter-examiner consistency and variation in different viva-voce assessment methods. It further investigates medical students\\u0026apos; perceptions regarding the fairness, transparency, and overall experience of three assessment formats: structured viva-voce, traditional viva-voce, and a hybrid method. By examining these perspectives, the study seeks to provide insights into optimizing viva-voce methods for improved reliability and student satisfaction.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eEthical consideration: The study adhered to the Declaration of Helsinki. The study was approved by the Institution Ethics Committee (IEC-DHR Registration EC/NEW/INST/2022/2810) of Manipal Tata Medical College Jamshedpur. (Ethics approval number: MTMC/IEC/2024/67)\\u003c/p\\u003e\\n\\u003cp\\u003eStudy design: The study was a comparative observational cross sectional study design.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants: The study participants were the phase 1 medical students 2023-24 batch of National Medical Commission (NMC) approved medical college. All 151 students studying in Manipal tata medical college Jamshedpur in Ist year MBBS were enrolled in the study with 81 females and 75 male students. Overall, six competent faculty members were involved in the study. All the faculty members were serving as Assistant Professors and above as per NMC norms for Manipal Tata Medical College. Four competent Biochemistry faculty members were in charge of conducting the viva-voce examination, and\\u0026nbsp;the other two were planners of the study.\\u003c/p\\u003e\\n\\u003cp\\u003eSetting of the study: This study was conducted in the department of Biochemistry during the III sessional examination of Ist MBBS students as a part of formative assessments. All the Biochemistry competencies as per the NMC -CBME curriculum 2019 were covered for the assessment. The planners trained four biochemistry faculty examiners to conduct the session. Isolated viva-voce rooms were set up for four examiners, which were labeled as Examiners 1 \\u0026amp; 2 (S1 E1 \\u0026amp; S1E2) of set 1 and Examiners 1 \\u0026amp; 2 (S2 E1 \\u0026amp; S2 E2) of set 2. No mobile phones or other gadgets were allowed in the exam hall. To curb inter-student communication, viva-voce rooms were arranged in a one-way manner so that each student left the department after completing the viva-voce. Even during the session, strict discipline was maintained, and no students were allowed to communicate with any other students.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eInstrument:\\u003c/p\\u003e\\n\\u003cp\\u003ePreparation: Structured viva-voce cards were planned and specifically prepared for this study by two competent biochemistry faculty, and it was discussed and finalized with four other biochemistry faculty who were also examiners. Planners got the pattern validated by experts in biochemistry. Competent external Biochemistry experts in grade Associate Professors and above, not associated with the study, were consulted for content validation. A structured questionnaire, as outlined in Table 1, was developed using Google Forms. The experts were requested to assess the relevance of each question using a 5-point Likert scale ranging from \\u0026quot;strongly disagree\\u0026quot; to \\u0026quot;strongly agree.\\u0026quot; The Content Validity Index (CVI) was subsequently calculated, with a CVI value of \\u0026ge;0.7 considered acceptable for inclusion.\\u003c/p\\u003e\\n\\u003cp\\u003eStructured viva-voce cards were used to evaluate students\\u0026apos; Biochemistry knowledge. Each 10-mark card included eight questions of increasing complexity based on Bloom\\u0026apos;s taxonomy. Domain 1 (Knowledge) and Domain 2 (Comprehension) had two 1-mark questions each, while Domain 3 (Application \\u0026amp; Analysis) had four(Table 1). To ensure anonymity of the cards, the cards were unmarked.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;The questions included were as follows: \\u003cstrong\\u003e(Table 1)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSl no\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eQuestion\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMarking\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRemarks\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 101px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDomain\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCVI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003eReference values of TWO parameters\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e1mark\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003eClinically important parameter covered under practical\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 101px;\\\"\\u003e\\n \\u003cp\\u003eRecall\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003eBiochemical defect of any TWO condition\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e1 mark\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003e(enzyme/vitamin/mineral deficiency or excess/ genetic defect\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003eDescribe the functions of\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e1 mark\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003eAny ONE biomolecule-Phosphofructokinase, Glucagon, cholesterol\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 101px;\\\"\\u003e\\n \\u003cp\\u003eUnderstand\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003eGive reasons for any clinical feature of any disease\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e1 mark\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003eExample: haemolysis in sickle cell anaemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003eDescribe the mechanism of action of any ONE drug\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e1 Mark\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003eStatin, 5 fluorouracil, methotrexate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"4\\\" valign=\\\"top\\\" style=\\\"width: 101px;\\\"\\u003e\\n \\u003cp\\u003eAnalysis and apply\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003eDiagnostic significance of a biochemical test\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e1 Mark\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003eHbA1c, Lipase, Troponin, CKMB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003eExplain the biochemical causes/etiopathogenesis of any disease\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e2 marks\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003eAny ONE explanation question. Cause of cataract in galactosemia, anaemia in glucose-6 phosphate deficiency\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 33px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 162px;\\\"\\u003e\\n \\u003cp\\u003eJustify\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e2 marks\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 192px;\\\"\\u003e\\n \\u003cp\\u003eAny ONE Justification question example-Oxidized Low-density lipoprotein is atherogenic, prolong starvation causes ketoacidosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eProcess:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe students were explained regarding the examination process, and consent was obtained; all students voluntarily consented to participate in the study. Each student was instructed to complete assessments of both structured and traditional (5 minutes each =10 minutes) from examiner 1 and examiner 2 sequentially. Hence, each student was assessed for 10 minutes with examiner 1 and 10 minutes with examiner 2, for a total of 20 minutes of viva voce. All involved faculty strictly maintained time for each session.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eStructured Viva-voce Session: Of the 20 different viva cards prepared each examiner received ten different viva-voce cards without any identification, kept upside down on their table. Each student randomly selected a viva-voce card by lottery system, and answered the questions mentioned in the viva-voce card in the first 5 minutes as a part of structured viva-voce.\\u0026nbsp;As per the expert\\u0026rsquo;s opinion, on average the allotted time was sufficient to complete the assessment.\\u003c/p\\u003e\\n\\u003cp\\u003eTraditional Viva-voce Session: - In the next 5-minute session with each examiner, each student faced a traditional viva-voce examination. The faculty randomly asked questions related to the viva-voce topic without a predetermined structure and marked the students accordingly.\\u0026nbsp;\\u003cbr\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eHybrid method: The marks obtained by students for structured and traditional viva-voce examinations were summed up to get the scores of the hybrid method.\\u003c/p\\u003e\\n\\u003cp\\u003eFeedback: Following the viva-voce session, students and faculty were asked to provide feedback on their perception of the assessment methods in Microsoft forms. Quantitative feedback was obtained using Likert scaling covering aspects such as fairness, examiner consistency, student engagement, opportunity for reflection, questioning quality, content coverage and overall effectiveness with the assessment process. Qualitative feedback using open-ended questions was also gathered to gain insights into their experiences. The qualitative feedback was analyzed using content analysis to identify key themes. Responses were coded based on frequently mentioned words and recurring ideas. The primary categories included advantages and disadvantages of assessment methods.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical analysis:\\u003c/strong\\u003e Descriptive statistics and a comparison of means between structured, traditional, and hybrid between examiner 1 and examiner 2 were done. Since the data was skewed, the Wilcoxon signed-rank test was used to analyze paired differences in scores given by two different examiners to the same student. Intraclass Correlation Coefficient (ICC) \\u0026amp; Cronbach \\u0026alpha; (10) was done to evaluate the reliability of measurements. Internal consistency of each viva format was assessed using Cronbach\\u0026rsquo;s alpha across cases. Inter-examiner agreement was evaluated using the intraclass correlation coefficient (ICC). It was calculated based on scores independently assigned by two examiners to the same group of students across the three viva formats. Although raters did not score students simultaneously, ICC was used to provide an estimate of the consistency in scoring patterns between the two raters for each format. Linear regression to explore relationships between variables and Pearson correlation to assess the strength and direction of associations. Quantitative feedback using Likert scales to gauge participant responses. The p value of \\u0026lt;0.01 was considered as statistically significant. Jamovi 2022 version 2.3 was used for statistical analysis (15). The content analysis method was performed for qualitative data obtained in feedback. Coding was performed manually by grouping similar responses, ensuring clarity and consistency in interpretation. This allowed for a structured analysis of perceptions regarding the effectiveness, fairness, and limitations of each viva format\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable No 2: Demographic Results\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"529\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 100px;\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eExaminers Set 1 N (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eExaminer Set 2 N (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal (N)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003eFemales\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e41 (27.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e40 (26.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e81(53.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003eMales\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e34 (22.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e36(23.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e70(46.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e75 (49.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e76 (50.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 109px;\\\"\\u003e\\n \\u003cp\\u003e151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eN= number of students\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 151 students participated in the study, comprising 81 females and 70 males. Male and female students were distributed approximately equally among the four examiners to ensure balanced representation \\u003cstrong\\u003e(Table 2).\\u0026nbsp;\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eQuantitative results:\\u003c/strong\\u003e \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3 Descriptive scores among examiner 1 and examiner 2 using the different evaluation methods:\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"678\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eViva-voce Type\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eExaminer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMin\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMax\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean \\u003cu\\u003e+\\u003c/u\\u003e SD\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eStatistics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP value by paired t test\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP value by Wilcoxon Signed rank test\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"6\\\" valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eStructured\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS1E1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e6.29\\u003cu\\u003e+\\u003c/u\\u003e1.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e2.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e0.032\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.034*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS1E2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e5.96\\u003cu\\u003e+\\u003c/u\\u003e1.27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS2E1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e2.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e5.95\\u003cu\\u003e+\\u003c/u\\u003e1.39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e1.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e0.077\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.067\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS2E2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e9.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e6.74\\u003cu\\u003e+\\u003c/u\\u003e1.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eE1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e6.26\\u003cu\\u003e+\\u003c/u\\u003e1.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e2.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e0.005*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.005*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eE2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e9.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e5.78\\u003cu\\u003e+\\u003c/u\\u003e1.92\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"6\\\" valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTraditional\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS1E1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e6.12\\u003cu\\u003e+\\u003c/u\\u003e2.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e1.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e0.219\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.047*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS1E2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e5.55\\u003cu\\u003e+\\u003c/u\\u003e1.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS2E1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e6.39\\u003cu\\u003e+\\u003c/u\\u003e1.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e-3.89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001**\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS2E2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003cu\\u003e+\\u003c/u\\u003e2.19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eE1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e6.12\\u003cu\\u003e+\\u003c/u\\u003e1.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e-1.54\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e0.125\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.220\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eE2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e6.35\\u003cu\\u003e+\\u003c/u\\u003e1.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"6\\\" valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHybrid\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS1E1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e12.3\\u003cu\\u003e+\\u003c/u\\u003e3.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e2.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e0.016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.002*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS1E2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e4.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e11.5\\u003cu\\u003e+\\u003c/u\\u003e2.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS2E1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e12.3\\u003cu\\u003e+\\u003c/u\\u003e2.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e-1.34\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e0.182\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eS2E2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e19.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e12.7\\u003cu\\u003e+\\u003c/u\\u003e3.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eE1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e12.3\\u003cu\\u003e+\\u003c/u\\u003e3.31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 81px;\\\"\\u003e\\n \\u003cp\\u003e0.646\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003e0.519\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e0.213\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eE2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 51px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e19.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 100px;\\\"\\u003e\\n \\u003cp\\u003e12.1\\u003cu\\u003e+\\u003c/u\\u003e3.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eSD: standard deviation; Min: minimum value; Max: maximum value; S1E1: Set 1 Examiner 1; S1E2: Set 1 Examiner 2; S2E1: Set 2 Examiner 1; S2E2: Set 2 Examiner 2. P: statistical significance between examiners (p \\u0026lt;0.01).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;Table 3\\u003c/strong\\u003e presents the descriptive statistics for student scores awarded by Examiners 1 and 2 across three assessment formats: structured viva-voce, traditional viva-voce, and the hybrid method. Both the structured and traditional viva-voce formats exhibited inter-examiner variation with the Wilcoxon signed rank test. A p-value of \\u0026lt;0.05 was considered statistically significant and \\u0026lt;0.01 as highly statistically significant. For set 1 and overall, of structured viva-voce, Set 1\\u0026amp; 2 of traditional viva-voce, set 1 of hybrid method the p-value was statistically significant, indicating notable inter-examiner variability in these formats. Traditional viva showed a highly statistically significant difference of \\u0026lt;0.001.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4 linear regression:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eViva-voce Type\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eExaminer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eR value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eR2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eEstm\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003et Value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eStructured\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eSet 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.148\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e-0.566\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e-1.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.069\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eSet 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.098\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.0099\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e-0.395\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e-1.23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.221\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eTogether\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.424\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.180\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.434\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e5.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eTraditional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eSet 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.122\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e-0.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e-1.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.177\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eSet 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.225\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.0504\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.784\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e2.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.006*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eTogether\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.458\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.210\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.413\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e6.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eHybrid\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eSet 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.127\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e-0.809\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e-1.56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eSet 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.0717\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.00513\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.467\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.880\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.380\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003eTogether\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.496\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.246\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e0.513\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e6.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eR value:\\u003c/em\\u003e \\u003cem\\u003ecorrelation coefficient, R2: Estm: Estimate (regression coefficient), t-Value:test statistic value P: statistical significance between examiners (p \\u0026lt;0.01).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003cstrong\\u003eTable 4\\u003c/strong\\u003e illustrates the findings of linear regression analysis performed on the scores assigned by Examiners 1 and 2 for structured, traditional, and hybrid viva-voce formats. Statistically significant associations were observed between the examiners\\u0026rsquo; scores across all three formats. The correlation coefficients indicated moderate correlation, with values of 0.424 for structured viva-voce and 0.458 for traditional viva-voce. The strongest association was observed in hybrid mode, with a correlation coefficient of 0.496. This suggests that the hybrid format facilitates better alignment between examiners\\u0026rsquo; scorings. While structured viva-voce allows for a more detailed evaluation, inter-examiner variability persists.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTable 5: \\u003cstrong\\u003eCorrelation Matrix and Reliability Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"629\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 185px;\\\"\\u003e\\n \\u003cp\\u003ePearsons Correlation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003eCronbach\\u0026rsquo;s \\u003cstrong\\u003e\\u0026alpha;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003eICC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003eViva-voce Type\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eExaminer\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003eR value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003eStructured\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eSet 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.159\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e0.170\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.460\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.442\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eSet 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.545\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.694\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.646\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eTogether\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.424\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.595\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.511\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003eTraditional\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eSet 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.421\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.568\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.542\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eSet 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.537\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.671\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.576\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eTogether\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.458\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.626\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.551\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 108px;\\\"\\u003e\\n \\u003cp\\u003eHybrid\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eSet 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.393\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.602\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.551\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eSet 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.587\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.729*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.685\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 104px;\\\"\\u003e\\n \\u003cp\\u003eTogether\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e0.496\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 117px;\\\"\\u003e\\n \\u003cp\\u003e0.663\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e0.591\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eR value:\\u003c/em\\u003e \\u003cem\\u003ecorrelation coefficient, P: statistical significance between examiners (p \\u0026lt;0.01).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePearson correlation analyses were performed to further assess the relationship between scores assigned by Examiners 1 and 2 across the three viva-voce formats (\\u003cstrong\\u003eTable 5\\u003c/strong\\u003e). Statistically significant associations were observed for the structured, traditional, and hybrid modes, except set 1 of structured viva-voce. Internal consistency, as an indicator of reliability, was measured using Cronbach\\u0026rsquo;s alpha. A Cronbach alpha value greater than 0.7 is acceptable, greater than 0.8 is considered good and above 0.9 is excellent reliability (10,16). Reliability analysis using Cronbach\\u0026rsquo;s \\u0026alpha; in this study showed low reliability of 0.595 for structured viva-voce and moderate reliability for traditional (0.626) and hybrid viva-voce method (0.663) (\\u003cstrong\\u003eTable 5).\\u003c/strong\\u003e Only hybrid viva-voce Cronbach \\u0026alpha;\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003ereached the threshold value of \\u0026gt;0.7. In comparison, the hybrid viva-voce consistently demonstrated higher correlation coefficients and reliability than the structured and traditional formats, suggesting that it may be a more effective assessment method or that examiners\\u0026rsquo; grading aligns more closely in this format. One-way random interclass correlation coefficient (ICC) (\\u0026lt;0.5 poor, 0.5-0.75 moderate, \\u0026gt;0.75 good reliability) was slightly higher for hybrid when compared to structured or traditional viva-voce, indicating higher inter rater(inter-examiner) consistency and reliability (\\u003cstrong\\u003eTable 5)\\u003c/strong\\u003e. These findings highlight the potential of the hybrid viva voce in reducing inter-examiner variability while ensuring consistent and comprehensive evaluation.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFeedback analysis:\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe students\\u0026apos; feedback was taken as the quantitative Likert scaling and open-ended qualitative questions. In the study, 16% of students expressed a preference for the traditional viva-voce format, while 28% favored the structured viva-voce and the majority of students (56%) preferred a hybrid approach that combined elements of both assessment methods \\u003cstrong\\u003e(Figure 2).\\u003c/strong\\u003e Quantitative feedback was collected using a Likert scale to evaluate structured and traditional viva-voce formats across various parameters. A significantly higher percentage of students rated the structured viva voce positively compared to the traditional viva voce, particularly in aspects such as content coverage and clarity of objectives \\u003cstrong\\u003e(Figure 3).\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 6: Qualitative feedback analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"660\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 285px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eStrengths\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 276px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLimitations\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eStructured viva-voce\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 285px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eObjectivity and fairness:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003eHelps consistent and unbiased marking.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eConsistency of questions helps students to prepare and perform better.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eQuestions from all topics, hence better coverage of topics.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eConsistency on questioning by all examiners\\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003cp\\u003eHelps build \\u003cstrong\\u003estudent confidence\\u003c/strong\\u003e by focusing on well-defined topics\\u003c/p\\u003e\\n \\u003cp\\u003eCompletes in equal time frame for all\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 276px;\\\"\\u003e\\n \\u003cp\\u003eHigher preparation time for faculty\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRigid \\u0026amp; less flexible:\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003eLow scope for exploring topics beyond the listed questions\\u003c/li\\u003e\\n \\u003cli\\u003eUnprepared students lose marks easily\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eProvides efficacy but is not ideal for assessing deeper understanding\\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTraditional viva-voce\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 285px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFlexibility:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003eEncourages underprepared students to answer questions\\u003c/li\\u003e\\n \\u003cli\\u003eEncourages prepared students to assess depth of Knowledge; broader preparation is encouraged.\\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003cp\\u003eLower chances of cheating\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003eCompletes in a \\u003cstrong\\u003eshorter time\\u003c/strong\\u003e frame\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 276px;\\\"\\u003e\\n \\u003cp\\u003eUnpredictable hence causes anxiety among students\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eExaminer variability:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003eInconsistency in covering broader range of topics\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eStudents worry about examiner-specific questions (Pet Questions)\\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003cp\\u003eOption to change questions can cause an \\u003cstrong\\u003euneven\\u003c/strong\\u003e assessment process\\u003c/p\\u003e\\n \\u003cp\\u003eLack of structure causes \\u003cstrong\\u003eunfairness\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eQualitative feedback was also analyzed from open-ended questions regarding the perceived advantages and disadvantages of both formats. Students highlighted that the structured viva voce\\u0026apos;s primary advantages were its objectivity and fairness, although its rigidity was identified as a drawback. Conversely, the traditional viva-voce was appreciated for its flexibility, but students noted examiner-to-examiner variability as a significant disadvantage \\u003cstrong\\u003e(Table 6\\u003c/strong\\u003e). The feedback from the faculty revealed the strengths of the method, as consistency in questioning patterns, and limitations, such as the higher preparation time for conducting the assessment sessions. Fairness was the most common word used for structured viva and flexibility was the most common word for traditional viva.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, viva-voce assessment methods were analyzed to evaluate inter-examiner consistency, variation, and check transparency and fairness in the scoring system. The qualitative and quantitative data obtained from the study were complementary to each other. Quantitative data were analyzed through descriptive statistics, correlation analysis, reliability analysis, and Likert scale for feedback, while qualitative insights were gathered through open-ended feedback questions from students and faculty.\\u003c/p\\u003e\\n\\u003cp\\u003eStructured viva-voce, as supported by examiners in this study and consistent with findings by Gor et al.\\u0026nbsp;(17), has the potential to reduce scoring bias through carefully selecting questions targeting the cognitive domains of Bloom\\u0026apos;s taxonomy, including knowledge, comprehension, application, and analysis. However, our findings revealed similar mean values as seen in study by Shaikh et al\\u0026nbsp;(18), low consistency in scoring between examiners for both structured and traditional viva-voce, with statistically significant differences in scores across different sets of examiners. These results align with those reported by Khilnani et al\\u0026nbsp;(19). In contrast, the hybrid mode of assessment demonstrated statistically significant differences in scoring between two examiners evaluating the same student only in set 1, highlighting its potential for improved consistency. However, the reduction in variation and improved reliability due to averaging the scores for both structured and traditional assessments cannot be overlooked. Further studies involving the randomization of students into different groups and a detailed comparison of scoring differences between examiners could provide clearer insights.\\u003c/p\\u003e\\n\\u003cp\\u003eAs observed by Gor et al.\\u0026nbsp;(17), correlation analysis in this study showed statistically significant associations across all three assessment methods: structured, traditional, and hybrid modes. However, unlike the findings of Suwarna et al.\\u0026nbsp;(16,20), reliability analysis in our study showed low reliability, primarily attributed to scoring variations with set 1 examiners.\\u0026nbsp;While our study focuses on psychometric indicators such as Cronbach\\u0026rsquo;s alpha and ICC to assess interrater reliability, we acknowledge that validity encompasses more than statistical consistency.\\u0026nbsp;Addressing the variations through intensive examiner training in assessment strategies, calibration sessions to standardize questions, along with mock practice sessions for students could enhance reliability and effectiveness in the future as suggested by Kane\\u0026nbsp;(6,17,21)\\u0026nbsp;The absence of examiner scripting by design in traditional viva is a known threat to scoring and generalization validity. In contrast, structured and hybrid formats, by using prompts and rubrics, better support consistent interpretation and use of scores.\\u003c/p\\u003e\\n\\u003cp\\u003eQuantitative feedback analysis using a Likert scale demonstrated a clear preference for structured viva-voce and the hybrid mode over the traditional assessment method. Structured viva-voce received favorable ratings across all measured parameters compared to traditional viva-voce, aligning with findings from Shenwai et al\\u0026nbsp;(22). Content analysis for qualitative feedback data revealed distinct perceptions of traditional and structured viva-voce methods among students and faculty. Students viewed the traditional viva-voce as flexible, with lower chances of cheating, and quicker to complete. However, they highlighted significant drawbacks, including unpredictability, higher examiner variability, and pressure to anticipate faculty-specific \\u0026quot;pet\\u0026quot; questions. The option for examiners to change questions at a student\\u0026rsquo;s request was noted to have the potential for biased marking and unfair assessments. In contrast, the structured viva-voce was appreciated for its objectivity, fairness, predictability, and focus on well-defined topics, enabling students to prepare effectively and achieve higher satisfaction due to broader topic coverage. However, students noted its rigidity, which could be discouraging for weaker candidates, and its inability to assess deeper understanding. \\u0026ldquo;Equality for all students irrespective of any teacher\\u0026rdquo; \\u0026ldquo;No feeling of only certain specific questions to be asked by each of the faculties.\\u0026rdquo; Were few of the comments regarding structured viva \\u0026amp; \\u0026ldquo;Teacher can decide what level of questions to ask from whom\\u0026rdquo; \\u0026ldquo;Low chances of cheating\\u0026rdquo; \\u0026ldquo;Flexibility\\u0026rdquo; were the comments for traditional viva.\\u003c/p\\u003e\\n\\u003cp\\u003eThe examiners opined that structured viva voce required more preparation time, which could be a deterrent. Nevertheless, they emphasized that if standardized could enable unbiased, systematic assessment fostering critical evaluation of students\\u0026apos; knowledge and skills.\\u003c/p\\u003e\\n\\u003cp\\u003eTo the best of our knowledge, no prior studies have specifically evaluated the effectiveness of the hybrid mode of assessment. Our findings reveal that the hybrid mode offers statistically significant advantages, including superior inter-examiner consistency, reduced bias, and better correlation. Notably, it emerged as the preferred assessment method among students. This innovative approach combines the structured evaluation of a standardized viva with the flexibility of the traditional method, ensuring unbiased assessments while allowing for a deeper analysis of students\\u0026apos; understanding and covering a broader range of topics. Additionally, the hybrid mode mitigates anxiety and fear associated with examiner-related variations in scoring by fostering transparency and fairness. Its ability to blend objectivity with adaptability makes it a promising model for comprehensive and equitable evaluation in medical education.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLimitations of the study:\\u003c/strong\\u003e The study\\u0026apos;s findings may be influenced by the single centric, specific context and the chosen subject, limiting their generalizability to all medical education settings. Additionally, the longer preparation time required for faculty may restrict the widespread adoption of this method. However, once established, the standardized structured viva material can be utilized consistently in subsequent assessments.\\u003c/p\\u003e\\n\\u003cp\\u003eStudents underwent assessments by two different examiners, thereby prolonging their evaluation time. Since neither randomization nor a crossover design was implemented, and both viva techniques were conducted in quick succession, faculty scoring may have been influenced by prior responses. Two examiners observing and scoring a single examination process could have given a better understanding of interrater consistency. While the hybrid mode appeared to be well-received by advanced learners\\u0026mdash;allowing them to answer structured viva questions rapidly while elaborating on concepts in the traditional viva\\u0026mdash;the observed statistical significance may have been influenced by the larger sample size rather than a true advantage of the method.\\u003c/p\\u003e\\n\\u003cp\\u003eFaculty feedback was collected through Microsoft forms, but better documentation could be achieved through recorded interview sessions for in-depth discussion. Lastly, improving the design of viva cards and providing intensive examiner training could enhance consistency and reliability in scoring across different evaluators.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eOverall, the hybrid format emerged as the most effective assessment method, offering enhanced reliability and student satisfaction by addressing the shortcomings of both individual formats. These findings suggest the potential of hybrid viva-voce in fostering a consistent and comprehensive evaluation framework. It can be implemented in medical colleges by integrating structured with traditional assessments, ensuring standardization, reducing examiner variation, and enhancing comprehensive evaluation of students\\u0026apos; clinical reasoning and knowledge. The well-structured questionnaire can improve inter-rater reliability. Further studies are warranted to support the hybrid model as an effective and reliable viva-voce assessment method. We shall plan to collaborate with other institutions to adopt a multicentric and multidisciplinary approach.\\u0026quot;\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eFinancial support\\u003c/strong\\u003e: Nil\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of Interest:\\u003c/strong\\u003e There was no conflict of interest.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u0026nbsp;\\u003c/strong\\u003eI acknowledge all my students for voluntarily participating in our study. I am thankful to Mr. Krishna Mohan Tiwari, Mrs. Kavita Verma, Mrs. Veena Devi, Ms. Nilima Ojha \\u0026amp; Mr. Anthony for their contribution to my study. Lastly, I thank the institution for supporting my study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical Trail Number: Not applicable\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate:\\u003c/strong\\u003e The study adhered to \\u0026ldquo;Declaration of Helsinki\\u0026rdquo;. The study was approved by Institution Ethics Committee (IEC-DHR Registration EC/NEW/INST/2022/2810) of Manipal Tata medical College Jamshedpur. (Ethics approval number: MTMC/IEC/2024/67). Consent from all the participants were received.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u003c/strong\\u003e Not applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u003c/strong\\u003e We have submitted all the available data, its statistical analysis and material associated with this study\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u003c/strong\\u003e I declare that any of the authors of this study have no competing interests associated with the study or its results.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e: No funding was obtained.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"621\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003eSl no\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eAuthor names\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eContributions\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003e1\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eDr Kavita Rasalkar\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eConception and designing of the study, analysis and interpretation of the data, preparation of manuscript for publication.\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003e2\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eDr Sulekha Sinha\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eDesigning of the study, Interpretation of data, revised the draft critically, approved the version to be published. Revisions done as per reviewers suggestion.\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003e3\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eDr Sunita Tripathy\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eConduction of study and Data acquisition\\u0026nbsp;\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003e4\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eDr Bikramaditya Mukherjee\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eConduction of study and Data acquisition\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003e5\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eDr Nagamma Takkella\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eConduction of study and Data acquisition\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003e6\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eDr Elvis Vishal Dadel\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eConduction of study and Data acquisition\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003e7\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eMr Monit Sundriyal\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eData tabulation in excel\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 58px;\\\"\\u003e8\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 207px;\\\"\\u003eMs Swetanka Prasad\\u0026nbsp;\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 356px;\\\"\\u003eCross checking of tabulated data\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u003c/strong\\u003e I acknowledge all the students for voluntarily participating in the study. I am thankful to Mr. Krishna Mohan Tiwari, Mrs. Kavita Verma, Mrs. Veena Devi, Ms. Nilima Ojha \\u0026amp; Mr. Anthony for their contribution to the study. Lastly, I thank the institution for supporting the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; information\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDr Kavita Rasalkar, Professor and Head, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDr Sulekha Sinha, Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDr Sunita Tripathy, Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India\\u003c/p\\u003e\\n\\u003cp\\u003eDr Bikramaditya Mukherjee, Associate Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India\\u003c/p\\u003e\\n\\u003cp\\u003eDr Nagamma Takkella, Assistant Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India\\u003c/p\\u003e\\n\\u003cp\\u003eDr Elvis Vishal Dadel, Assistant Professor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India\\u003c/p\\u003e\\n\\u003cp\\u003eMr Monit Sundriyal, Tutor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India\\u003c/p\\u003e\\n\\u003cp\\u003eMs Swetanka Prasad, Tutor, Department of Biochemistry, Manipal Tata Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eUG-Curriculum-Vol-I.pdf [Internet]. [cited 2024 Jul 27]. Available from: https://www.nmc.org.in/wp-content/uploads/2020/01/UG-Curriculum-Vol-I.pdf\\u003c/li\\u003e\\n\\u003cli\\u003eBasheer A. Impact of assessment of medical students in India on assuring quality primary care. Australas Med J. 2015 Feb 28;8(2):67\\u0026ndash;9. \\u003c/li\\u003e\\n\\u003cli\\u003eEpstein RM. Assessment in Medical Education. Cox M, Irby DM, editors. N Engl J Med. 2007 Jan 25;356(4):387\\u0026ndash;96. \\u003c/li\\u003e\\n\\u003cli\\u003eBoud D. Assessment and Learning: Contradictory or Complementary? In: Assessment for Learning in Higher Education. Routledge; 1995. \\u003c/li\\u003e\\n\\u003cli\\u003eDhasmana DC, Bala S, Sharma R, Sharma T, Kohli S, Aggarwal N, et al. Introducing structured viva voce examination in medical undergraduate pharmacology: A pilot study. Indian J Pharmacol. 2016 Oct;48(Suppl 1):S52\\u0026ndash;6. \\u003c/li\\u003e\\n\\u003cli\\u003eAnbarasi K, Karunakaran J, Ravichandran L, Arthi B. Effectiveness of the Structured and Conventional Methods of Viva Examination in Medical Education: A Systematic Review and Meta-analysis. J Clin Diagn Res [Internet]. 2022 [cited 2024 Jul 27]; Available from: https://www.jcdr.net//article_fulltext.asp?issn=0973-709x\\u0026amp;year=2022\\u0026amp;volume=16\\u0026amp;issue=9\\u0026amp;page=JE01\\u0026amp;issn=0973-709x\\u0026amp;id=16977\\u003c/li\\u003e\\n\\u003cli\\u003eAnurag Agarwal, Bipin Batra, AK Sood. Evolutionary trends in radiology assessment: The importance of the learning cycle and its assessment in radiology. \\u003c/li\\u003e\\n\\u003cli\\u003eSilva V de, Hanwella R, Ponnamperuma G. The validity of oral assessment (viva) that assesses specific and unique competencies in a post-graduate psychiatry examination. Sri Lanka J Psychiatry [Internet]. 2013 Jan 13 [cited 2024 Dec 16];3(2). Available from: https://sljpsyc.sljol.info/articles/10.4038/sljpsyc.v3i2.5133\\u003c/li\\u003e\\n\\u003cli\\u003eImran M, Doshi C, Kharadi D. Structured and unstructured viva voce assessment: A double-blind, randomized, comparative evaluation of medical students. Int J Health Sci. 2019;13(2). \\u003c/li\\u003e\\n\\u003cli\\u003eAbuzied AIH, Nabag WOM. Structured viva validity, reliability, and acceptability as an assessment tool in health professions education: a systematic review and meta-analysis. BMC Med Educ. 2023 Jul 25;23(1):531. \\u003c/li\\u003e\\n\\u003cli\\u003eTutton PJM, Glasgow EF. Reliability and predictive capacity of examinations in anatomy and improvement in the reliability of viva voce (oral) examinations by the use of a structured rating system. Clin Anat. 1989;2(1):29\\u0026ndash;34. \\u003c/li\\u003e\\n\\u003cli\\u003eThomas CS, Mellsop G, Callender K, Crawshaw J, Ellis PM, Hall A, et al. The oral examination: a study of academic and non-academic factors. Med Educ. 1993 Sep;27(5):433\\u0026ndash;9. \\u003c/li\\u003e\\n\\u003cli\\u003eOakley B, Hencken C. Oral examination assessment practices: effectiveness and change within a first year undergraduate cohort. J Hosp Leis Sport Tour Educ. 2005 Apr;4(1):3\\u0026ndash;14. \\u003c/li\\u003e\\n\\u003cli\\u003eAhsan M, Mallick A. A Study to Assess the Reliability of Structured Viva Examination over Traditional Viva Examination among 2nd‑Year Pharmacology Students. J Datta Meghe Inst Med Sci Univ. 2022 Nov 5;17:589\\u0026ndash;94. \\u003c/li\\u003e\\n\\u003cli\\u003ejamovi - open statistical software for the desktop and cloud [Internet]. [cited 2024 Apr 17]. Available from: https://www.jamovi.org/\\u003c/li\\u003e\\n\\u003cli\\u003eSuwarna Madhukumar, Pavithra M B, Amrita Ns. Conventional Viva and Structured Viva \\u0026mdash; Comparison and Perception of Students. Indian J Public Health Res Dev. 2022 Apr 12;13(2):167\\u0026ndash;72. \\u003c/li\\u003e\\n\\u003cli\\u003eGor S, Budh D, Athanikar B. Comparison of conventional viva examination with objective structured viva in second year pathology students. Int J Med Sci Public Health. 2014;3(5):537. \\u003c/li\\u003e\\n\\u003cli\\u003eShaikh ST. Objective Structured Viva Examination Versus Traditional Viva Examination in Evaluation of Medical Students. Anat Physiol [Internet]. 2015 [cited 2024 Jul 27];05(03). Available from: https://www.omicsonline.org/open-access/objective-structured-viva-examination-versus-traditional-viva-examination-inevaluation-of-medical-students-2161-0940-1000175.php?aid=53387\\u003c/li\\u003e\\n\\u003cli\\u003eKhilnani AK, Charan J, Thaddanee R, Pathak RR, Makwana S, Khilnani G. Structured oral examination in pharmacology for undergraduate medical students: Factors influencing its implementation. Indian J Pharmacol. 2015 Oct;47(5):546. \\u003c/li\\u003e\\n\\u003cli\\u003eGanji KK. Evaluation of Reliability in Structured \\u003cem\\u003eViva Voce\\u003c/em\\u003e As a Formative Assessment of Dental Students. J Dent Educ. 2017 May;81(5):590\\u0026ndash;6. \\u003c/li\\u003e\\n\\u003cli\\u003eSireci S. On Validity Theory and Test Validation. Educ Res. 2007 Nov 1;36. \\u003c/li\\u003e\\n\\u003cli\\u003eShenwai MR, B. Patil K. Introduction of Structured Oral Examination as A Novel Assessment tool to First Year Medical Students in Physiology. J Clin Diagn Res JCDR. 2013 Nov;7(11):2544\\u0026ndash;7. \\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-medical-education\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"meed\",\"sideBox\":\"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/meed/default.aspx\",\"title\":\"BMC Medical Education\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Structured Viva voce, Traditional Viva voce, Hybrid viva-voce, Formative Assessment, summative assessment, Examiner, Evaluator, Students’ performance, Examination, inter examiner consistency, mitigation of Bais, Medical education, Biochemistry, Oral examination, competency, NMC, CBME 2019\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5669110/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5669110/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e Medical students' skills and knowledge have traditionally been assessed through written and oral examinations (viva-voce). Structured viva-voce is an objective structured method to orally assess students. As an assessment tool it was used informally since 1989, however it was publicized by describing it separately by Oakley and Hencken in 2005. Hybrid method is combination of both structured and traditions viva-voce methods\\u003c/p\\u003e\\n\\u003cp\\u003eThis study aims to assess the methods for inter-examiner consistency to minimize variations in scoring during viva-voce. It further investigates medical students' perceptions regarding the fairness, transparency, and overall experience of the assessment formats: structured viva-voce, traditional viva-voce, and hybrid method. By examining these perspectives, the study seeks to provide insights into optimizing viva-voce methods for improved reliability and student satisfaction.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods: \\u003c/strong\\u003eOral assessment was scheduled. Validated structured viva-voce cards, based on Bloom’s taxonomy and expert-reviewed, were prepared. Each student underwent a 5-minute structured viva using two different card sets, followed by a 5-minute traditional viva conducted by both examiners. A hybrid format included combining both methods. Feedback was obtained through a mixed questionnaire with quantitative (Likert scale) and qualitative (open-ended) items on the examination methods.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults and conclusion:\\u003c/strong\\u003e The study evaluated variation in scoring between 2 examiners for three viva-voce formats: structured, traditional, and hybrid (a combination of both traditional and structured) among 151 students with 53.6% females and 46.3% males. The Wilcoxon signed rank test revealed significant inter-examiner variability in structured viva-voce and Set 2 of traditional viva-voce (p \\u0026lt; 0.05), while the hybrid method showed better consistency between examiners. Pearson correlation and reliability analyses indicated that the hybrid viva-voce demonstrated higher inter-examiner consistency, correlation coefficients, and reliability (ICC and Cronbach’s α = 0.663) compared to structured and traditional formats, suggesting it may be a more effective assessment method. Feedback revealed that 56% of students preferred the hybrid format for its balance of objectivity and flexibility. While structured viva-voces excelled in fairness and coverage, traditional viva-voces were appreciated for flexibility but suffered from inconsistency.\\u003c/p\\u003e\\n\\u003cp\\u003eOverall, the hybrid format emerged as the effective assessment method, offering enhanced reliability and student satisfaction by addressing the shortcomings of both individual formats. 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