Student Performance in Medical Biochemistry and Genetics: Comparing Campus-based versus Zoom-based Lecture Delivery

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Ritchie, Katherine M. Ruger, Kirsten L. Waarala, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1716900/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: Study objectives were to appraise the effectiveness of Zoom delivery versus live campus-based delivery of lectures in biochemistry and genetics courses and assess the integrity of remote versus campus administered exams. Methods: Participants were 601 students entering Michigan State University College of Osteopathic Medicine in 2019 or 2020. The former completed courses and exams on campus, while the latter completed courses online due to the COVID-19 pandemic. For the biochemistry and genetics courses, the same lecturers delivered the same content and used identical exam questions for assessments in 2019 and 2020. The investigators compared percent correct for each question in 2019 and 2020. Results: This study found 84/126 (~67%) of the questions yielded little difference (3% or less in % Correct) between live delivery and Zoom delivery. For questions whose % Correct index differed by 4% or more, Zoom delivery yielded a better performance for 16 questions (~13%), while 19 questions (~15%) showed live lectures performed better. Seven of the questions (~6%) had an identical mode of delivery in 2019 and 2020 (e.g. self-study exercise). These served as “control questions” for which equivalent student performance was expected. The 126 questions analyzed spanned a wide range in the % Correct index, from ~60% Correct to >90% Correct. Conclusions: The results suggest that Zoom and on-campus delivery of the content in biochemistry and genetics yielded similar achievement of course objectives. The high concordance, between 2019 and 2020, of the % Correct for individual questions also speaks to exam integrity including online proctoring. online learning medical school biochemistry genetics Figures Figure 1 Figure 2 Figure 3 Background The COVID-19 pandemic and the ensuing requirements for social distancing have provoked a sea-change in medical education in the pre-clerkship years: transition to remote learning (online lectures and small-group interactions) and adaptation of testing environments for assessment. A plethora of ideas and description of actual practices have been put forth to convert curricula to online learning and administer exams remotely. 1 , 2 There are descriptions, for example, on a “Quarantine Curriculum”, 3 a student-led development of a “COVID-19 Curriculum”, 4 as well as discussions on the role of medical students’ government 5 and opportunities to make changes to the assessment of outcomes. 6 Some consequences of these changes, necessitated by the pandemic, have recently been analyzed and reported, mostly in terms of surveys. 7 , 8 , 9 When the pandemic hit in the spring of 2020, Michigan State University College of Osteopathic Medicine (MSUCOM) changed its campus-based lecture delivery to virtual delivery of lectures via Zoom webinars or meetings. The instructional team for two courses in biochemistry and molecular biology (BMB) recognized the unique opportunity to compare the effectiveness of the two modes of content delivery: face-to-face versus online. The team made a conscious decision to maintain the same lecturers delivering the same content and used identical exam questions to assess the same content so that student performance on individual assessment items can be compared. While the transition to online was a necessity due to the pandemic, there may be positive aspects of online learning to consider and perhaps adopt to some extent even after the pandemic. 10 The researchers wished to determine whether online learning was as effective as traditional models. Prior studies on comparing face-to-face on-campus versus virtual/online delivery of content have yielded mixed results. On the one hand, several studies have touted that e-learning yielded superior outcomes than campus-based classroom sessions. For example, Lockyer et al . 11 reported that, in measured outcomes related to HIV/AIDS, collaborative activities were more effective in the Web-based learning than in the face-to-face environment. In addition, Zhang 12 found that students in an interactive e-learning environment achieved better performance than those in a traditional classroom. More recently, Pickering 13 reported that the introduction of an anatomy eBook enhanced assessment outcomes for those students who were in the lowest quartile but not in the other quartile groups. On the other hand, there have also been results that favored the traditional campus-based classrooms. In a rigorous, quantitative study by Figlio et al ., 14 students in an introductory microeconomics course were randomly assigned to attending live lectures versus watching the same lectures in an online setting. They report that the traditional lecture instruction yielded better test results than the internet instruction. Similarly, Arias et al . 15 reported that when students were randomly assigned to either an online or face-to-face section of the same course and then compared in terms of course exam average and pre- versus post-tests, the face-to-face students performed better than the online students in a statistically significant manner. Finally, there is yet another group of studies that suggest no difference in the two learning formats in several measures of learning outcomes. 16 , 17 In the present communication, we report the analysis of first-year medical students’ performance in terms of the degree of difficulty of individual assessment items. The comparison was made to determine the effect, if any, of Zoom-based delivery of lectures in 2020 relative to campus-based delivery of the same content in 2019. The data and analysis may be of interest to students, faculty, and administrators who experienced the pandemic as well as those involved in post pandemic curriculum development. Methods Subjects This study compared the exam performance of first-year medical students in biochemistry (BMB 516; Semester 1) and in molecular biology and genetics (BMB 528; Semester 2) at MSUCOM. The comparison was made to determine the effect, if any, of virtual (Zoom-based) delivery of lectures necessitated by the Covid-19 pandemic in 2020 for the Class of 2024, relative to campus-based lecture delivery in 2019 for the Class of 2023. Admissions data for the two classes are displayed in Table 1 . Table 1 Admissions data for the Classes of 2023 and 2024 at MSU COM Class of 2023 (2019) Class of 2024 (2020) Number of students 301 300 Mean GPA a \(\pm\) STDEV b 3.63 \(\pm\) 0.26 3.66 \(\pm\) 0.24 Mean Science GPA \(\pm\) STDEV 3.58 \(\pm\) 0.29 3.61 \(\pm\) 0.26 Mean MCAT c \(\pm\) STDEV 505 \(\pm\) 4 506 \(\pm\) 4 MCAT – CARS d \(\pm\) STDEV 125 \(\pm\) 2 125 \(\pm\) 2 MCAT – CPBS e \(\pm\) STDEV 126 \(\pm\) 2 126 \(\pm\) 2 MCAT – BBFL f \(\pm\) STDEV 127 \(\pm\) 2 126 \(\pm\) 2 a GPA --- grade point average earned for the undergraduate degree; b \(\pm\) STDEV --- standard deviation of the mean; c MCAT --- Medical College Admission Test; d CARS --- Critical Analysis and Reasoning Skills; e CPBS --- Chemical and Physical foundations of Biological Systems; f BBFL --- Biological and Biochemical Foundations of Living systems Each year, the entering class consisted of ~ 300 students: (a) ~ 200 located at the East Lansing (EL) site; (b) ~ 50 at Detroit Medical Center (DMC) site; and (c) ~ 50 at Macomb University Center (MUC). All three sites have an identical curriculum. Ethics Approval : The Michigan State University Institutional Review Board on Human Subjects has approved this study (IRB number 00005873). Lecture Delivery In both years, Semester 1 spanned 9 weeks from June 15 through August 14; BMB 516 was a 1-credit course (a combination of ~ 12 lectures and ~ 5 activity sessions), taught alongside an 8-credit anatomy course and a 1-credit epidemiology and biostatistics course. In both years, BMB 528 (2-credit course consisting of a combination of ~ 29 lectures and 3 activity sessions) spanned the first eight weeks of Semester 2, during which pathophysiology, immunology, and microbiology courses were also ongoing. In 2019, the mode of lecture delivery was in campus-based classrooms. Each live lecture had a point of origination (e.g. DMC) in which students were physically in the classroom with the lecturer (see Additional file 1). At the non-origination sites (e.g. EL and MUC), students watched the lecture via Polycom video conferencing in real time. There is a faculty member in each of the non-origination site classrooms who can direct questions/discussion to the lecturer or to whom students can direct questions following the session. It should be emphasized that, despite the fact of being “remote from the lecturer,” students at non-origination sites were physically in the classroom with their peers, along with a content expert faculty. More importantly, both internal course grades (see Additional file 2) as well as external metrics such as performance on national licensure exams (COMLEX Level 1) 18 indicate no statistically significant differences in outcome measures between site-of-origin and receiving sites. In 2020, the Covid-19 pandemic necessitated the switch to lecture delivery via Zoom webinars. To the extent possible, we maintained the same lecturers delivering the same content with very minor exceptions. In addition to the lecturer, we staffed each webinar (lecture session) with another faculty member to: (a) bring any major point of misunderstanding or technical issue to the attention of the lecturer; and (b) triage questions from students submitted through the Q&A function of Zoom, to be addressed at appropriate junctures during the session or just before the end of the session. Class Attendance and Access to Lecture Recordings Since 2014, the instructional team in BMB has been engaged in a project to increase class attendance and engagement by rewarding real-time responses to i > clicker questions (if they get one correct) during class sessions that can contribute up to 2.4% of the points counting toward the final course grade. The number of students responding to i > clicker questions was used to track attendance for BMB 528 in 2019. Zoom webinar attendance for BMB 516 and BMB 528 in 2020 was tracked by the unique views in the Zoom Attendee Report which was pulled out after the lecture. The lectures in the BMB courses were recorded and students can asynchronously access these recordings in the MediaSpace repository on an on-demand basis. In 2019, the recordings were a part of the Polycom broadcast between the three sites; in 2020, the recordings were made as a part of the Zoom webinar. In conjunction with the i > clicker project, we also monitored the frequency that the recording of a particular lecture was being accessed for viewing. Examinations : During the first two semesters at MSUCOM, students are assessed at regular intervals (2–4 weeks) and each exam contained assessment items from more than one course; the number of questions in an exam reflected the number of sessions of a particular course during that period. In the two BMB courses, individual questions were generated by faculty members and tagged with instructional objectives. After vetting by the course instructional team, the Course Coordinator enters the questions into the secure assessment platform ExamSoft ( https://examsoft.com/ ). The Semester Director then assembles an exam from the question pool, and it is vetted a second time by the Course Coordinators that have content in that exam. ExamSoft allows for secure computer-based testing. In 2019, the exams were conducted in on-campus classrooms with identification verification, in-person proctoring and other security measures (checking pockets etc.). In 2020, the exams were conducted “at home” using ExamMonitor for remote proctoring. ExamSoft reports an item analysis of the questions used in a particular examination. In this report, we focused on the “% Correct” parameter as an indicator of the degree of difficulty of the question; the lower the value of % Correct, the more difficult the question was for the students. Statistical Analysis of the Data : Class averages, standard deviations, and standard error of the mean were calculated using the Microsoft Excel spreadsheet software. Chi-square analyses were carried out using the statistical analysis program available online ( https://www.socscistatistics.com/tests/chisquare2/default2.aspx ). Results Item Analysis of Examination Questions in 2019 and 2020 In 2019, we delivered lectures in on-campus classrooms; in 2020, we delivered them virtually via Zoom webinars. The same lecturers delivered the same content with very minor exceptions, and we used identical exam questions to assess the same content. For each question, we compared the % Correct in the item analysis report. There were 159 total questions in six exams of the two BMB 516 and BMB 528 courses (last column, Table 2 ). Some of the questions in each examination did not lend themselves to a direct comparison, either because of a slight change in wording necessitated from student feedback in 2019 or because the mode of delivery did not involve lectures. These questions were grouped under “Other” (Column 6) in Table 2 . We compared student performance in 2019 versus 2020 for 126 questions, accounting for ~ 80% of the examination questions used in both years (“Number Compared”, Table 2 ). Table 2 Summary of the number of questions in various categories when 2019 exams were compared with 2020 exams a Exam Category I (control questions) Category II 3% or less difference Category III 4% or more 2019 2020 Other Number Compared Total Number BMB 516, Exam 1 1 15 3 4 10 23 33 BMB 516, Exam 2 0 19 4 4 6 27 33 BMB 528, Exam 1 0 16 3 2 0 21 21 BMB 528, Exam 2 2 14 1 3 4 20 24 BMB 528, Exam 3 3 12 1 3 5 19 24 BMB 528, Exam 4 1 8 4 3 8 16 24 Total 7 84 16 19 33 126 159 a In 2019, lectures were delivered in on-campus classrooms; in 2020, lectures were delivered virtually via Zoom webinars. In Categories I – IV, identical questions were used to assess the same content. Category I --- The mode of delivery of content examined in these questions was identical in 2019 and 2020 (e.g. via assigned reading material or self-study exercise). These served as our Control Questions. Category II --- There was a difference of 3% or less in % Correct between 2019 and 2020. Category III --- There was a difference of 4% or more in % Correct, with 2020 Zoom delivery showing a better performance or higher % Correct than 2019 on-campus delivery (2019 2020). Other --- Questions for which performance in the two years cannot be easily compared, either because of a change in the wording of a particular question or because the mode of content delivery was altered (e.g. a self-study exercise in 2019 was replaced by a lecture in 2020). For seven of the questions we analyzed, the mode of delivery of content was identical in 2019 and 2020 (e.g. assigned reading or self-study exercise); these served as our “control questions” (Category I, Table 2 ) for which we expected student performance to be the same from year to year. Indeed, the % Correct was within 3% of each other for six of these questions. One question yielded 57% Correct in 2019 versus 68% Correct in 2020, representing the lone exception. The standard error of the mean for % Correct of all 14 control questions (seven from each year) was 3.63. Since the standard error of the mean represents a measure of the dispersion of a sample around the population mean (how much variation you expect by random sampling of the population), we used 3% difference as the criterion in the groupings described below. We found 84/126 (~ 67%) of the questions showed little/no difference (a difference of 3% or less in % Correct) between live campus-based delivery (2019) and Zoom delivery (2020). These were grouped into Category II in Table 2 . The questions in Category II constitute a majority of the questions in any exam, across all six exams in the two courses and therefore, spanned the entire range of scientific content of the two courses (Table 2 ). Moreover, the questions encompass, in terms of Bloom’s taxonomy, both the recall/remembering type as well as questions of higher levels of cognition involving understanding, analysis, and application. The questions in this category span a wide range in terms of the % Correct index (Fig. 1), with ~ 45% of them in the < 90% Correct range. The histogram distributions for 2019 and 2020 look very similar; this conclusion is supported by a chi-square analysis, which showed that the two distributions were not significantly different ( p = 0.9534). We divided those questions in which the % Correct index differed by 4% or more between 2019 and 2020 into two categories (Table 2 ). There were 16 questions (~ 13%) that showed better performance in 2020 than in 2019. In other words, a Zoom delivery yielded a higher % Correct in each of the questions in Category III. On the other hand, there were 19 questions (~ 15%) that showed better performance in 2019 than in 2020. In other words, campus-based delivery yielded a higher % Correct in these questions in Category IV. The number of questions in Categories III and IV essentially balance each other out across all six exams and therefore, the delivery method (campus-based versus Zoom-based) did not differentially impact any particular topic of scientific content. Together with the large fraction of questions in Category II, showing little/no difference between 2019 and 2020, these results suggest that conversion of lecture delivery from campus-based classrooms to Zoom webinars online did not significantly affect student learning and performance. Class Characteristics and Student Performance, 2019 versus 2020 The first-year students entering MSUCOM in 2019 (Class of 2023) and in 2020 (Class of 2024) presented with equivalent academic credentials (Table 1 ). Both the overall undergraduate GPA as well as the GPA in science courses were within a standard deviation of each other. Similarly, there was no significant difference in terms of the composite MCAT scores and in terms of specific MCAT categories such as Critical Analysis and Reasoning Skills. Consistent with these data on entry into medical school, the two classes performed comparably in the early exams of their respective first two semesters (Table 3 ). Two key considerations regarding exams and the grading system at MSUCOM may be important in terms of this table: (a) Each exam contained assessment items from concurrent courses during the semester; the number of questions in an exam reflected the number of sessions of a particular course during that period. (b) MSUCOM used a P/N (pass/no-pass) grading system with 70% as the minimum required for passing the BMB courses. When considering questions derived from the BMB course only, campus-based delivery in 2019 yielded a slightly higher class average for five of the six exams compared to Zoom delivery in 2020, although the class averages for each of the corresponding exams in the two years were within 3 percentage points of each other (Table 3 , Part A). This is counterbalanced by the observation that, in terms of the overall exam covering all content, the class averages were higher in 2020 (Zoom-based delivery) than in 2019 (campus-based delivery) (Table 3 , Part B). It is possible that, in the P/N grading system, students felt comfortable in terms of the number of points they had in the BMB course such that more study or attention was devoted to the content of the other concurrent course(s). Table 3 Summary of the class averages on exams: BMB and all content questions Exam 2019 2020 A) BMB Content Only a BMB 516, Exam 1 81 \(\pm\) 11 84 \(\pm\) 11 BMB 516, Exam 2 87 \(\pm\) 8 85 \(\pm\) 9 BMB 528, Exam 1 81 \(\pm\) 10 80 \(\pm\) 10 BMB 528, Exam 2 86 \(\pm\) 9 85 \(\pm\) 8 BMB 528, Exam 3 86 \(\pm\) 9 84 \(\pm\) 9 BMB 528, Exam 4 82 \(\pm\) 10 81 \(\pm\) 10 B) All Content b Semester 1, Exam 1 78 \(\pm\) 10 84 \(\pm\) 9 Semester 1, Exam 2 83 \(\pm\) 7 86 \(\pm\) 7 Semester 2, Exam 1 85 \(\pm\) 8 84 \(\pm\) 9 Semester 2, Exam 2 84 \(\pm\) 8 85 \(\pm\) 7 Semester 2, Exam 3 84 \(\pm\) 8 87 \(\pm\) 8 Semester 2, Exam 4 83 \(\pm\) 8 84 \(\pm\) 8 a Each exam contained assessment items from more than one course; part A analyzed questions from the BMB course. The data are expressed as class average (in %) \(\pm\) standard deviation. b Part B provides the class average covering all questions in a particular exam, one part of which contained the BMB questions analyzed in part A. The data are expressed as class average (in %) for the entire exam. This notion is supported by comparing the histogram distribution of the number of students in a particular interval of the percent of total points counting toward the final grade (Figure 2). For both BMB courses, there were more students in the 80-84% range in 2019 while, in 2020, there were more students in the 85-89% range. As shown in Figure 2, the number of N-grades in BMB 516 was 9 in 2019 while the corresponding number in 2020 was 6; the number of N-grades in BMB 528 was 2 in 2019 while the corresponding number in 2020 was zero. Coupled with the item analysis of exam questions, these results on student performance suggest that online Zoom delivery of the content in biochemistry and genetics yielded as good, if not better, an outcome as on-campus classroom delivery. Lecture Attendance and Access to Lecture Recordings, 2019 versus 2020: Class attendance averaged between ~80% to ~90% in a course-specific and year-specific manner (data not shown). Attendance in BMB 516, 2020 averaged ~91%; this represented the first semester in medical school for the Class of 2024 and so the students were most likely curious and anxious regarding their performance. Attending classes, albeit via Zoom, represented a mechanism to see fellow classmates and the faculty. This same group of students became more familiar with medical school and their attendance in the second semester BMB 528 dropped off to ~83%. In 2019, the same BMB 528 course (second semester for Class of 2023) averaged ~91% in attendance, most likely incentivized to a large extent by the possibility of earning “clicker points” (described under Class Attendance and Access to Lecture Recordings in the Methods section). This difference in attendance may be reflected, in all four exams in the course, by the slightly higher class averages in 2019 than the corresponding scores in 2020. We have also monitored the frequency of asynchronous student access to lecture recordings (Figure 3). For BMB 516 in the first semester, student access was higher in 2020 than in 2019, again most probably reflecting that, in 2020, the students were anxious because their medical school experience had been virtual for the most part. For BMB 528 in the second semester, the frequency of access to the recordings was reversed: more in 2019 than in 2020. Discussion The key conclusion derived from the present study is that online Zoom delivery of the content in biochemistry and genetics, necessitated by the Covid-19 pandemic in 2020, yielded about the same outcome as on-campus classroom delivery in 2019. This conclusion is based on analysis, for each examination question, the % Correct index yielded by students who learned the content via the two modes of delivery. For a large fraction of the exam items analyzed, those questions with a low % Correct (high degree of difficulty) in 2019 yielded a very similar low % Correct index in 2020 while questions with a high % Correct (low degree of difficulty) in 2019 also resulted in a high % Correct index in 2020. The high concordance, between 2019 and 2020, of the % Correct index for individual questions speaks to the security of the exam questions in the ExamSoft bank. In addition, the data also lend some confidence to the ExamMonitor remote proctoring process. Most important of all, however, we believe that the data provides the basis for being especially proud of the integrity of our medical students. Together, the data and analysis reported here may provide some level of comfort to students, faculty, and academic administrators in terms of achievement of instructional objectives and integrity of scholarship during a difficult time. There are several recent reports on the effect of the pandemic on the teaching of the foundational sciences in medical education. For example, Shahrivini et al. 7 reported a survey of first- and second year medical students regarding the impact of remote learning on quality of instruction and ability to participate and on preparedness for subsequent stages of medical training. While students preferred the flexibility of learning at their own pace, many students felt isolated and less-than-connected to their classmates and medical school. On the other hand, Suneja et al 8 reported based on final scores of assessments, the learning outcomes were fully attained in terms of the first-year curriculum including anatomy, physiology, and biochemistry along with professional and personal development modules. In fact, the disruption of physical classrooms, necessitated by the pandemic, led to unanticipated benefits derived from increased use of technology, at both the faculty and student levels. Our study complements and supplements these reports by providing, on a direct item-by-item comparison basis, of individual examination questions. Reviews of the distinguishing features of online versus face-to-face delivery of content often emphasize the “asynchronous and flexible nature” of the online medium. 7 , 19 , 20 Three aspects of the present study need to be brought out in this context. First, each of the lectures in our study, in both years, were scheduled for a specific date and time. Therefore, to interact with the lecturer, a student had to attend the lecture physically in a campus classroom (2019) or attend the Zoom webinar in real time (2020). In this sense, the lectures in both years were synchronous. Second, students had access, asynchronously, to recordings of the lectures in both years. Finally, pre-COVID MSUCOM had three sites connected by Polycom video conferencing during a lecture. A student at a non-origination site attended the lecture via Polycom; alternatively, a student could also virtually watch the video live streamed via Polycom. It is important to note that Hortos et al . used external metrics, such as performance on national licensure exams (COMLEX Level 1), to show that there were no statistically significant differences in outcome measures between site-of-origin and receiving sites 18 . Moreover, we have also found that there has been no significant difference in average course grades for the BMB courses between the three sites going back to 2012 (see Additional file 2 for 2018 and 2019 and data not shown for previous years), further supporting that there were no statistically significant differences in outcome measures between site-of-origin and receiving sites. In this connection, it should also be noted that in post-course evaluations in 2020, ~ 58% of the students indicated a preference for synchronous live webinars while ~ 33% preferred asynchronous pre-recorded lectures. Despite the flexibility afforded by a pre-recorded lecture, the students wanted a scheduled event (granted, they would have access to the recording in either case). One interpretation is that these students longed for direct interactions with the faculty and their peers because they had not been able to congregate physically as a class in medical school. Two other possible deficiencies need to be brought out regarding our study. First, we recognize the difficulty in determining student engagement during lecture delivery via Zoom, particularly since the camera of each student was not turned on at any time during the session. However, even during in-person lectures, there are challenges in determining student engagement; they could be physically present in the classroom but engaged in other activities (e.g. social media or online shopping). Second, we also acknowledge that there are other aspects of in-person learning that support medical students and develop valuable skills besides the mere acquisition of biochemistry knowledge and our study does not address those skills. Even before the pandemic, there were calls for significant changes in medical education, with suggestions to overcome barriers to online learning 10 and with predictions that pre-clerkship curriculum will be delivered completely online. 21 Online learning can increase the accessibility of medical education since it could be available almost anywhere and anytime. For pre-clerkship medical curriculum, it is easy to imagine a blended model where students attend some sessions in person while others are available for the learner to complete at their own pace. This is a more student-centered approach and allows more flexibility to pursue research, community engagement and self-care. All these positive aspects of online learning argue that it should be adopted to some extent even after the pandemic. Conclusions Our present report contributes to this discussion by documenting that, in terms of assessment of scientific foundations of medical knowledge, the two modalities yielded the same outcome. The relationship between assessment and learning has been extensively discussed and argued; 22 , 23 suffice it to say that we subscribe to the view best expressed, “Assessment is good for learning and learning is good for assessment.” 24 Abbreviations MSUCOM - Michigan State University College of Osteopathic Medicine BMB – biochemistry and molecular biology EL – East Lansing MUC – Macomb University Center DMC – Detroit Medical Center Declarations Ethics and consent to participate : The Institutional Review Board at Michigan State University has approved this project (IRB# 00005873). The need for consent was waived by the IRB. Consent for publication: Not applicable Availability of data and materials : Additional Data can be accessed via Harvard Dataverse at https://doi.org/10.7910/DVN/RK7KXL Competing interests: The authors declare that they have no competing interests. Funding : This work was supported by the Office of the Associate Dean for Medical Education and by the Department of Biochemistry and Molecular Biology, College of Osteopathic Medicine, Michigan State University in the form of curricular support and publication costs. Authors’ contributions: MF made substantial contributions to the conception and design of the work, acquisition and interpretation of the data and in the revision of the work. RR made contributions to the conception and design of the work, to the acquisition, analysis and interpretation of the data and in the revision of the work. KR made substantial contributions to the acquisition and interpretation of the data and in the revision of the work. KW made substantial contributions to the interpretation of the data and in the revision of the work. CW made substantial contributions to the acquisition and interpretation of the data and in the revision of the work. Acknowledgements: The authors acknowledge the contributions of John L. Wang in the writing of this manuscript. References Woolliscroft JO. Innovation in response to the COVID-19 pandemic crisis. Acad Med. 2020;95:1140-1142. Stanton B. Medical education in the age of COVID-19 [published online ahead of print December 10, 2020]. Acad Med. doi: 10.1097/ACM.0000000000003890 Ross DA. Creating a “Quarantine Curriculum” to enhance teaching and learning during the COVID-19 pandemic. Acad Med. 2020; 95:1125-1126. Kochis M, Goessling W. Learning during and from a crisis: the student-led development of a COVID-19 curriculum [published online ahead of print September 15, 2020]. Acad Med. doi: 10.1097/ACM.0000000000003755. 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Anat Sci Educ. 2009;2:199-204. Cilliers FJ. Is assessment good for learning or learning good for assessment? A. Both? B. Neither? C. It depends? Perspect Med Educ. 2015;4:280-281. Supplementary Files FanerAdditionalfile1.docx FanerAdditionalfile2.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 28 Aug, 2022 Reviewers agreed at journal 05 Aug, 2022 Reviewers invited by journal 28 Jul, 2022 Editor invited by journal 15 Jun, 2022 Editor assigned by journal 06 Jun, 2022 First submitted to journal 01 Jun, 2022 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-1716900","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":124717475,"identity":"77d380b7-49e6-466e-8612-3e908468e24a","order_by":0,"name":"Martha Audra Faner","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYBAC9gYogx9CMRPWwnMAypBsIFmLwQGitbCfPfi4Mscu3/ja8WcSDBXWiQ0EtfDkJRue3ZZsue12jpkEw5l0wlrsGXLMJBu3MRuY3c5hk2BsO0yELfxvzH82bqs3MJ6d/kyC8R8xWiRyzBgbtx02MJBOMJNgbCBKyxtjoMOOG0jczjG2SDiWbkyEw3IMPzZuqzbgn53+8MaHGmtZglpQQQJpykfBKBgFo2AU4AIAEE85imVWdfgAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-8113-9076","institution":"Michigan State University College of Osteopathic Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Martha","middleName":"Audra","lastName":"Faner","suffix":""},{"id":124717476,"identity":"4d3107a7-341b-4d3f-9f96-c7df597df7a2","order_by":1,"name":"Raquel P. Ritchie","email":"","orcid":"","institution":"Michigan State University College of Osteopathic Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Raquel","middleName":"P.","lastName":"Ritchie","suffix":""},{"id":124717477,"identity":"49685f03-f7c2-43e8-a93e-93bd3e8bbbd1","order_by":2,"name":"Katherine M. Ruger","email":"","orcid":"","institution":"Michigan State University College of Osteopathic Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Katherine","middleName":"M.","lastName":"Ruger","suffix":""},{"id":124717478,"identity":"ead5c23c-73e6-4361-96ca-361582bfb574","order_by":3,"name":"Kirsten L. Waarala","email":"","orcid":"","institution":"Michigan State University College of Osteopathic Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kirsten","middleName":"L.","lastName":"Waarala","suffix":""},{"id":124717479,"identity":"fbfe7ef3-3e8b-43cf-842e-720a16cc2ff4","order_by":4,"name":"Carol A. Wilkins","email":"","orcid":"","institution":"Michigan State University College of Osteopathic Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Carol","middleName":"A.","lastName":"Wilkins","suffix":""}],"badges":[],"createdAt":"2022-06-01 18:28:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1716900/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1716900/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":24628478,"identity":"5e52d22a-f9a6-4c23-a7a2-f06b1b217868","added_by":"auto","created_at":"2022-08-01 20:15:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37720,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the histograms, 2019 (black bars) versus 2020\u003c/p\u003e\u003cp\u003e(gray bars), showing the number of Category II questions that yielded\u003c/p\u003e\u003cp\u003e% Correct in the ranges 58\u003c/p\u003e\u003cp\u003e69, 70 79, 80 89, and \u0026gt;90. For each of the\u003c/p\u003e\u003cp\u003equestions in Category II, there was a difference of 3% or less in the\u003c/p\u003e\u003cp\u003e% Correct index between 2019 and 2020. The two distributions were not\u003c/p\u003e\u003cp\u003esignificantly different (\u003c/p\u003e\u003cp\u003ep =0.9534).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-1716900/v1/d6fe6c6afbc6231f851f14f7.png"},{"id":24628477,"identity":"4ed45865-8bc7-4477-a70a-d26f2e1cf51d","added_by":"auto","created_at":"2022-08-01 20:15:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72288,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the histograms, 2019 (black bars) versus 2020 (grey bars), showing the number of students\u003c/p\u003e\u003cp\u003ewho earned the percentage of points counting toward the final course grade in the ranges \u0026lt;59 through 95\u003c/p\u003e\u003cp\u003e99, in\u003c/p\u003e\u003cp\u003eintervals of 5%. (A) BMB 516; (B) BMB 528. In both courses of each year, a P\u003c/p\u003e\u003cp\u003egrade (passing) required 70% of the\u003c/p\u003e\u003cp\u003etotal number of points in the course.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-1716900/v1/8f4ce4d6c8b4f1358d7bd023.png"},{"id":24629069,"identity":"e34e11f4-2ec0-4420-801e-cf2ff3082369","added_by":"auto","created_at":"2022-08-01 20:20:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":31667,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the histograms showing the number of views of\u003c/p\u003e\u003cp\u003electure recordings in 2019 (black bars) versus 2020 (gray bars).\u003c/p\u003e\u003cp\u003e(A) BMB 516; (B) BMB 528.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-1716900/v1/8308adcf0bcd8f4c6f08e732.png"},{"id":24629073,"identity":"a2a9b7a4-7c01-4fdd-897f-ff9112807dad","added_by":"auto","created_at":"2022-08-01 20:20:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":552773,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1716900/v1/4a5feb24-e9d7-4f06-b7bd-955756bb29bb.pdf"},{"id":24628481,"identity":"9c88e97f-0460-472d-8b43-1975be0724b1","added_by":"auto","created_at":"2022-08-01 20:15:54","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":17407,"visible":true,"origin":"","legend":"","description":"","filename":"FanerAdditionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-1716900/v1/29cb07adbb1aa6c25da73fe2.docx"},{"id":24628480,"identity":"fb94a9c4-5fd7-4b25-a070-cc19902f9bb9","added_by":"auto","created_at":"2022-08-01 20:15:54","extension":"docx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":15790,"visible":true,"origin":"","legend":"","description":"","filename":"FanerAdditionalfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-1716900/v1/133d61fb485442b353a666bb.docx"}],"financialInterests":"","formattedTitle":"Student Performance in Medical Biochemistry and Genetics: Comparing Campus-based versus Zoom-based Lecture Delivery","fulltext":[{"header":"Background","content":"\u003cp\u003eThe COVID-19 pandemic and the ensuing requirements for social distancing have provoked a sea-change in medical education in the pre-clerkship years: transition to remote learning (online lectures and small-group interactions) and adaptation of testing environments for assessment. A plethora of ideas and description of actual practices have been put forth to convert curricula to online learning and administer exams remotely.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e There are descriptions, for example, on a \u0026ldquo;Quarantine Curriculum\u0026rdquo;,\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e a student-led development of a \u0026ldquo;COVID-19 Curriculum\u0026rdquo;,\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e as well as discussions on the role of medical students\u0026rsquo; government\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e and opportunities to make changes to the assessment of outcomes.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Some consequences of these changes, necessitated by the pandemic, have recently been analyzed and reported, mostly in terms of surveys.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhen the pandemic hit in the spring of 2020, Michigan State University College of Osteopathic Medicine (MSUCOM) changed its campus-based lecture delivery to virtual delivery of lectures via Zoom webinars or meetings. The instructional team for two courses in biochemistry and molecular biology (BMB) recognized the unique opportunity to compare the effectiveness of the two modes of content delivery: face-to-face versus online. The team made a conscious decision to maintain the same lecturers delivering the same content and used identical exam questions to assess the same content so that student performance on individual assessment items can be compared. While the transition to online was a necessity due to the pandemic, there may be positive aspects of online learning to consider and perhaps adopt to some extent even after the pandemic.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e The researchers wished to determine whether online learning was as effective as traditional models.\u003c/p\u003e \u003cp\u003ePrior studies on comparing face-to-face on-campus versus virtual/online delivery of content have yielded mixed results. On the one hand, several studies have touted that e-learning yielded superior outcomes than campus-based classroom sessions. For example, Lockyer \u003cem\u003eet al\u003c/em\u003e.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e reported that, in measured outcomes related to HIV/AIDS, collaborative activities were more effective in the Web-based learning than in the face-to-face environment. In addition, Zhang\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e found that students in an interactive e-learning environment achieved better performance than those in a traditional classroom. More recently, Pickering\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e reported that the introduction of an anatomy\u003c/p\u003e \u003cp\u003eeBook enhanced assessment outcomes for those students who were in the lowest quartile but not in the other quartile groups.\u003c/p\u003e \u003cp\u003eOn the other hand, there have also been results that favored the traditional campus-based classrooms. In a rigorous, quantitative study by Figlio \u003cem\u003eet al\u003c/em\u003e.,\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e students in an introductory microeconomics course were randomly assigned to attending live lectures versus watching the same lectures in an online setting. They report that the traditional lecture instruction yielded better test results than the internet instruction. Similarly, Arias \u003cem\u003eet al\u003c/em\u003e.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e reported that when students were randomly assigned to either an online or face-to-face section of the same course and then compared in terms of course exam average and pre- versus post-tests, the face-to-face students performed better than the online students in a statistically significant manner. Finally, there is yet another group of studies that suggest no difference in the two learning formats in several measures of learning outcomes.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the present communication, we report the analysis of first-year medical students\u0026rsquo; performance in terms of the degree of difficulty of individual assessment items. The comparison was made to determine the effect, if any, of Zoom-based delivery of lectures in 2020 relative to campus-based delivery of the same content in 2019. The data and analysis may be of interest to students, faculty, and administrators who experienced the pandemic as well as those involved in post pandemic curriculum development.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSubjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study compared the exam performance of first-year medical students in biochemistry (BMB 516; Semester 1) and in molecular biology and genetics (BMB 528; Semester 2) at MSUCOM. The comparison was made to determine the effect, if any, of virtual (Zoom-based) delivery of lectures necessitated by the Covid-19 pandemic in 2020 for the Class of 2024, relative to campus-based lecture delivery in 2019 for the Class of 2023. Admissions data for the two classes are displayed in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAdmissions data for the Classes of 2023 and 2024 at MSU COM\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eClass of 2023 (2019)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eClass of 2024 (2020)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean GPA\u003csup\u003ea\u003c/sup\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e STDEV\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.63 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.66 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean Science GPA \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e STDEV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.58 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.61 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean MCAT\u003csup\u003ec\u003c/sup\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e STDEV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e505 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e506 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMCAT \u0026ndash; CARS\u003csup\u003ed\u003c/sup\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e STDEV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMCAT \u0026ndash; CPBS\u003csup\u003ee\u003c/sup\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e STDEV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMCAT \u0026ndash; BBFL\u003csup\u003ef\u003c/sup\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e STDEV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\u003csup\u003ea\u003c/sup\u003e GPA --- grade point average earned for the undergraduate degree; \u003csup\u003eb\u003c/sup\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e STDEV --- standard deviation of the mean; \u003csup\u003ec\u003c/sup\u003e MCAT --- Medical College Admission Test; \u003csup\u003ed\u003c/sup\u003e CARS --- Critical Analysis and Reasoning Skills; \u003csup\u003ee\u003c/sup\u003eCPBS --- Chemical and Physical foundations of Biological Systems; \u003csup\u003ef\u003c/sup\u003eBBFL --- Biological and Biochemical Foundations of Living systems\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eEach year, the entering class consisted of ~\u0026thinsp;300 students: (a)\u0026thinsp;~\u0026thinsp;200 located at the East Lansing (EL) site; (b)\u0026thinsp;~\u0026thinsp;50 at Detroit Medical Center (DMC) site; and (c)\u0026thinsp;~\u0026thinsp;50 at Macomb University Center (MUC). All three sites have an identical curriculum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Michigan State University Institutional Review Board on Human Subjects has approved this study (IRB number 00005873).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLecture Delivery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn both years, Semester 1 spanned 9 weeks from June 15 through August 14; BMB 516 was a 1-credit course (a combination of ~\u0026thinsp;12 lectures and ~\u0026thinsp;5 activity sessions), taught alongside an 8-credit anatomy course and a 1-credit epidemiology and biostatistics course. In both years, BMB 528 (2-credit course consisting of a combination of ~\u0026thinsp;29 lectures and 3 activity sessions) spanned the first eight weeks of Semester 2, during which pathophysiology, immunology, and microbiology courses were also ongoing.\u003c/p\u003e\n\u003cp\u003eIn 2019, the mode of lecture delivery was in campus-based classrooms. Each live lecture had a point of origination (e.g. DMC) in which students were physically in the classroom with the lecturer (see Additional file 1). At the non-origination sites (e.g. EL and MUC), students watched the lecture via Polycom video conferencing in real time. There is a faculty member in each of the non-origination site classrooms who can direct questions/discussion to the lecturer or to whom students can direct questions following the session. It should be emphasized that, despite the fact of being \u0026ldquo;remote from the lecturer,\u0026rdquo; students at non-origination sites were physically in the classroom with their peers, along with a content expert faculty. More importantly, both internal course grades (see Additional file 2) as well as external metrics such as performance on national licensure exams (COMLEX Level 1)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e indicate no statistically significant differences in outcome measures between site-of-origin and receiving sites.\u003c/p\u003e\n\u003cp\u003eIn 2020, the Covid-19 pandemic necessitated the switch to lecture delivery via Zoom webinars. To the extent possible, we maintained the same lecturers delivering the same content with very minor exceptions. In addition to the lecturer, we staffed each webinar (lecture session) with another faculty member to: (a) bring any major point of misunderstanding or technical issue to the attention of the lecturer; and (b) triage questions from students submitted through the Q\u0026amp;A function of Zoom, to be addressed at appropriate junctures during the session or just before the end of the session.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClass Attendance and Access to Lecture Recordings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince 2014, the instructional team in BMB has been engaged in a project to increase class attendance and engagement by rewarding real-time responses to i\u0026thinsp;\u0026gt;\u0026thinsp;clicker questions (if they get one correct) during class sessions that can contribute up to 2.4% of the points counting toward the final course grade. The number of students responding to i\u0026thinsp;\u0026gt;\u0026thinsp;clicker questions was used to track attendance for BMB 528 in 2019. Zoom webinar attendance for BMB 516 and BMB 528 in 2020 was tracked by the unique views in the Zoom Attendee Report which was pulled out after the lecture.\u003c/p\u003e\n\u003cp\u003eThe lectures in the BMB courses were recorded and students can asynchronously access these recordings in the MediaSpace repository on an on-demand basis. In 2019, the recordings were a part of the Polycom broadcast between the three sites; in 2020, the recordings were made as a part of the Zoom webinar. In conjunction with the i\u0026thinsp;\u0026gt;\u0026thinsp;clicker project, we also monitored the frequency that the recording of a particular lecture was being accessed for viewing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExaminations\u003c/strong\u003e: During the first two semesters at MSUCOM, students are assessed at regular intervals (2\u0026ndash;4 weeks) and each exam contained assessment items from more than one course; the number of questions in an exam reflected the number of sessions of a particular course during that period. In the two BMB courses, individual questions were generated by faculty members and tagged with instructional objectives. After vetting by the course instructional team, the Course Coordinator enters the questions into the secure assessment platform ExamSoft (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://examsoft.com/\u003c/span\u003e\u003c/span\u003e). The Semester Director then assembles an exam from the question pool, and it is vetted a second time by the Course Coordinators that have content in that exam.\u003c/p\u003e\n\u003cp\u003eExamSoft allows for secure computer-based testing. In 2019, the exams were conducted in on-campus classrooms with identification verification, in-person proctoring and other security measures (checking pockets etc.). In 2020, the exams were conducted \u0026ldquo;at home\u0026rdquo; using ExamMonitor for remote proctoring. ExamSoft reports an item analysis of the questions used in a particular examination. In this report, we focused on the \u0026ldquo;% Correct\u0026rdquo; parameter as an indicator of the degree of difficulty of the question; the lower the value of % Correct, the more difficult the question was for the students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis of the Data\u003c/strong\u003e: Class averages, standard deviations, and standard error of the mean were calculated using the Microsoft Excel spreadsheet software. Chi-square analyses were carried out using the statistical analysis program available online (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.socscistatistics.com/tests/chisquare2/default2.aspx\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eItem Analysis of Examination Questions in 2019 and 2020\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 2019, we delivered lectures in on-campus classrooms; in 2020, we delivered them virtually via Zoom webinars. The same lecturers delivered the same content with very minor exceptions, and we used identical exam questions to assess the same content. For each question, we compared the % Correct in the item analysis report.\u003c/p\u003e\n\u003cp\u003eThere were 159 total questions in six exams of the two BMB 516 and BMB 528 courses (last column, Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Some of the questions in each examination did not lend themselves to a direct comparison, either because of a slight change in wording necessitated from student feedback in 2019 or because the mode of delivery did not involve lectures. These questions were grouped under \u0026ldquo;Other\u0026rdquo; (Column 6) in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. We compared student performance in 2019 versus 2020 for 126 questions, accounting for ~\u0026thinsp;80% of the examination questions used in both years (\u0026ldquo;Number Compared\u0026rdquo;, Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of the number of questions in various categories when 2019 exams were compared with 2020 exams\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExam\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory I\u003c/p\u003e\n \u003cp\u003e(control\u003c/p\u003e\n \u003cp\u003equestions)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory II\u003c/p\u003e\n \u003cp\u003e3% or less difference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory III\u003c/p\u003e\n \u003cp\u003e4% or more\u003c/p\u003e\n \u003cp\u003e2019\u0026thinsp;\u0026lt;\u0026thinsp;2020\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory IV\u003c/p\u003e\n \u003cp\u003e4% or more\u003c/p\u003e\n \u003cp\u003e2019\u0026thinsp;\u0026gt;\u0026thinsp;2020\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003cp\u003eCompared\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 516, Exam 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 516, Exam 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 528, Exam 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 528, Exam 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 528, Exam 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 528, Exam 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e In 2019, lectures were delivered in on-campus classrooms; in 2020, lectures were delivered virtually via Zoom webinars. In Categories I \u0026ndash; IV, identical questions were used to assess the same content.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eCategory I --- The mode of delivery of content examined in these questions was identical in 2019 and 2020 (e.g. via assigned reading material or self-study exercise). These served as our Control Questions.\u003c/p\u003e\n\u003cp\u003eCategory II --- There was a difference of 3% or less in % Correct between 2019 and 2020.\u003c/p\u003e\n\u003cp\u003eCategory III --- There was a difference of 4% or more in % Correct, with 2020 Zoom delivery showing a better performance or higher % Correct than 2019 on-campus delivery (2019\u0026thinsp;\u0026lt;\u0026thinsp;2020).\u003c/p\u003e\n\u003cp\u003eCategory IV --- There was a difference of 4% or more in % Correct, with 2019 on-campus delivery showing a better performance or higher % Correct than 2020 Zoom delivery (2019\u0026thinsp;\u0026gt;\u0026thinsp;2020).\u003c/p\u003e\n\u003cp\u003eOther --- Questions for which performance in the two years cannot be easily compared, either because of a change in the wording of a particular question or because the mode of content delivery was altered (e.g. a self-study exercise in 2019 was replaced by a lecture in 2020).\u003c/p\u003e\n\u003cp\u003eFor seven of the questions we analyzed, the mode of delivery of content was identical in 2019 and 2020 (e.g. assigned reading or self-study exercise); these served as our \u0026ldquo;control questions\u0026rdquo; (Category I, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) for which we expected student performance to be the same from year to year. Indeed, the % Correct was within 3% of each other for six of these questions. One question yielded 57% Correct in 2019 versus 68% Correct in 2020, representing the lone exception. The standard error of the mean for % Correct of all 14 control questions (seven from each year) was 3.63. Since the standard error of the mean represents a measure of the dispersion of a sample around the population mean (how much variation you expect by random sampling of the population), we used 3% difference as the criterion in the groupings described below.\u003c/p\u003e\n\u003cp\u003eWe found 84/126 (~\u0026thinsp;67%) of the questions showed little/no difference (a difference of 3% or less in % Correct) between live campus-based delivery (2019) and Zoom delivery (2020). These were grouped into Category II in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The questions in Category II constitute a majority of the questions in any exam, across all six exams in the two courses and therefore, spanned the entire range of scientific content of the two courses (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Moreover, the questions encompass, in terms of Bloom\u0026rsquo;s taxonomy, both the recall/remembering type as well as questions of higher levels of cognition involving understanding, analysis, and application. The questions in this category span a wide range in terms of the % Correct index (Fig.\u0026nbsp;1), with ~\u0026thinsp;45% of them in the \u0026lt;\u0026thinsp;90% Correct range. The histogram distributions for 2019 and 2020 look very similar; this conclusion is supported by a chi-square analysis, which showed that the two distributions were not significantly different (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.9534).\u003c/p\u003e\n\u003cp\u003eWe divided those questions in which the % Correct index differed by 4% or more between 2019 and 2020 into two categories (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). There were 16 questions (~\u0026thinsp;13%) that showed better performance in 2020 than in 2019. In other words, a Zoom delivery yielded a higher % Correct in each of the questions in Category III. On the other hand, there were 19 questions (~\u0026thinsp;15%) that showed better performance in 2019 than in 2020. In other words, campus-based delivery yielded a higher % Correct in these questions in Category IV. The number of questions in Categories III and IV essentially balance each other out across all six exams and therefore, the delivery method (campus-based versus Zoom-based) did not differentially impact any particular topic of scientific content. Together with the large fraction of questions in Category II, showing little/no difference between 2019 and 2020, these results suggest that conversion of lecture delivery from campus-based classrooms to Zoom webinars online did not significantly affect student learning and performance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClass Characteristics and Student Performance, 2019 versus 2020\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first-year students entering MSUCOM in 2019 (Class of 2023) and in 2020 (Class of 2024) presented with equivalent academic credentials (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Both the overall undergraduate GPA as well as the GPA in science courses were within a standard deviation of each other. Similarly, there was no significant difference in terms of the composite MCAT scores and in terms of specific MCAT categories such as Critical Analysis and Reasoning Skills.\u003c/p\u003e\n\u003cp\u003eConsistent with these data on entry into medical school, the two classes performed comparably in the early exams of their respective first two semesters (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Two key considerations regarding exams and the grading system at MSUCOM may be important in terms of this table: (a) Each exam contained assessment items from concurrent courses during the semester; the number of questions in an exam reflected the number of sessions of a particular course during that period. (b) MSUCOM used a P/N (pass/no-pass) grading system with 70% as the minimum required for passing the BMB courses. When considering questions derived from the BMB course only, campus-based delivery in 2019 yielded a slightly higher class average for five of the six exams compared to Zoom delivery in 2020, although the class averages for each of the corresponding exams in the two years were within 3 percentage points of each other (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, Part A). This is counterbalanced by the observation that, in terms of the overall exam covering all content, the class averages were higher in 2020 (Zoom-based delivery) than in 2019 (campus-based delivery) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, Part B). It is possible that, in the P/N grading system, students felt comfortable in terms of the number of points they had in the BMB course such that more study or attention was devoted to the content of the other concurrent course(s).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of the class averages on exams: BMB and all content questions\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExam\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eA) BMB Content Only\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 516, Exam 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 516, Exam 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 528, Exam 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 528, Exam 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 528, Exam 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMB 528, Exam 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eB) All Content\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemester 1, Exam 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemester 1, Exam 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemester 2, Exam 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemester 2, Exam 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemester 2, Exam 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemester 2, Exam 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e Each exam contained assessment items from more than one course; part A analyzed questions from the BMB course. The data are expressed as class average (in %) \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e standard deviation.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e Part B provides the class average covering all questions in a particular exam, one part of which contained the BMB questions analyzed in part A. The data are expressed as class average (in %) for the entire exam.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThis notion is supported by comparing the histogram distribution of the number of students in a particular interval of the percent of total points counting toward the final grade (Figure 2). \u0026nbsp;For both BMB courses, there were more students in the 80-84% range in 2019 while, in 2020, there were more students in the 85-89% range. As shown in Figure 2, the number of N-grades in BMB 516 was 9 in 2019 while the corresponding number in 2020 was 6; the number of N-grades in BMB 528 was 2 in 2019 while the corresponding number in 2020 was zero. \u0026nbsp;Coupled with the item analysis of exam questions, these results on student performance suggest that online Zoom delivery of the content in biochemistry and genetics yielded as good, if not better, an outcome as on-campus classroom delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLecture Attendance and Access to Lecture Recordings, 2019 versus 2020:\u0026nbsp;\u003c/strong\u003eClass attendance averaged between ~80% to ~90% in a course-specific and year-specific manner (data not shown). \u0026nbsp;Attendance in BMB 516, 2020 averaged ~91%; this represented the first semester in medical school for the Class of 2024 and so the students were most likely curious and anxious regarding their performance. \u0026nbsp;Attending classes, albeit via Zoom, represented a mechanism to see fellow classmates and the faculty. \u0026nbsp; This same group of students became more familiar with medical school and their attendance in the second semester BMB 528 dropped off to ~83%. \u0026nbsp; In 2019, the same BMB 528 course (second semester for Class of 2023) averaged ~91% in attendance, most likely incentivized to a large extent by the possibility of earning \u0026ldquo;clicker points\u0026rdquo; (described under Class Attendance and Access to Lecture Recordings in the Methods section). \u0026nbsp; This difference in attendance may be reflected, in all four exams in the course, by the slightly higher class averages in 2019 than the corresponding scores in 2020. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe have also monitored the frequency of asynchronous student access to lecture recordings (Figure 3). For BMB 516 in the first semester, student access was higher in 2020 than in 2019, again most probably reflecting that, in 2020, the students were anxious because their medical school experience had been virtual for the most part. For BMB 528 in the second semester, the frequency of access to the recordings was reversed: more in 2019 than in 2020.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe key conclusion derived from the present study is that online Zoom delivery of the content in biochemistry and genetics, necessitated by the Covid-19 pandemic in 2020, yielded about the same outcome as on-campus classroom delivery in 2019. This conclusion is based on analysis, for each examination question, the % Correct index yielded by students who learned the content via the two modes of delivery. For a large fraction of the exam items analyzed, those questions with a low % Correct (high degree of difficulty) in 2019 yielded a very similar low % Correct index in 2020 while questions with a high % Correct (low degree of difficulty) in 2019 also resulted in a high % Correct index in 2020.\u003c/p\u003e \u003cp\u003eThe high concordance, between 2019 and 2020, of the % Correct index for individual questions speaks to the security of the exam questions in the ExamSoft bank. In addition, the data also lend some confidence to the ExamMonitor remote proctoring process. Most important of all, however, we believe that the data provides the basis for being especially proud of the integrity of our medical students. Together, the data and analysis reported here may provide some level of comfort to students, faculty, and academic administrators in terms of achievement of instructional objectives and integrity of scholarship during a difficult time.\u003c/p\u003e \u003cp\u003eThere are several recent reports on the effect of the pandemic on the teaching of the foundational sciences in medical education. For example, Shahrivini \u003cem\u003eet al.\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e reported a survey of first- and second year medical students regarding the impact of remote learning on quality of instruction and ability to participate and on preparedness for subsequent stages of medical training. While students preferred the flexibility of learning at their own pace, many students felt isolated and less-than-connected to their classmates and medical school. On the other hand, Suneja \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e reported based on final scores of assessments, the learning outcomes were fully attained in terms of the first-year curriculum including anatomy, physiology, and biochemistry along with professional and personal development modules. In fact, the disruption of physical classrooms, necessitated by the pandemic, led to unanticipated benefits derived from increased use of technology, at both the faculty and student levels. Our study complements and supplements these reports by providing, on a direct item-by-item comparison basis, of individual examination questions.\u003c/p\u003e \u003cp\u003eReviews of the distinguishing features of online versus face-to-face delivery of content often emphasize the \u0026ldquo;asynchronous and flexible nature\u0026rdquo; of the online medium.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Three aspects of the present study need to be brought out in this context. First, each of the lectures in our study, in both years, were scheduled for a specific date and time. Therefore, to interact with the lecturer, a student had to attend the lecture physically in a campus classroom (2019) or attend the Zoom webinar in real time (2020). In this sense, the lectures in both years were synchronous. Second, students had access, asynchronously, to recordings of the lectures in both years. Finally, pre-COVID MSUCOM had three sites connected by Polycom video conferencing during a lecture. A student at a non-origination site attended the lecture via Polycom; alternatively, a student could also virtually watch the video live streamed via Polycom. It is important to note that Hortos \u003cem\u003eet al\u003c/em\u003e. used external metrics, such as performance on national licensure exams (COMLEX Level 1), to show that there were no statistically significant differences in outcome measures between site-of-origin and receiving sites\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Moreover, we have also found that there has been no significant difference in average course grades for the BMB courses between the three sites going back to 2012 (see Additional file 2 for 2018 and 2019 and data not shown for previous years), further supporting that there were no statistically significant differences in outcome measures between site-of-origin and receiving sites. In this connection, it should also be noted that in post-course evaluations in 2020, ~\u0026thinsp;58% of the students indicated a preference for synchronous live webinars while\u0026thinsp;~\u0026thinsp;33% preferred asynchronous pre-recorded lectures. Despite the flexibility afforded by a pre-recorded lecture, the students wanted a scheduled event (granted, they would have access to the recording in either case). One interpretation is that these students longed for direct interactions with the faculty and their peers because they had not been able to congregate physically as a class in medical school.\u003c/p\u003e \u003cp\u003eTwo other possible deficiencies need to be brought out regarding our study. First, we recognize the difficulty in determining student engagement during lecture delivery via Zoom, particularly since the camera of each student was not turned on at any time during the session. However, even during in-person lectures, there are challenges in determining student engagement; they could be physically present in the classroom but engaged in other activities (e.g. social media or online shopping). Second, we also acknowledge that there are other aspects of in-person learning that support medical students and develop valuable skills besides the mere acquisition of biochemistry knowledge and our study does not address those skills.\u003c/p\u003e \u003cp\u003eEven before the pandemic, there were calls for significant changes in medical education, with suggestions to overcome barriers to online learning\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e and with predictions that pre-clerkship curriculum will be delivered completely online.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Online learning can increase the accessibility of medical education since it could be available almost anywhere and anytime. For pre-clerkship medical curriculum, it is easy to imagine a blended model where students attend some sessions in person while others are available for the learner to complete at their own pace. This is a more student-centered approach and allows more flexibility to pursue research, community engagement and self-care. All these positive aspects of online learning argue that it should be adopted to some extent even after the pandemic.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur present report contributes to this discussion by documenting that, in terms of assessment of scientific foundations of medical knowledge, the two modalities yielded the same outcome. The relationship between assessment and learning has been extensively discussed and argued;\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e suffice it to say that we subscribe to the view best expressed, \u0026ldquo;Assessment is good for learning and learning is good for assessment.\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMSUCOM - Michigan State University College of Osteopathic Medicine\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMB \u0026ndash; biochemistry and molecular biology\u003c/p\u003e\n\u003cp\u003eEL \u0026ndash; East Lansing\u003c/p\u003e\n\u003cp\u003eMUC \u0026ndash; Macomb University Center\u003c/p\u003e\n\u003cp\u003eDMC \u0026ndash; Detroit Medical Center\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics and consent to participate\u003c/strong\u003e: The Institutional Review Board at Michigan State University has approved this project (IRB# 00005873). The need for consent was waived by the IRB.\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: Additional Data can be accessed via Harvard Dataverse at https://doi.org/10.7910/DVN/RK7KXL\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This work was supported by the Office of the Associate Dean for Medical Education and by the Department of Biochemistry and Molecular Biology, College of Osteopathic Medicine, Michigan State University in the form of curricular support and publication costs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e MF made substantial contributions to the conception and design of the work, acquisition and interpretation of the data and in the revision of the work. RR made contributions to the conception and design of the work, to the acquisition, analysis and interpretation of the data and in the revision of the work. KR made substantial contributions to the acquisition and interpretation of the data and in the revision of the work. KW made substantial contributions to the interpretation of the data and in the revision of the work. CW made substantial contributions to the acquisition and interpretation of the data and in the revision of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors acknowledge the contributions of John L. Wang in the writing of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWoolliscroft JO. Innovation in response to the COVID-19 pandemic crisis. Acad Med. 2020;95:1140-1142.\u003c/li\u003e\n \u003cli\u003eStanton B. Medical education in the age of COVID-19 [published online ahead of print December 10, 2020]. Acad Med. doi: 10.1097/ACM.0000000000003890\u003c/li\u003e\n \u003cli\u003eRoss DA. Creating a \u0026ldquo;Quarantine Curriculum\u0026rdquo; to enhance teaching and learning during the COVID-19 pandemic. Acad Med. 2020; 95:1125-1126.\u003c/li\u003e\n \u003cli\u003eKochis M, Goessling W. Learning during and from a crisis: the student-led development of a COVID-19 curriculum [published online ahead of print September 15, 2020]. Acad Med. doi: 10.1097/ACM.0000000000003755.\u003c/li\u003e\n \u003cli\u003eSchuiteman S, Ibrahim NI, Hammoud A, Kruger L, Mangrulkar RS, Daniel M. The role of medical student government in responding to COVID-19. Acad Med. 2021; 96:62-67.\u003c/li\u003e\n \u003cli\u003eHauer KE, Lockspeiser TM, Chen HC. The COVID-19 pandemic as an imperative to advance medical student assessment: three areas for change. Acad Med. 2021; 96: 182-185.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Shahrvini B, Baxter SL, Coffey CS, MacDonald BV, Lander L. Pre-clinial remote undergraduate medical education during the COVID-19 pandemic: a survey study. BMC Med Educ. 2021;21:13.\u003c/li\u003e\n \u003cli\u003eSuneja S, Gangopadhyay S, Kaur C. Efforts to cope with CBME in COVID-19 era to teach biochemistry in medical college. Biochem. Mol. Biol. Educ. 2020;48:670-674.\u003c/li\u003e\n \u003cli\u003eVitorini P, Galassi A. From blended to online due to the COVID outbreak: the case study of a data science course. J. Open, Distance and e-Learning 2021;36:212-223\u003c/li\u003e\n \u003cli\u003eO\u0026rsquo;Doherty D, Dromey M, Lougheed J, Hannigan A, Last J, McGrath D. Barriers and solutions to online learning in medical education \u0026ndash; an integrative review. BMC Med Educ. 2018;18:1:130.\u003c/li\u003e\n \u003cli\u003eLockyer L, Patterson J, Harper B. Measuring effectiveness of health education in a web-based learning environment: A preliminary report. 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Evaluating web-supported learning versus lecture-based teaching: quantitative and qualitative perspectives. High Educ. 2005;50:645-664.\u003c/li\u003e\n \u003cli\u003eJohnson SD, Aragon SR, Shaik N, Palma-Rivas N. Comparative analysis of learning satisfaction and learning outcomes in online and face-to-face learning environments. J Interactive Learning Res. 2000;11:29-49.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Hortos K, Sefcik D, Wilson SG, McDaniel JT, Zemper E. Synchronous videoconferencing: impact on achievement of medical students. Teaching and Learning in Medicine 2013;25:211-215.\u003c/li\u003e\n \u003cli\u003eBrown R. 13 differences between online and face to face courses. 13 Differences Between Online and Face to Face Courses - Miami University (miamioh.edu)\u003c/li\u003e\n \u003cli\u003eKhara S. Post COVID-19 education system: eLearning vs. classroom-based learning. Post COVID-19 Education System: eLearning Vs. Classroom-Based Learning (elearningindustry.com)\u003c/li\u003e\n \u003cli\u003eEmanuel EJ, The inevitable reimagining of medical education. JAMA. 2020;323:1127-1128.\u003c/li\u003e\n \u003cli\u003eMcLachlan JC. The relationship between assessment and learning. Med Educ. 2006;40:716-717.\u003c/li\u003e\n \u003cli\u003eWormald BW, Schoeman S, Somasunderam A, Penn M. Assessment drives learning: an unavoidable truth? Anat Sci Educ. 2009;2:199-204.\u003c/li\u003e\n \u003cli\u003eCilliers FJ. Is assessment good for learning or learning good for assessment? A. Both? B. Neither? C. It depends? Perspect Med Educ. 2015;4:280-281.\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":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","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":"online learning, medical school, biochemistry, genetics","lastPublishedDoi":"10.21203/rs.3.rs-1716900/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1716900/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Study objectives were to appraise the effectiveness of Zoom delivery versus live campus-based delivery of lectures in biochemistry and genetics courses and assess the integrity of remote versus campus administered exams.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Participants were 601 students entering Michigan State University College of Osteopathic Medicine in 2019 or 2020. The former completed courses and exams on campus, while the latter completed courses online due to the COVID-19 pandemic.\u0026nbsp;For the biochemistry and genetics courses, the same lecturers delivered the same content and used identical exam questions for assessments in 2019 and 2020.\u0026nbsp;The investigators compared percent correct for each question in 2019 and 2020. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study found 84/126 (~67%) of the questions yielded little difference (3% or less in % Correct) between live delivery and Zoom delivery.\u0026nbsp;For questions whose % Correct index differed by 4% or more, Zoom delivery yielded a better performance for 16 questions (~13%), while 19 questions (~15%) showed live lectures performed better.\u0026nbsp;Seven of the questions (~6%) had an identical mode of delivery in 2019 and 2020 (e.g. self-study exercise).\u0026nbsp;These served as “control questions” for which equivalent student performance was expected.\u0026nbsp;The 126 questions analyzed spanned a wide range in the % Correct index, from ~60% Correct to \u0026gt;90% Correct. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The results suggest that Zoom and on-campus delivery of the content in biochemistry and genetics yielded similar achievement of course objectives.\u0026nbsp;The high concordance, between 2019 and 2020, of the % Correct for individual questions also speaks to exam integrity including online proctoring.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Student Performance in Medical Biochemistry and Genetics: Comparing Campus-based versus Zoom-based Lecture Delivery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-01 20:15:52","doi":"10.21203/rs.3.rs-1716900/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-08-28T13:33:10+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2022-08-05T11:35:54+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-07-28T15:10:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"BMC Medical Education","date":"2022-06-15T08:29:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-06-06T11:59:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2022-06-01T14:26:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","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}}],"origin":"","ownerIdentity":"c4fd348b-9433-4b24-b0e2-fee8e388b8a9","owner":[],"postedDate":"August 1st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-11-07T15:49:27+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-01 20:15:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1716900","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1716900","identity":"rs-1716900","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}