Digital Clinical Assessment – The New Normal?

By Sheik Abdul Malik

Updated Apr 06, 2026

COVID-19 pushed clinical assessment online almost overnight. For postgraduate medical and surgical students, that created a far bigger question than convenience: can a virtual exam judge clinical ability well enough to protect standards and progression?

In an unprecedented move, the General Medical Council (GMC) made significant changes to examinations, moving them from clinical settings into virtual ones. Could a postgraduate assessment format in a field built on patient-centred, face-to-face care still measure clinical ability accurately? In a 2021 paper submitted to the Journal of Oral and Maxillofacial Surgery [1], researchers examined virtual assessment methods that could keep surgical and medical trainees progressing while also reducing the spread of coronavirus in the confined spaces usually used for these assessments.

The GMC was not alone in turning to the virtual world to host these vital examinations. Assessments such as Membership of the Royal College of Psychiatrists (MRCPsych) and Membership of the Royal College of Obstetricians and Gynecologists (MRCOG), among others, moved online to test medical and surgical knowledge, sometimes through forms of online oral assessment, often without the traditional demonstration of practical clinical skills.

Digital Disparity

Whilst other disciplines have used online assessment for years, this is still a relatively new development within medicine, where people-focused practice is central to professional rigour. With the usual interpersonal routines of theatres and hospitals unlikely to return quickly for students during the pandemic, novel virtual assessment methods have become a practical necessity.

Adapting written examinations for an online platform is not without challenges, but medical schools have done it before [2]. Even so, feasibility is not the same as fairness. Regulators such as the GMC have had to manage technical reliability, maintain confidence in academic integrity during COVID-19 online assessments and reduce the disadvantages faced by candidates who have weaker access to suitable technology or quiet working space.

Assessing the Problems

Creating and implementing digital assessments can be expensive, especially when platforms, support and technical contingencies all need funding. Specialised training may also be needed so examiners and candidates can use the technology with confidence. Students can be hit hardest by the transition. Those who do not have reliable access to high-quality computing facilities face obvious barriers to participation, and the reduced assessment of practical surgical skills and patient examination can leave candidates feeling under-prepared for real-world clinical problems.

There are, however, potential advantages to online assessment for postgraduate medical and surgical students. International candidates can participate without travelling, which lowers cost and reduces emissions. A virtual examination also removes the need for a physical venue, which can make delivery more economical. Candidates may perform better in a familiar environment, and the absence of international travel and crowded exam spaces reduces the risk of COVID-19 transmission. The key benefit is flexibility, provided it does not come at the expense of credibility.

Taking the Clinical into the Virtual

The Royal College of Psychiatrists (MRCPsych) went a step further by moving clinical examinations online in a bid to minimise the negative effects of the pandemic. Other institutions continued to run face-to-face assessments with stringent social distancing measures and universal mask use.

One distinct advantage is that the pandemic accelerated digital literacy and sharpened verbal and non-verbal communication skills, both of which are valuable in modern clinical practice.

Despite this, one thing remains vital even in a digital world: practice. Extended assessment on a computer can affect concentration, but hydration, regular breaks and rehearsal with the platform can reduce fatigue and anxiety. Adequate practice before an online assessment also helps candidates become familiar with the interface and feel more settled on the day. It is not possible to remove every technical issue or distraction, but preparation gives candidates a better chance of performing to the standard expected in an in-person exam.

The Future of Assessments

Whilst it is impossible to predict exactly what future medical and surgical assessments will look like for postgraduate candidates, the shift triggered by the pandemic is unlikely to disappear completely. Whether patient-focused clinical examinations can be delivered fully online is still unresolved, a tension echoed in dentistry students' views on remote learning, but many written assessments are likely to remain digital. That creates an opportunity for students to build new digital skills while institutions decide where online delivery works well and where in-person assessment remains essential. In the longer term, that balance could shape both assessment design and clinical practice.

FAQ

Q: How do virtual assessments compare to traditional in-person assessments in terms of effectiveness and student satisfaction? Are there any studies or metrics that show the impact of virtual assessments on learning outcomes and exam performance?

A: The evidence is mixed, which is exactly why the debate remains active. Written or knowledge-based assessments often translate online more successfully than practical clinical assessments, but student satisfaction still depends heavily on reliability, clarity and support. The paper discussed here focuses more on the challenges of online delivery and performance optimisation than on a single headline metric, so the safest conclusion is that virtual assessment can work, but only when the format suits the skill being tested and institutions invest in the conditions that make it fair.

Q: What specific technologies and platforms are being used to facilitate these virtual assessments in medical and surgical fields, and how do they ensure the integrity and security of the examination process?

A: Institutions have used a mix of video conferencing tools, secure online exam platforms and simulation-based environments to deliver virtual assessment. What matters most is not the brand name of the platform but whether it can support identity checks, stable delivery, clear candidate instructions and a process that examiners trust. From a student perspective, integrity depends as much on usability as on security. If the technology is confusing or unreliable, confidence in the assessment quickly drops even if formal safeguards are in place.

Q: Given the necessity of practical skills in medical education, how are institutions planning to address the gap in hands-on clinical experience that cannot be replicated virtually? Are there any innovative solutions being developed to simulate or substitute this aspect of medical training?

A: This is the hardest problem to solve, because not every clinical skill can be replicated virtually. The most realistic response is usually a hybrid one: keep what works online, such as some written or discussion-based components, while protecting in-person opportunities for hands-on assessment in nursing education wherever they are essential. Simulation tools may help bridge some of the gap, but they are more likely to supplement clinical experience than replace it. For institutions, the takeaway is clear: convenience should not become a reason to stop assessing the practical skills that matter most.

References

[Source Paper] R. Ellis, R.S. Oeppen, P.A. Brennan, Virtual postgraduate exams and assessments: the challenges of online delivery and optimising performance, British Journal of Oral and Maxillofacial Surgery, Volume 59, Issue 2, 2021, Pages 233-237, ISSN 0266-4356,
DOI: 10.1016/j.bjoms.2020.12.011

[1] Ahmed Elzainy, Abir El Sadik, Waleed Al Abdulmonem, Experience of e-learning and online assessment during the COVID-19 pandemic at the College of Medicine, Qassim University, Journal of Taibah University Medical Sciences, Volume 15, Issue 6, 2020, Pages 456-462, ISSN 1658-3612,
DOI: 10.1016/j.jtumed.2020.09.005

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