Introduction

In every educational institution, its assessment policy, course length and content all have an impact on how well its students perform [1,2]. There are two examination-related methods that are frequently used: semester-based examinations and annual examinations. Students take an end-of-year examination in an annual system and a six-monthly examination in a semester system. These examinations, which are due at different points throughout the course, have an impact on the students’ academic performance [3]. Additionally, there are differences between annual and semester systems in terms of how students learn [4]. It has been demonstrated that the structure of assessment tools, such as essay writing and objective assessment questions like MultipleChoice Questions (MCQs), has an impact on student performance, particularly in domains that evaluate more sophisticated cognitive capacities [5]. Students employ various learning tactics depending on a variety of criteria, like as the course they are enrolled in and the type of examination they take [2,6]. The teaching, learning, and assessment have all been impacted by the widespread movement for medical education reform [7]. The semester system, which is thought to offer more opportunity for assessments and feedback, has taken the place of the annual examination system in this environment of higher education reform [8]. The fundamental change to the semester system is the adoption of objective assessment methods. These methods frequently use MultipleChoice Questions (MCQs) as a tool for evaluating students’ knowledge of particular subjects and ask students to choose the right response from the given options [9].

Biggs [9] suggests that the institution’s environment for educational assessment influences students’ learning strategies. He asserts that assessments with only MCQs foster low cognitive learning based on the acquisition and memory of facts and knowledge, whereas assessments using essays, examine higher cognitive levels. Hence, MCQs cannot accurately assess the more sophisticated cognitive talents [5]. Students who solely answered MCQs in their earlier academic examinations struggled to write essays on basic science subjects when they were included in examinations later [10]. Smith and Miller [6] stated that students employ a higher level of cognitive processing in the essay-based examination than the MCQ examination when discussing students’ perceptions of these two types of examinations. In a study by Mujeeb and Pardeshi [11] the scores of medical students answering MCQs and Short Essay Questions (SEQs) was evaluated. A statistically significant positive correlation (r = 0.64, p=0.01) was discovered between the scores on MCQs and SEQs. However, for students who either failed an examination (r = 0.11, p = 0.08) or had a high distinction (r = -0.27, p = 0.13), no significant correlation was observed. The Modified Essay Question (MEQs) format, which combines MCQs and whole essays, is another type of essay test. However, it has been noted that they are challenging to create and frequently fall short of testing highly developed judgment and reasoning abilities as measured by essays, hence not frequently used [12].

The Bologna Declaration promoted the widespread adoption of semester system, encouraging many higher education institutions, including those in Pakistan, to adopt this scheduling strategy [13]. This declaration aspires to provide a consistent degree system from bachelor’s to doctoral levels [14] and to bring uniformity in higher education in European countries [13]. While data suggests the semester system could produce superior outcomes, unfortunately, the implementation of declaration is underdeveloped in some areas of medical education [15]. In a study published in 2016, Masic and Begic [16] looked at the academic performance of medical students in Bosnia and Herzegovina enrolled in the Bologna system’s annual examination model or semester examination model. The results of their study showed that students in the semester system outperformed academically those in the annual system (p 0.05). This beneficial impact transcends the realm of medical education, as Yousaf and Hashim found comparable results of enhanced performance among students in the semester system within the context of commerce education [17]. Students at several universities indicated greater satisfaction with the semester system of examinations than did teachers [18]. Despite the distinctions between the two systems, there is no discernible difference in the examination anxiety levels of the students [19]. The annual examination-based education system gives students more time to grasp the subject as compared to the semester-based education system with its semester-ending examinations [4]. Additionally, with frequent teacher-student contacts and evaluation feedback, the semester system offers students the chance for continual learning and assessment [20].

Pakistan followed the educational legacies left by postcolonial rule, especially the design of the medical curriculum. This covers the preclinical and clinical parts of medical education that are carried over from the British system of medical education, which included yearly examinations at the conclusion of academic years. However, alternative teaching, learning, and evaluation strategies have recently been introduced by several universities in Pakistan. The pre-clinical and clinical years made up the traditional and new curriculum structure used by medical universities in Pakistan. In the traditional curriculum, during preclinical years, courses like pharmacology were taught all year long and evaluated at the conclusion. The large lectures, small-group tutorials, and lab sessions were all used as teaching techniques. The written and oral assessments made up the parts of examinations. The written papers required in-depth responses to essay questions to be completed within a three-hour time limit. The appropriate faculty completed the grading manually. These techniques were widespread in Pakistani medical schools and universities before.

The higher education institutions of Pakistan’s now use a standardized semester system, according to policy guidelines circulated by the Higher Education Commission of Pakistan (HEC). The introduction of this method is being monitored and evaluated by the National Committee on Examination method (NCES). After deliberations with stakeholders the group created rules and advised semester-based examinations as the ideal method to standardize degree programs in Pakistan. According to the suggestions, the adoption of this system was supposed to be finished by 2008 [20]. The medical institutions also adopted the semester system in accordance with HEC guidelines. The Pakistan Medical and Dental Council (PMDC) regulates the courses, curricula, and evaluation procedures in the medical colleges and universities The PMDC, did not suggest any modifications to the course structure or modes of instruction to be used in semester system. As a result, with the previous course contents the single end-of-year examinations were replaced with end-of-semester examinations as part of other changes to assessment procedures. Accordingly, in semester examinations, the format of the question papers changed from lengthy descriptive essays to objective questions. The PMDC, however, has voiced discontent with the results of introducing the semester system in medical institutes and is thinking about going back to the original decision to abandon the annual system [21].

In pre-clinical undergraduate medicine, pharmacology is an essential subject for future doctors. However, the method of teaching, learning and assessment varies depending on the program context [22]. Pharmacology is a field that is constantly evolving. The use of newer drugs with increased and potentially dangerous drug interactions and toxicities for a wide range of important illnesses is commonly seen. A full understanding of the pharmacokinetics, pharmacodynamics, drug-drug interactions, and other characteristics of the substance being prescribed is therefore necessary for accurate medication dosing today. For doctors, nurses, and physician assistants, inadequate clinical pharmacologic training can frequently be traced back to undergraduate education. Hence, it is generally agreed that it is essential to regularly evaluate the teaching programs and changes adopted to improve those. Due to the constantly evolving types and repositories of pharmaceuticals as well as technology developments in educational processes, pharmacology education has gone through many stages in the evolution sequence. Revisions and updates to learning objectives, teaching-learning materials and techniques, and evaluation at the Undergraduate (UG) and Postgraduate (PG) levels were significant turning points in the evolutionary sequence. Teaching and evaluation methodologies used for pharmacology are undergoing several improvements [23-25].

Research Question

This aim of this research is to analyse the impact semester system has on the academic performance of students in the subject of pharmacology. There is a dearth of actual data in this regard. Information comparing academic achievement between the two systems, particularly in the field of medical education in Pakistan, is largely based on anecdotal evidence. The objective of this study was to compare between academic performance of students in the revised semester and conventional annual examination systems in preclinical discipline of Pharmacology.

Methods

This is a retrospective cohort study conducted in Pakistan. The data from public medical universities were required. There were two criteria of selection of the study sites. First, the site should have graduates who took annual and semester-based examinations. Second, the site should have at least one hundred students admitted each year. The universities which fulfilled the criteria were contacted to seek permission to have access to the data. Five universities were contacted by the researcher after ethical approval of the research project. Only two universities consented to provide the data. The access to the data was granted by the Liaquat University of Medical and Allied Health Sciences (LUMAHS) and the Peoples Medical College. The Liaquat University of Medical and Allied Health Sciences (LUMAHS) in Pakistan, formerly Liaquat Medical College was established in 1947. It evolved from an institution founded in 1881. Initially located in Hyderabad, it later moved to Jamshoro in 1963. LUMAHS offers MBBS and BDS courses and gained the status of a postgraduate medical institute in 1989. In 2001, it was elevated to the level of a university of medical and health sciences, admitting over 350 students each year. The Peoples Medical College, a prestigious public medical school for women, opened its doors in Nawabshah, Pakistan, in April 1974. The college has produced over 6,000 female doctors. In 2010, it received a name change to Shaheed Mohtarma Benazir Bhutto Medical University (SMBBMU). About 200 students are accepted each year into the MBBS program at SMBBMU, which has a similar curriculum to other public medical schools in Pakistan.

The data were the official records showing students’ assessment scores achieved during undergraduate medical education in the Pharmacology written examination component. The data were de-identified by the university staff with the student’s name replaced by a code before supplying it to the researcher. The IBM Statistical Programme for Social Sciences (SPSS) version 29 SPSS for windows was used for statistical analysis. The individual student data with missing values was omitted from the analysis. The data included end-of-semester and annual examinations scores in percentage format. A detailed descriptive analysis including test for normality of the data was carried out at the initial stage of study to explore and understand the characteristics of the population under study. Later, the student t test was conducted to analyse the dis/similarities between different groups of students who graduated overtime. Jaccard and Becker [26] pointed an argument between the use of parametric and non-parametric techniques among researchers. In social science research, the ideal normality of distribution is observed rarely. They argued that the parametric techniques are considered robust in producing results even if there are minor violations of the distributional assumptions. Hence, the frequency of different errors and accuracy of conclusions made are relatively unaffected compared with conditions when assumptions are met.

Results

The dataset provided was results of semester-based and annual examination results of various batches of students. The data of students (N=463) who graduated in year 2014 having semester system of examination and students (N=1480) who graduated in year 2013, 2012 and 2010 having annual system of examination were collected. The initial data analysis suggested that the data did not violate the assumptions of normality (Skewness = -0.46). The current data fulfilled the assumptions of parametric statistics. The descriptive statistics of the data are presented in Table 1 shows the of Pharmacology knowledge scores achieved by two groups of students. The students who took semester-based examination achieved (N=463, M= 71.2, SD= 8.7) higher scores than the students who took the conventional annual examination (N=1480, M=58.63, SD=9.50). The mean percentage scores of students who took the semester-based examination was statistically significantly higher (t (1941) = 25.32, P <.01, CI 95% (11.60-13.55) as shown in Table 2.

Table 1: Descriptive data of students’ achievement scores in Pharmacology written examination component in two examination systems.

Table 2: Student t Test to analyse the significance of difference between students’ achievement scores in Pharmacology theory component in two examination systems