The COVID-19 pandemic forced healthcare to rethink and re-envision how remote learning should be administered. The disruption of traditional in-class instruction had many instructors struggling to rapidly pivot to deliver content and evaluate knowledge and skills remotely. Few resources were available to prepare educators for this shift, particularly when it came to remote assessment. Summative and formative examinations had been conducted with online software programs even before the pandemic, typically synchronously and in-person in a classroom environment. During the pandemic, faculty were expected to provide a robust remote proctoring process while maintaining academic integrity, which was a significant and novel challenge. 

A synchronous remote proctored exam confers a great deal of responsibility upon students, who were expected to establish a quiet learning space free of distraction, ensure access to a working laptop and high-speed Wi-Fi network, and access to a fully charged mobile phone with a camera for surveillance during testing. Students were concerned with this surveillance and their privacy. With an in-person test, faculty are responsible for ensuring a secure testing environment and were also concerned about the lack of consistency in the quality and type of testing environment available to each student.

Most software programs used for examination prohibit students from opening additional screens or performing any online functions that would put them at risk of cheating. While there are no best practices for remote proctoring in health professions education, there are options. Remote proctor programs can be used to provide continuous audio and video monitoring. Alternatively, video-conferencing tools require students to log on and remain visible on their camera during test taking. Another option is not to have a proctor at all and rely on student honesty and professionalism.

At my institution the faculty learned that it was helpful for both faculty and students to have a very clear process for how remote proctoring would be conducted. For instance, I developed a simple diagram from a screenshot with the permission of a student depicting the faculty view of them during an online test and used it to demonstrate the expected, correct positioning of their laptop and cell phone to guide how they would set up the learning space for video-conferencing surveillance during a test. Written instructions were developed with our technology center describing how to access the test and establish video- conferencing with a mobile-phone. The faculty developed processes for how a student could ask questions from the proctor during the test without disturbing other students synchronously logged on to the video call using the chat feature followed by a video-conferencing break out room dedicated to these interactions. It was important for all faculty to conduct remote proctoring in a consistent manner; hence, these materials and processes were carried throughout each course.

The most significant concern with remote proctoring was academic integrity. Despite having students attest to their commitment to integrity, faculty had little control over whether students had other means of augmenting their test taking such as other people in the room or learning aids posted out of view of the camera on their phone.

Remote proctoring is here to stay but this is an opportunity to create a more robust remote testing environment, as well as better multiple-choice, matching, and fill in the blank questions to reduce the risks of cheating. Development of artificial intelligence algorithms will allow us to personalize the testing experience and focus on targeted knowledge deficiencies among test takers. Until this technology becomes readily available, educators must endure the burden of creating challenging tests, evaluating results, and administering fair examination practices. We must also rely on students to maintain the code of academic integrity within their own home environments.

How have you mitigated the shift to an online testing environment and remote proctoring? Comment below and join the conversation.

Did you know that the Harvard Macy Institute Community Blog has had more than 300 posts? Previous blog posts have explored topics including designing programmatic assessment structures to support learning, engaging students virtually, and being together, when apart

Sunny G. Hallowell

Sunny G. Hallowell, PhD, APRN, PPCNP-BC (Educators ’21; Leaders ’21) is a health professions educator, researcher, and pediatric nurse practitioner. She is currently Associate Professor of Nursing at Villanova University. Sunny’s areas of professional interests include health services research, pediatric outcomes, and health care innovation. Sunny can be followed on Twitter