Effectiveness of Structured Online Assignments on Academic Performance and Learner Perceptions among Undergraduate Medical Students in Community Medicine: A GRAMMS-Compliant Convergent Mixed-Methods Study
Abstract
Background: Online formative assessment is gradually becoming an integral component of competency based medical education: however, there is limited research on structured online assessment tasks as a separate intervention within Community Medicine at an undergraduate level. Methods: The current study employed a concurrent mixed-methods approach following the Guidelines for the Reporting of A Mixed Methods Study (GRAMMS) protocol among 151 third-year MBBS students at a tertiary medical college in Tamil Nadu, India (March–July 2025). Weekly assignments in form of online cases based on homework assignment done independently outside college curriculum time by using Google Classroom over a period of three months were carried out. Pre- and post-intervention (Internal Assessment 1/IA1, Internal Assessment 2/IA2) marks scored out of 80 with similar set of MCQs, short questions and case studies having identical syllabus content but parallel questions in both sets were compared using paired ‘t’ test. Results: The mean IA score rose from 43.96 ± 15.03 (54.9% of 80) to 47.78 ± 10.68 (59.7% of 80) after the intervention, a mean improvement of 3.82 points (t(150) = -3.73, p<0.001; Cohen’s d = 0.29, small-to-moderate effect). Accessibility/ease of submission was the most important facilitator factor (Smith’s S = 0.320), while connectivity/internet issues emerged as the most important barrier. In terms of pairwise ranking, personalised learning came out as the most valued attribute. Conclusion: Strategically constructed and learner-controlled online assignments led to a statistically significant and moderate improvement in academics. However, institutional interventions that address the issues of technical infrastructure, assessment validity and topical diversity are required to enhance this pedagogy in Community Medicine programs.