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Literature on School Education, Quality, and Outcomes: A Review

• First Online: 27 September 2017

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• Charu Jain 3 &
• Narayan Prasad 4  

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To understand why it is essential to invest in education and at what level of education, various research scholars across the globe have conducted research studies and have tried to analyse the relationship between educational performance indicators and socio-economic outcomes in developing the methods of measuring quality of education and identification of its determinants. This chapter reviews the literature of such noteworthy studies. However, it has been noted that in the absence of qualitative indicators of education, most researchers have used quantitative indicators as a base for doing these analyses. Although most of the research work in this area has been conducted at global level, we have tried to present a few Indian cases as well to identify what has already been done and what needs to be done.

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National Council of Applied Economic Research, New Delhi, Delhi, India

School of Social Sciences, Indira Gandhi National Open University (IGNOU), New Delhi, Delhi, India

Narayan Prasad

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Jain, C., Prasad, N. (2018). Literature on School Education, Quality, and Outcomes: A Review. In: Quality of Secondary Education in India. Springer, Singapore. https://doi.org/10.1007/978-981-10-4929-3_3

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DOI : https://doi.org/10.1007/978-981-10-4929-3_3

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In This Article Expand or collapse the "in this article" section Case Study in Education Research

Introduction, general overview and foundational texts of the late 20th century.

• Conceptualisations and Definitions of Case Study
• Case Study and Theoretical Grounding
• Choosing Cases
• Methodology, Method, Genre, or Approach
• Case Study: Quality and Generalizability
• Multiple Case Studies
• Exemplary Case Studies and Example Case Studies
• Criticism, Defense, and Debate around Case Study

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• Data Collection in Educational Research
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Case Study in Education Research by Lorna Hamilton LAST REVIEWED: 27 June 2018 LAST MODIFIED: 27 June 2018 DOI: 10.1093/obo/9780199756810-0201

It is important to distinguish between case study as a teaching methodology and case study as an approach, genre, or method in educational research. The use of case study as teaching method highlights the ways in which the essential qualities of the case—richness of real-world data and lived experiences—can help learners gain insights into a different world and can bring learning to life. The use of case study in this way has been around for about a hundred years or more. Case study use in educational research, meanwhile, emerged particularly strongly in the 1970s and 1980s in the United Kingdom and the United States as a means of harnessing the richness and depth of understanding of individuals, groups, and institutions; their beliefs and perceptions; their interactions; and their challenges and issues. Writers, such as Lawrence Stenhouse, advocated the use of case study as a form that teacher-researchers could use as they focused on the richness and intensity of their own practices. In addition, academic writers and postgraduate students embraced case study as a means of providing structure and depth to educational projects. However, as educational research has developed, so has debate on the quality and usefulness of case study as well as the problems surrounding the lack of generalizability when dealing with single or even multiple cases. The question of how to define and support case study work has formed the basis for innumerable books and discursive articles, starting with Robert Yin’s original book on case study ( Yin 1984 , cited under General Overview and Foundational Texts of the Late 20th Century ) to the myriad authors who attempt to bring something new to the realm of case study in educational research in the 21st century.

This section briefly considers the ways in which case study research has developed over the last forty to fifty years in educational research usage and reflects on whether the field has finally come of age, respected by creators and consumers of research. Case study has its roots in anthropological studies in which a strong ethnographic approach to the study of peoples and culture encouraged researchers to identify and investigate key individuals and groups by trying to understand the lived world of such people from their points of view. Although ethnography has emphasized the role of researcher as immersive and engaged with the lived world of participants via participant observation, evolving approaches to case study in education has been about the richness and depth of understanding that can be gained through involvement in the case by drawing on diverse perspectives and diverse forms of data collection. Embracing case study as a means of entering these lived worlds in educational research projects, was encouraged in the 1970s and 1980s by researchers, such as Lawrence Stenhouse, who provided a helpful impetus for case study work in education ( Stenhouse 1980 ). Stenhouse wrestled with the use of case study as ethnography because ethnographers traditionally had been unfamiliar with the peoples they were investigating, whereas educational researchers often worked in situations that were inherently familiar. Stenhouse also emphasized the need for evidence of rigorous processes and decisions in order to encourage robust practice and accountability to the wider field by allowing others to judge the quality of work through transparency of processes. Yin 1984 , the first book focused wholly on case study in research, gave a brief and basic outline of case study and associated practices. Various authors followed this approach, striving to engage more deeply in the significance of case study in the social sciences. Key among these are Merriam 1988 and Stake 1995 , along with Yin 1984 , who established powerful groundings for case study work. Additionally, evidence of the increasing popularity of case study can be found in a broad range of generic research methods texts, but these often do not have much scope for the extensive discussion of case study found in case study–specific books. Yin’s books and numerous editions provide a developing or evolving notion of case study with more detailed accounts of the possible purposes of case study, followed by Merriam 1988 and Stake 1995 who wrestled with alternative ways of looking at purposes and the positioning of case study within potential disciplinary modes. The authors referenced in this section are often characterized as the foundational authors on this subject and may have published various editions of their work, cited elsewhere in this article, based on their shifting ideas or emphases.

Merriam, S. B. 1988. Case study research in education: A qualitative approach . San Francisco: Jossey-Bass.

This is Merriam’s initial text on case study and is eminently accessible. The author establishes and reinforces various key features of case study; demonstrates support for positioning the case within a subject domain, e.g., psychology, sociology, etc.; and further shapes the case according to its purpose or intent.

Stake, R. E. 1995. The art of case study research . Thousand Oaks, CA: SAGE.

Stake is a very readable author, accessible and yet engaging with complex topics. The author establishes his key forms of case study: intrinsic, instrumental, and collective. Stake brings the reader through the process of conceptualizing the case, carrying it out, and analyzing the data. The author uses authentic examples to help readers understand and appreciate the nuances of an interpretive approach to case study.

Stenhouse, L. 1980. The study of samples and the study of cases. British Educational Research Journal 6:1–6.

DOI: 10.1080/0141192800060101

A key article in which Stenhouse sets out his stand on case study work. Those interested in the evolution of case study use in educational research should consider this article and the insights given.

Yin, R. K. 1984. Case Study Research: Design and Methods . Beverley Hills, CA: SAGE.

This preliminary text from Yin was very basic. However, it may be of interest in comparison with later books because Yin shows the ways in which case study as an approach or method in research has evolved in relation to detailed discussions of purpose, as well as the practicalities of working through the research process.

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Evolution of quality assurance practices in enhancing the quality of open and distance education in a developing nation: a case study

Asian Association of Open Universities Journal

ISSN : 2414-6994

Article publication date: 18 August 2022

Issue publication date: 5 October 2022

The purpose of this study is to look at the challenges and successes that the case institution has had in implementing and maintaining quality assurance (QA) processes. The study also looks into the role of QA techniques in improving an institution's performance in a developing country.

Design/methodology/approach

The research is qualitative. Nine significant persons were interviewed, including the institution's top administration, faculty members and related staff. Data were gathered to learn more about the background, incremental changes and numerous internal and external elements that influenced how QA was approached over time.

The findings revealed the challenges and experiences of the evolution of QA practices in the case institution. The results show the changes in QA practices regarding three aspects, including people, place and program of case institutions under three phases. During phases I and II, the adoption and upgradation of QA practices were very slow; phase III showed significant improvement in all three aspects. In addition, the positive impact of QA practices is evident in improving the performance of students and teaching and nonteaching staff of the case institution.

Practical implications

The findings of this research could aid open and distance learning (ODL) providers in other developing nations in understanding the challenges of such a system. It may also make it easier for other ODL providers to comprehend the QA-led success in stakeholder confidence, employability and reputation.

Originality/value

The research will give insights into how QA procedures are used and valued in ODL in developing nations.

• Quality assurance
• Developing economies
• Open and distance education
• Bangladesh Open University
• Performance

Ferdousi, F. , Ahmed, A. and Momen, M.A. (2022), "Evolution of quality assurance practices in enhancing the quality of open and distance education in a developing nation: a case study", Asian Association of Open Universities Journal , Vol. 17 No. 2, pp. 147-160. https://doi.org/10.1108/AAOUJ-02-2022-0025

Emerald Publishing Limited

Copyright © 2022, Farhana Ferdousi, Amir Ahmed and Md Abdul Momen

Published in the Asian Association of Open Universities Journal . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) license. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this license may be seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

Higher education faces numerous interconnected challenges, including limited access to tertiary level institutions, insufficient funding, inadequate information communication technology (ICT) infrastructure and low research output ( Mannan, 2015 ). Particularly in developing countries, educational systems face a variety of challenges. It includes rising costs due to fiscal constraints, a lack of curriculum renewal, a lack of appropriate learning materials, a shortage of trained teachers, an insufficient level of systemic compatibility and inadequate teaching aids, all of which contribute to low-quality and ineffective education ( Dhawan, 2020 ). In addition, natural disasters such as COVID-19 have wreaked havoc on these countries' traditional face-to-face education infrastructures ( Churiyah et al. , 2020 ). Additionally, many groups, particularly the rural poor and disadvantaged, including women, have limited access to quality education. However, in these circumstances, the requirement for large numbers of people resulted in the concept of open and distance learning (ODL), which has developed into a critical component of higher education in both developed and developing countries ( Alhumaid et al. , 2020 ).

The concept of ODL focuses on open access to education and training to make the learners free from the constraints of time and place and offer flexible learning opportunities to individuals and groups of learners. However, the central purpose of ODL is to provide education to those who lack the opportunity to obtain formal education. In open education, there are no formal classroom practices and students focus on independent study. In addition, learning content, including lectures, is disseminated by correspondence, broadcast using electronic media or provided through a learning management system here. Distance education (DE) is seen as a cost-effective and efficient means of increasing access to education. While DE with its utilization of advanced communication technology is a unique tool to enhance the quality of education in various groups and areas of the country ( Arthur-Nyarko et al ., 2020 ), contemporary communication technologies also facilitate the reach of education to a large number of people who can learn in their place, pace and time ( Tomasik et al. , 2021 ).

ODL was initially criticized for its poor quality, its lower standards of students who enroll and being detrimental to higher education planning in the country ( Stella and Gnanam, 2004 ). Even after introducing several changes in course materials, curriculum and teaching methods, there is considerable controversy throughout academia and among employers about what constitutes quality in ODL and how to ensure it ( Devkota, 2021 ). Assuring the quality of education is a fundamental aspect of gaining and maintaining credibility for programs, institutions and national higher-education systems worldwide. Despite a long and generally successful track record, ODL is still required to prove that the quality of student learning is at least equivalent to face-to-face teaching ( Arkorful and Abaidoo, 2015 ). A robust quality assurance (QA) system can assist in accomplishing this. However, the interest of stakeholders in ODL has increased interest in QA. While some argue that ODL QA practices are comparable to those used in traditional education, others argue that ODL tests conventional assumptions and thus that current QA mechanisms are insufficient to ensure the quality of ODL ( Palvia et al. , 2018 ). On the other hand, QA is not an attempt to create quality but a systematic and comprehensive effort to improve it. QA aims to demonstrate and improve the quality of an institution's methods, educational products and outcomes. It includes developing and producing instructional materials, academic programs, services, support and student learning standards in ODL ( Margaryan et al. , 2015 ).

While there are a large number of studies ( Hoecht, 2006 ; Ryan, 2015 ; Kahveci et al. , 2012 ) that have focused on the practices of QA in the traditional education system, some studies have looked into the same from ODL ( Perraton, 2012 ; Darojat et al. , 2015 ; Kihwelo, 2013 ; Scull et al ., 2011 ; Stella and Gnanam, 2004 ). However, while some studies have concentrated on the nature and importance of ODL, some other studies ( Darojat et al. , 2015 ; Kihwelo, 2013 ; Scull et al ., 2011 ; Stella and Gnanam, 2004 ) have shown the use of QA in the context of ODL. In this respect, while previous studies ( Stella and Gnanam, 2004 ) are mostly based on developed countries, only a few studies ( Darojat et al. , 2015 ; Belawati and Zuhairi, 2007 ) have examined the use of QA in ODL from a developing country's perspective. Available evidence indicates that the acceptance of ODL differs from country to country. In some developed countries, including the USA, Australia and the UK, stakeholders recognize the off-campus degrees considerably ( Stella and Gnanam, 2004 ), while the situation is different in some European countries where ODL promoters are struggling to gain acceptance of ODL. While the open university was introduced as an Apex Body in a developing country like India, Bangladesh is still concerned about the broader acceptance of ODL despite some positive changes being apparent in recent times during COVID-19 ( Churiyah et al. , 2020 ).

However, the focus on a developing country like Bangladesh is necessary due to its unique environment. It differs from developed countries in terms of opportunities, facilities, technological advancement, etc. ( Dhawan, 2020 ). Accordingly, a specific QA strategy is not universally adaptable because the DE “outfit” differs widely from institution to institution and from one country to another. This warrants that the pace of development and process of maintenance of QA in ODL be flexible ( Arthur-Nyarko et al ., 2020 ). This study, therefore, explores the experiences of incorporating QA practices in the Bangladesh Open University (BOU), the only open and distance education (ODE) provider in Bangladesh. In addition, this study further contributes to the literature by addressing the following research question:

What are the experiences of BOU in adopting and maintaining QA practices?

To explore the experiences of BOU in adopting QA practices;

To explore the experiences of BOU in maintaining QA practices;

To explore the impact of QA practices in enhancing the performance of BOU.

2. Context of QA practices in ODL and Bangladesh Open University (BOU)

While quality involves satisfying a defined standard in higher education, the quality of the inputs (e.g. staff, libraries, laboratory equipment and facilities) is generally assumed to determine the quality of its output (i.e. graduates and research).

However, recent studies argue that the quality inputs do not necessarily guarantee quality outputs; instead, it is critical to evaluate the outcome of the education, which is measured by students' learning achievement. A critical educational goal in higher education is to achieve high-quality teaching and learning or pedagogical techniques that result in student learning outcomes. Achieving high-quality teaching and learning requires a multidimensional approach that includes curriculum and course design, learning contexts, feedback, learning outcomes assessment, learning environments and student support services. In an ODL system, a comprehensive and integrated online student support system is mandatory to maintain the quality of ODL. ODL requires more endeavors in logistics, supply chain management and supporting activities, such as laboratories to support effective teaching and learning of science online at a distance. QA in the context of ODL requires a detailed examination of those characteristics that can give credibility to the various programs and products of ODL ( Tomasik et al. , 2021 ). With the increasing acceptance of ODL as widening access to education, it has become increasingly necessary that the QA process be developed and maintained if the ODL provision is relevant and more functional than the products recognized in the conventional higher learning in the emerging open learning environment ( Amin and Jumani, 2022 ).

Nevertheless, QA in ODL institutions has gained serious attention from institutions and stakeholders over a couple of decades. Accordingly, institutions began to redefine and revise their institutional missions, strategies and visions that address quality issues. While some studies have concentrated on exchanging ideas and experiences regarding the “best practices of QA implementation” in ODL contexts from around the world ( Tait, 1997 ), other studies examining the use of QA in Asian ODL have revealed significant variation in the level of QA practices ( Devkota, 2021 ). Therefore, considering the socioeconomic differences, this study focuses on exploring the experiences of BOU in adopting and maintaining the QA practices since its inception.

However, as students' backgrounds and needs diversify, BOU faces increasing pressure to accommodate the students' requests for flexibility. In this context, this institution has implemented QA practices as a cost-effective method and tool for addressing the ODL quality challenge. As in ODL, it is required to keep the quality concept in mind while developing and implementing systems, processes and procedures. In BOU, implementing QA principles in ODL was a monumental task as it required a great deal of effort, patience, socialization and training to ensure that innovation is a productive effort. However, BOU did not formulate a QA policy during its establishment, but the QA evolved along with its maturity. The formulation of the QA policy occurs at a later stage of its establishment based on the learners and institutional experience.

BOU was chosen as a case as it is the only university that provides both open and distance education (ODE) in Bangladesh and has experienced many challenges and changes from its inception. The institution was contacted via the registrar (hereafter “organization contact”). In examining the implementation of QA in BOU, 17 interviews were conducted over eight months with the university's key personnel ( Table 1 ) to explore the experiences in adopting and maintaining QA practices since its inception. Interviewees were selected based on their knowledge regarding the implementation of QA, and accordingly, two participants from top-level management, five administrative staff members, nine faculty members and one faculty member associated with the Institutional Quality Assurance Cell (IQAC) were interviewed. Interviewees were required to have had involvement with QA activities in the BOU, to have a minimum of five years' experience with the institution and to be willing to participate in the study. The case institution contact provided his support to find relevant respondents from different departments who met the aforementioned criteria.

A qualitative approach was used to better understand the experiences from the inception to date and the impact of using QA practices in enhancing the performance of the BOU. Using an interview schedule (open-ended questions), data were collected to obtain information concerning the context, gradual changes and various internal and external factors that brought such changes. The researchers collected data.

Meetings were held on the BOU campus using an interview guide. In order to gain an insight into the implementation process of QA, BOU's internal documents covering the last 10 years were also analyzed. The documents included BOU's meeting minutes, brochures and quality manuals. Prior consent was taken from the interviewees. Participants were offered the opportunity to interview in Bangla. Three participants chose to have the interviews conducted in Bangla, and the remaining participants chose the interviews to be conducted in English.

While participants were allowed to be interviewed in both Bangla and English, many respondents responded in English, and only a few respondents gave their responses in Bangla. Accordingly, the Bangla interviews were transcribed and translated. Data were analyzed using NVivo software (NVivo is a software program used for qualitative research, and it facilitates the analysis of text, audio, video and image data, including interviews, focus groups, surveys, social media and journal articles). While at the early stage of data analysis, the data were grouped into many codes. Finally, these codes were specifically categorized into different time phases such as phase I, phase II and phase III. The documents used included meeting minutes, bulletins and institutions' websites.

Furthermore, evidence was also collected from other records, including the University Grants Commission's (UGC's) instructions. The triangulation method was incorporated where the responses of the interviews and the documents collected from various sources and observations were compared ( McKinnon et al ., 2000 ). Using multiple data sources reduces the risk of a validity issue because it relates to different research contexts or information about the same comparable research. The reliability was ensured through the use of archival documents.

4. Case study

A case study is a standard research tool in the social sciences. Case studies are investigations into the causes of underlying concepts that focus on a specific person, organization or event. A case study is a detailed and in-depth examination of a person, group or event in contrast to a single vision of an individual obtained from a survey response or an interview; case studies capture a variety of viewpoints. The case study method allows for a better grasp of the subject at hand ( Bennett, 2004 ). It also reduces the possibility of prejudice by diluting the agenda of a single individual. The case study method is always preferable in education research for revealing a complex grasp of underlying phenomena ( Yazan, 2015 ). The research employs the case study technique for the study at hand, based on the preceding explanation. Here, for the underlying objective, the research works with BOU.

4.1 About the Bangladesh Open University

In 1992, BOU was the first and only university established to provide ODE in Bangladesh. As a public university initially, the BOU started with a minimal number of students and staff members, which eventually increased to 29,700 academic staff members and 574,000 students (website). This university uses a flexible mode of education delivery in providing education and training from anywhere at its own pace.

The focus of this university is to promote education through multimedia instruction at all levels of education in science, agriculture, humanities, social science, etc. It offers 56 formal academic programs, along with 19 nonformal programs (environmental protection, basic science, elementary mathematics, agriculture, bank service, marketing management, health nutrition, population and gender issues) where ICTs are the core to provide education. With a blended learning approach, the university's instructional system comprises mainly the development of instructional materials in modular form, delivery of the printed materials to the learners, face-to-face tutoring of students at selected tutorial centers (called study centers), online tutoring (for both national and international students) and delivery of learning materials through ICTs.

4.2 Phases of changes in QA practices in the BOU

4.2.1 phase i (embryonic): period from 1992 to 1995.

The first phase was the “embryonic” phase for the case institution [1] . From the inception to 1995, this period is considered as the phase I of BOU when QA practices were relatively weak compared to any other period (participant 1). This phase mostly emphasized the initial development of infrastructure including regional centers (RCs) [2] and subregional centers (SRCs) [3] in different parts of the country; study centers as well as administrative and academic building in the main campus. However, BOU faced numerous challenges in hiring desired academic and administrative staff (participant 1). Participants' views reveal that the low acceptance of ODL and lack of expertise in the management of the ODL system were the key challenges and impeding factors in ensuring quality at this phase. Moreover, initially, the tools, techniques and facilities to support every activity were in their infancy.

4.2.2 Phase II (evolution): initial QA framework of BOU (1996–2013)

While there was no QA framework found until the early stage of phase II, some extent of QA practices received attention at the later stage of this phase. However, during the second quarter of this phase, BOU adopted an “internal QA framework”. In this respect, BOU used to have a “needs analysis framework” to identify the needs and gaps regarding three components, that is, (1) people, (2) programs and (3) place. This framework aimed to identify the desired quality requirements and then analyze the gap between the expectation and reality. As mentioned by participant 1, the “needs analysis framework” includes identifying the QA practices needed for the people (academic staff, administrative staff and students); program (curriculum, module, teaching, learning other processes and procedures) and place (space and facilities).

… The critical challenge in quality improvement emerged from people with diverse backgrounds. The lack of adequate training to develop the required skill within the staff and academics also challenged the success of the ODL system.

…. classroom delivery is a crucial skill for a faculty member to enrich his[her] knowledge … …till 2013, the faculty members were more involved in preparing modules and undertaking exams and other duties only. It was a significant drawback in enhancing the faculty knowledge and skills.

… the previous selection process failed to ensure quality of staff, ……however, in many cases, staff were found inappropriate for the selected positions.

In addition, the diverse background of students with no admission test also led BOU to produce low-performing graduates. Participants believed that there was a lack of interactive communication between the students and tutors, which is considered one of the critical inhibiting factors against BOU's success (participant 9). However, until this phase, the “study centers” used to facilitate direct interaction between tutors and students only every week. Moreover, with respect to the people aspect, participants viewed that while there was a little arrangement for the development and incentive programs for the faculty members and staff (participants 1 and 8), phase II took a few initiatives, including faculty and staff development through allocating funds for both local and foreign training.

… though the development of a faculty member largely depends on research and training, these were received less priority.

Participants' views also suggest that the lack of research culture was a key to the demotivation of faculty involvement in research. Moreover, the easy promotion was also viewed as an inhibiting factor in this regard.

Moreover, some underminers operate in the shadows to demoralize QA issue processes by creating or exaggerating destructive features of the BOU-implemented change. Other teachers, particularly those who lack a firm understanding of the topic or the willpower to resist, may be readily persuaded to join the negative debate. The BOU's upper management takes the issue of challenging employees seriously. They discuss this conduct in private or public, as appropriate, and determine the underlying causes. Regarding QA practices, BOU established a tone and a standard of conduct. Peer pressures shape it so that tough people become accustomed to it (participants 5 and 9).

Nevertheless, along with the “program” aspect, the “place” also appears to have received moderate attention even though most participants recognized it as a key operational area that must be given attention in improving quality. As the participants viewed, while there were many “study centers” all over Bangladesh with inadequate facilities, the lack of a proper monitoring system was central to the quality problem. In addition, the “RCs” also received less attention from the authority. However, over time, the increased awareness regarding the necessity of physical facilities in increasing the quality of staff members, faculty members and students led the authority to improve the facilities of “RCs,” “subregional centers,” “study centers” and the main campus.

4.2.3 Phase III (matured): QA practices from the end of 2013 to present

… although the new selection and promotion processes were highly debated, these proved necessary for improving the quality of academic and administrative staff.

… the research grant was found as a motivating tool in increasing faculty involvement in research. The fund also motivated external researchers in conducting collaborative research.

Additionally, participants 9 and 16 emphasize the role of ranking in developing the institution's QA practices, notably in the growth of its people and processes. University rankings are growing increasingly popular and have extended globally. According to some scholars, rankings can help ensure that schools and universities are of high quality ( Pham, 2018 ). However, because the assessment tools are not as effective as they could be, mainstream university rankings do not increase the quality of higher education as much as anticipated ( Liu, 2020 ).

In addition, phase III showed significant attention in respect to “program” aspects. Participants' views expressed that while updating the curriculum did not get much priority in phase II, phase III brought remarkable changes. Participants revealed that the curriculum review received key priority where a committee comprising members from different departments used to discuss and thoroughly examine the curriculum for any change and improvements, including the content editing, the mode editing, the language editing, etc. The changes in the curriculum took place from 2014 to 2019 (participant 1) in different academic programs. Moreover, e-learning materials that are very popular with the learners were prepared to complement the self-learning material to enrich the learners' knowledge further. Participants' views suggest that the top management was inclined to continuously update the materials supplied to the distance learners, whether in print or electronic form. Participants' views also expressed that phase III shows considerable interest in equipping learners with better learning tools including high-speed internet, micro-SD cards containing video and audio programs inserted into mobile sets of students, which assist students even when they are off-line. The university also uses YouTube ( www.youtube.com/user/bdopenuniversity ) and BouTube ( www.boutube.com ) to help students by providing all necessary textbooks/modules.

Moreover, along with the previous system, a few more technology-based systems and application software programs were introduced to ensure smooth administrative services and provide better online services to students. In addition, at this phase, the expansion of academic programs has also been prioritized. At this stage, study centers in foreign countries received attention. As revealed from participant 3, centers were established in South Korea, four centers in Qatar and more are under consideration in the Middle East.

In addition, participant 7 brings up the issue of massive open online courses (MOOCs) as the key to accelerating the success of BOU's ongoing QA practices. MOOCs can give students access to the knowledge they might not have otherwise. They can also help people who cannot afford college ( Al-Rahmi et al. , 2019 ). MOOCs are an excellent way to get a nontraditional education online, and they can work well with traditional university education.

However, suitable and attractive infrastructure at phase III also got critical attention. Although the importance of the “place” aspect in the QA framework sparked various debates, BOU emphasized the development of good infrastructure and facilities to comply with the desired quality requirements. In line with that, BOU focused more on increasing the facilities of “study centers,” “RCs” and the main campus. However, in order to comply with the requirements of the government, during the later part of this phase, BOU established an IQAC with the financial and technical assistance from the UGC's Higher Education Quality Enhancement Project (see Figure 2 ).

The objective of IQAC is to promote a quality culture following national QA guidelines and international practices. Moreover, the focus was to ensure that the university's QA procedures were designed following the Quality Assurance Unit guidelines and national requirements. Additionally, the establishment of this cell focuses on developing, sustaining and enhancing the quality of education and public perception of the university through consistent QA practices and performance. It contributes to the development of the university's image in the eyes of stakeholders by ensuring transparency, accountability and sound management practices in all areas of administration and preparing the university to meet external QA and accreditation requirements. The cell also includes setting development goals and indicators of improvement in the educational and administrative functions of the organization. The cell develops the plan to achieve the government's desired goals, including identifying the problems by evaluating the overall features of the university's degree programs, curriculum, methods of teaching, teacher training, research activities and administrative activities. Based on these, BOU emphasized the following QA activities.

… the continuous QA practices may help BOU increase the ODL program's acceptance to a greater extent.

However, participants indicate that QA practices increased stakeholders' satisfaction, including the students, employers and regulatory bodies. Participants' views also mentioned that increased recognition is one of the critical indicators of the positive consequences of QA practices (see Figure 3 ).

5. Conclusion, implications and limitations of the study

This study aimed to analyze the experiences of implementing and maintaining the QA practices by BOU. Moreover, the study analyzes the impact of QA practices in enhancing BOU effectiveness. The findings show the importance of the role played by QA in increasing the effectiveness of the institution. The study contributes to two strands of literature: QM studies within the management literature and developing countries. It provides practical evidence on the challenges and experiences and how the emphasis on QA practices changed over time. Specifically, the findings provide an insight into the change that was made to the practices of BOU.

The analysis revealed that the changes in QA practices of the case institution mainly focused on three components, comprising people, program and place under three phases, including phase I, phase II and phase III. The result shows that the nature of ODL is different from that of traditional education, which causes unique challenges for BOU to manage quality. The QA practices in ODL and the traditional system are different in many ways, in terms of the qualification of academic and administrative staff, students' background, mode of education, teaching-learning methods, space and facilities, etc. However, the result reveals that there were no such QA practices during phase I; instead, this phase concentrated more on developing basic infrastructures. The emphasis was more on introducing the new model of the education system – the ODL approach to many students. The key challenges were attracting and recruiting desired candidates for the academic and administrative positions, the low acceptance of ODL and the lack of expertise in the management of the ODL system. The finding has also been supported by the scholars Kihwelo (2013) .

The study demonstrated that while the first stage of phase II was found to have no attention to QA practices, the later stage of phase II shows little to moderate attention to various aspects of QA practices. In this phase, a “needs analysis framework” was developed to identify the requirements of QA practices in terms of people (academic staff members, administrative staff members and students); program (curriculum, module, teaching, learning and other processes and procedures) and place (space and facilities). This framework helped the case institution in identifying the challenges, such as inexperienced academic and staff positions, diverse backgrounds of students with no admission test, lack of face-to-face interaction between teachers and students and rigorous recruitment and promotion process, which inhibit the desired quality.

Regarding the programming aspect, findings reveal that while the experienced faculty members from reputed universities were involved in preparing the modules, there was a lack of an initiative in regularly reviewing the curriculum and modules. However, the result shows that while there was little attention with respect to faculty training and research, a moderate level of improvement was mentioned at the later stage of this phase. Moreover, this phase pays moderate attention in increasing the facilities of its regional and study centers.

However, compared to phase I and phase II, phase III showed significant changes in QA practices in terms of all three aspects, including people, process and programs. The participants mentioned changes in terms of faculty recruitment and promotion; review of curriculum and modules; inclusion of modern tools and techniques in the mode of learning and teaching; rigorous training for faculty and staff development and availability of research grants. Finding suggests that following the aforementioned developments, a continuous improvement mechanism is developed after establishing IQAC. The IQAC led BOU in ensuring QA practices according to the national requirements. The analysis suggests that in an effort to enhance the acceptability of ODL to the stakeholders, BOU is preparing to apply for the accreditations. The findings indicate that any improvement is the result of awareness and intention of the top management. When top management understands the need and benefits of assuring quality, they can create a milestone. Therefore, it is imperative for the top management to create a systematic process to adopt QA practices and monitor the outcome on a regular basis.

The study extends the existing literature by exploring the experiences of implementing and maintaining the QA practices and the impact on the effectiveness of ODE in a developing country like Bangladesh. In particular, the analysis incorporates a qualitative approach to exploring the research objectives. In doing so, the findings assist the regulators and authorities of ODL providers in developing countries in understanding how to enhance the use and effectiveness of QA practices. The focus on a developing country was considered important as the use and effectiveness of QA in developing countries are different from those in developed countries due to the political, social and cultural environment. Moreover, while QA practices are prevalent in developed countries, institutions within developing economies experience difficulties incorporating such practices due to scant facilities, resistance and negligible investment in technologies. Similar results are observed in other developing nations, such as India. Even though institutions in underdeveloped nations endeavor to provide excellent education, each institution has its own contextual goals, norms and laws, budgetary constraints, security concerns and technical legacies ( Patra et al. , 2022 ). Consequently, the measures must consider the specific environment of the concerned institution. In addition, developing nations' governments must identify the issues that impede the institution's application of QA procedures and then develop the required measures to overcome these obstacles.

The study also extends the literature by providing an insight into the effectiveness of QA, in terms of increased recognition, employability and satisfaction of stakeholders. This implies that institutions should endeavor to make greater use of QA practices to provide better services, thereby enhancing the institution's image. This finding supports the previous studies by Tsekouras et al. (2003) .

However, the findings imply that QA is a never-ending process. If institutions simultaneously focus on improving three aspects, including people, processes and programs, it is possible to enhance the effectiveness of the institutions. Therefore, the institutions should endeavor to use QA practices to provide better services, thereby enhancing the institution's image, which also highlights the critical role of QA practices in enhancing performance.

The study has limitations. While the case study aimed to explore the changes in QA practices through a retrospective analysis of organizational participants' views of the changes, there is a possible risk of missing valuable information due to the inability of respondents to recall events. While such concerns were minimized by using multiple data sources, future research may extend the current study by investigating the findings in different research sites.

Internal needs analysis/gap analysis framework of BOU

QA framework during phase III

IQAC-induced QA practices

List of participants

The time period of each phase is on the basis of the discussion of the participants.

Regional centers (RCs) usually organize the admission tests and maintain linkage with study centers including local school, colleges and universities.

Here, the “people” refers to the internal and external stakeholders including governing council members, management team members, senior academic and students who are part of QA activities. The “program” refers to the processes, procedures and activities including curricular design, teaching and learning, governance systems, professional development of staff, research, student assessment, staff recruitment, student admission, institutional ceremonies and student support services. “Place” refers to the space and facilities which are required to support every activity.

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Impact of Policy Implementation on Education Quality: A Case Study on Philippines’ Low Ranking in International and Local Assessment Programs

• Updated as of 7:14 am April 3, 2023

Louie Benedict R. Ignacio The Department of Political Science Faculty of Arts and Letters, University of Santo Tomas

Andrea Gaile A. Cristobal The Department of Political Science Faculty of Arts and Letters, University of Santo Tomas

Paul Christian David The Department of Political Science Faculty of Arts and Letters, University of Santo Tomas

Corresponding Author: Paul Christian David, The Department of Political Science, Faculty of Arts and Letters, University of Santo Tomas, Espana, Manila Email :  [email protected]

Recommended Citation: Ignacio, L. B., Cristobal, A., David, P., (2022). Impact of Policy Implementation on Education Quality: A Case Study on Philippines’ Low Ranking in International and Local Assessment Programs. Asian Journal on Perspectives in Education, 3(1), 41-54

In the recent report released by the Programme for International Student Assessment (PISA), the Philippines was ranked as one of the lowest in Mathematics, Science, and Reading Comprehension among 79 participating countries. The country also ranked low in other assessment programs, including TIMSS, SEA-PLM, and NAT. Despite the educational reforms established to improve the Philippine Education System, the Philippines remains low and significantly below its neighboring countries regarding quality education. Therefore, this study (1) describes how the Department of Education has undertaken the objectives of R.A. 10533, (2) determines the effect of policy implementation on the ranking of Philippine education quality in local and international assessment programs through the perspective of education experts, and (3) identifies the importance of local and international assessment programs in analyzing the current condition of education quality in the Philippines. This research has employed a qualitative approach using thematic analysis on narratives coming from (1) DepEd-OUCI, (2) DepEd-BEA, and (3) Education Policy experts, as well as documents used by the Department of Education and the Curriculum Consultative Committee. This study concludes that there are still challenges plaguing the implementation process. Hence, the need for further improvement in certain aspects is enumerated in this research. Moreover, considerable discrepancies in the disorganized and incoherent implementation system amongst and within the Department of Education, administrators, and other stakeholders, as well as confounded policy interpretation due to system instability, were all deduced.

Curriculum, policy implementation, PISA, assessment, Enhanced Basic Education

Introduction

Due to the drastic changes in the educational system, online distance learning is one of the alternative modalities to sustain continuous educational programs during pandemics, which develops the new literacies in Information Communication Technology (ICT) necessary to improve 21st-century learning. The students practice 21st-century skills such as collaboration, communication, critical thinking, and creativity in instructional technological tools (Bedir, 2019; Budiarti et al., 2021; Hendy, 2020; Pardede, 2020). In online learning, the learners collaborate with their classmates through virtual meetings, email, messenger, and google and Microsoft collaboration links in online applications. Internet access is used for communication between the teacher and students and students to their fellow students by using varied technological applications that exchange information between the messenger and the receiver. At the same time, the learners practice critical analysis on how to manipulate technical tools with the procedural steps on how to use the learning materials. Also, the students become independent learners who discover and search the lessons with creativity and productivity. Thus, the learners become creative in operating computer-based learning in the classes where the learner construct their learning designs. Therefore, reviewing the learners’ online education skills is crucial in new normal times.

The United Nations released its Sustainable Development Goals in 2015, which are set to be provided with a plan of action coordinated by all participating countries towards achieving it by 2030. One of its goals is to guarantee an inclusive and good quality of education that will instill lifelong learning applicable to one’s daily life (UN, 2015). In addition, the United Nations intends to solve the issue of the growing problem of maleducation due to the unclear reception of formal learning as a fundamental human right and the discrepancy between the standard of basic education from a local and global standpoint (Thaung, 2018). To combat this problem, states, through accountability, coordination, and regular monitoring, reviewing, and financing, must be able to resolve the low quality of primary education, inequitable access to higher and technical vocational education, and ingraining of skills that can be used for work, inequality in gender, and education on global citizenship.

The Philippines is no exemption among countries experiencing the effects of the growing global recession. According to the World Bank (2019), a growing learning crisis exists in relatively emerging economies like the Philippines, Kenya, Tanzania, South American countries, etc. Because of this, the World Bank posited that the lack of substantial and extensive monitoring in policy and curriculum implementation is the root cause of a persistent global learning crisis.

National agencies such as the National Economic and Development Authority (NEDA) continuously campaign towards awareness and resolving the issue (Roldan, 2018). The highlight of the government’s actions was the enactment of the Enhanced Basic Education Act, or Republic Act 10533 last 2013, which sought to reform and improve the existing curriculum by adjusting the standards and principles that educational institutions must uphold to improve the quality of education in the Philippines and compete in a global scale. The Department of Education, the central agency for implementing the enumerated standards, was mandated by the law to partner with agencies like Commission on Higher Education (CHED) and Technical Education for Skills Development Authority (TESDA). Different local and international assessment programs were adopted to gauge the necessary actions, such as Programme for International Student Assessment, Trends in International Mathematics and Science Study, Southeast Asia Primary Learning Metrics, and National Achievement Test (Elliott, Stankov, Lee, & Beckmann, 2019).

However, despite the actions by the government and seven years of implementation of the law, there is minimal to no progress in terms of the quality of education manifested by the Philippines’ low ranking (Roman, 2019). It is for this reason that this study aims to know the impact of administrative negligence in terms of implementing Republic Act 10533 in the Philippines’ low ranking and why the Philippines is heading on a downward trajectory.

With the condition of the Philippine education system, it is evident that an aspect of the system needs to be checked to get into the cause of this issue. Hence, this study aims to determine the impact of implementing state education policy in the Philippines on international and local assessment programs. Specifically, this study intends to evaluate whether the objectives of R.A. 10533 are being emphasized by the Department of Education, determine the effect of policy implementation on the ranking of Philippine education quality in local and international assessment programs, and identify the importance of local and international assessment programs in analyzing the condition of education quality in the Philippines.

The study intends to provide an understanding of the importance of global consciousness in the decline of quality education in the country. Existing literature provided various approaches to factors that affect the student’s academic performance and determinants of quality education. However, these studies focus only on the environmental factors that affect the student’s academic performance and their linkage to the teachers’ quality of teaching. The lacking discussion led this study to focus on the Philippines joining PISA and SEA-PLM. Hence, the Top-Down Approach of the Implementation Process of Public Policy theory manifests an avenue for disseminating curricular data from the macro-institutions to its micro-counterparts (Marsh & Huberman, 1984). Also, the premise of this theory will aid in understanding that the interventions of the institutions and administrators play a considerable role in fulfilling the objectives of RA 10533 through standard monitoring and implementing procedures for education quality improvement. Furthermore, this research may be presented to the Department of Education to develop better policies for educational reforms since the study evaluates the government agencies’ compliance with curriculum implementation and its development based on the standards presented in Republic Act No. 10533.

This research has utilized the Top-Down Approach of Implementation, co-authored by Paul Sabatier and Daniel Mazmanian in 1979 in their journal article entitled, “The Conditions of Effective Implementations: A Guide to Accomplishing Policy Objective.” This theory considers policy framers as the principal element of the implementing process of a policy and takes policy implementation as an administrative and managerial process more than a politically motivated procedure (Sabatier & Mazmanian, 1979). This theory was created to respond to the growing dispersion of comprehension of the limited extent of applicable programs and types of policymaking and implementing institutions.

The Top-Down approach posits that decisions by government officials are the starting point of the policy implementation process (Sabatier, 1986). The framing of policies is succeeded by raising specific questions revolving around the process of implementation itself, such as the extent of the implementing action in achieving the goal, the extent of the impact of policy, aspects affecting the implementation, and the reformation of the policy based on responses that are given after undergoing a process of evaluation. This theory also argues that there are six (6) necessary conditions for a successful and efficacious implementation: (a) Obvious and stable provision of objectives; (b) Sufficient justification of causation; (c) Legalization of the implementing process to enhance the urgency for compliance of the officials and target groups; (d) Officials’ commitment to an effective and productive implementation; (e) Maintained political support from interest groups and constituencies; and (f) Socio-economic factors that may have an impact on the support of people to the policy. The discourse on its merit continues today since its publication (Bardach, 1978; Berman and McLaughlin, 1976; Elmore, 1978; Jones, 1975; Lance, Lautenschlager, Sloan, & Varca, 1989; Murphy, 1973; Pressman and Wildavsky, 1973). The applicative properties of the theory were already being tested in different fields to know the limits and boundaries of its capabilities, such as its application in disseminating curricular data from the macro-institutions to their micro-counterparts (Marsh & Huberman, 1984).

The premises of the Top-Down theory aided this study in arguing that the burden of advancing the policy and evaluation is on the educational institutions, i.e., the Department of Education and the whole Curriculum Consultative Committee, affirming that the knowledge in the national-scale curriculum implementation is the lead determinant of practical curriculum reformation. Using the approach, this study argues that enhancing the focus and attention of the national agencies in implementing the Enhanced Basic Education Act of 2013 can increase the ranking and rating of the Philippines in both local and international assessment programs.

Literature Review

Curriculum and Policy Implementation

The curriculum is a prime factor in enhancing students’ academic participation and performance (Yu & Mocan, 2019). It is a chosen, arranged, unified, and evaluative provision of experiences among students that will help them attain different learning objectives, resulting from development and maturation for its application in real-life situations (Mulenga, 2018). Thus, the educational system of the Philippines is no different from its neighboring countries because it also passed through phases of improvement due to the dramatic changes brought by educational evolution (Guzman, 2003). However, despite numerous educational reformations, it is still clear that any systematic change in the education system should be accompanied by a high level of pro-activity, which defines the system’s quality. It is a process that involves focusing on exceeding expectations, continuous development, and sharing responsibilities (Schargel, as cited in Guzman, 2003). Therefore, if the education system will firmly contribute to the improvement of a proper social order to fight social ills, then there should be a sustained re-examination of its retooling since it has become clear that reforms introduced at both national and local levels are geared toward the achievement of effectiveness, quality, responsiveness, and excellence (Guzman, 2003). Also, students who experience an improved curriculum have seen a significant improvement in interest and engagement in learning. It also manifested positive student development, resulting in better performance (Yu & Mocan, 2019). Therefore, in order for the Philippines to be as progressive as it can be and be globally competitive, the education curriculum shall adhere on a specific set of standards that the Department of Education, with its cooperation with Commission on Higher Education and Technical Education and Skills Development Authority, which includes the following: (a) Student-centered, inclusive and development-focused curriculum; (b) Curriculum shall always remain relevant, responsive to national issues and Research-based; (c) Curriculum shall be careful and sensitive to other culture; (d) Curriculum shall be based on the Philippine context but can compete with the global arena; (e) Curriculum shall apply constructivist, inquiry-based, reflective, collaborative and integrative form of pedagogies; (f) Curriculum shall impose a Mother-Tongue Based System of learning – starting from the language being used in their houses to a foreign language; (g) A spiral progression approach on the students mastery and skills of different lessons shall be applied in the curriculum; and (h) Different local areas shall be able to modify and bend the curriculum in accordance to their educational, social and cultural contexts (Enhance Basic Education Act of 2013). 

Policy implementation is a process of upholding the basic standards and principles of the curriculum and putting into practice a set of plans and programs that aims for a change to whom and where it will be applied (Fullan, 1982). Implementing the K to 12 program aims to improve the education system in the Philippines to advance and further the recognition of a globally competitive Filipino. In this goal, the students shall master the necessary skills to attain the demand of the global education system (Dizon et al., 2019). Under Rule II, Section 10 of the Implementing Rules and Regulations of the Enhanced Basic Education Act of 2013, the Department of Education, in its purpose of developing the curriculum, shall be governed by the following:

10.1 The devising of the curriculum itself in fulfillment of Section 5 of the Act, the DepEd is responsible for the liaison with both the CHED and TESDA to make a coordinated educational curriculum concurrent with the basic, tertiary, and technical-vocational education in generating globally competitive Filipino students.

10.2 In developing the enhancement of the curriculum, the Department of Education shall be guided by the prescribed standards and principles listed under Section 5 of the law.

10.3 The production and development of materials, such as locally produced teaching and learning sources, shall be highly promoted to strengthen the learning resource development and distribution systems at the regional and divisional educational units.

10.5 The essentiality of stakeholder’s engagement and association, not directly on the implementation of the Enhanced Basic Education Act, but for the assessment of what is there to be addressed.

Furthermore, Rule II, Section 30 mandates the key role of the DepEd, CHED, and TESDA in creating a mechanism and tactical plans for the transition towards achieving an Enhanced Basic Education within a 10-year cycle that will end in 2021-2022; on the other hand, Rule VIII, Section 33 orders the establishment of a “Joint Congressional Oversight Committee for Enhanced Basic Education which serves as the evaluation and assessment committee of the reports, including budgetary, facilities and curricular summaries. It was also delegated the responsibility of evaluating the progress and deficiencies in aspects that greatly affects the performance of the students, teachers, and other stakeholders. The said law also imposes the necessity for establishing a “Curriculum Consultative Committee” that is delegated the power to oversee the implementation and evaluate whether the newly developed curriculum adheres to the provisions of the law.

In addition, curriculum development in enhancing basic education focuses on professional development since it is deemed necessary to improve the students. However, policies that aim to improve the teaching profession lack continuous follow-ups on reforms, making the changes look fragmented and insufficient (Miço, 2019).  Thus, in addressing such challenges, CHED coordinated with DepEd to establish a curriculum that is both research-based and globally competitive. TESDA also participates in the curriculum’s implementation by ensuring that students can apply the knowledge handed by the curriculum through work (Martin, Patacsil & Nieva, 2019). With the help of these macro-agencies, the evaluation of the effectiveness of policy implementation will be acquired. According to Swarnakar, Singh, & Tiwari (2019), assessing the effectiveness of the policy implementation is vital to the pursuit of improvement and contextualization by identifying the lacking and excess factors that impede the supposed positive contribution of the policy itself to take place. Furthermore, by assessing the implementation procedure, the government will also be able to put light on the current conditions of the subject and target groups which necessitates deeper and more contextual attention and response to better the relationship between the macro and micro agencies.

Assessment Programs

Assessment programs compare the educational attainment of students of different countries to provide a direct response to education reforms. It is one of the best ways to determine whether the Philippine education system, through engaging both locally and internationally, is improving (Balagtas et al., 2019; Martens, Niemann, & Teltemann, 2016). International assessments for education became a globally accepted standard because of their extensive and far-reaching inference and indication for reorganizing and restructuring national education systems. It establishes an international benchmark for the theoretical and applicable understanding which influenced and dominated the ideas of educational policymakers and even researchers since it provides two purposes: (1) the data gathered can be used to impact and influence policymakers; and (2) it focuses on a high-performing country to set as an example for other countries to understand and imitate its success (Schmidt & Burroughs, 2016).

According to Balagtas et al. (2019), one of the best ways to determine whether the Philippine education system is improving in the present is through its performance in Trends in Mathematics and Science Studies (TIMSS). Therefore, countries that performed well on the mathematics and science examinations given by TIMSS are most likely also performing well on the PISA assessment (i.e., Hong Kong-China, Singapore, and Japan).

The ​​Southeast Asia Primary Learning Metrics is another large-scale assessment program designed to fit the contextual problems in education within the region; that will provide an opportunity for each participating country to determine the growing issues and resolve these in a manner that will improve the country’s education system.

The results of large-scale international assessments are putting pressure on participating countries to reshape their curriculum to adhere to the standards imposed by the Program (Fischman, Topper, Goebel, & Holloway, 2019). However, the pressure being felt did not reflect nor manifest the reformation of education in all these countries; instead, it paved the way for large-scale comparisons from regional to global standards. The problem is that many countries are not deliberately qualifying education as a priority, which engenders their education security despite having adequate financial resources (Tatarinov, V. V., & Tatarinov, V. S., 2020).

Methodology

This qualitative and exploratory paper is a case study focused on the government agencies’ engagement and participation in policy implementation and their adherence to the standards provided by Republic Act 10533. It analyzed documents about the transition from the Basic Education Curriculum to the Enhanced Basic Education Curriculum, progress reports from agencies subjected to the same law to oversee the policy implementation, and narratives from the Department of Education and different Education Policy experts. These data cannot be quantified and calculated by mere numbers hence, requiring an in-depth understanding for the establishment of more conclusive interpretation, especially the statements gathered from interviews which necessitates a more composite, rich, and multi-faceted approach.

This research gathered data from the statements from educational policy experts in the Philippines and the Department of Education Bureau of Education Assessment and Office of the Undersecretary for Curriculum and Instructions. Furthermore, a semi-structured interview was applied to the department representatives and the experts. In addition, reports and documents from the Curriculum Consultative Committee, the transition report from the Basic Education Curriculum to the Enhanced Basic Education Program, the midterm report from the Joint Congressional Committee, and the government agencies comprising the Curriculum Consultative Committee were utilized. Furthermore, the study was conducted using documents from 2016 to 2020 only since these are the succeeding years after the mandatory midterm report of the Department of Education as presented in the Congress of the Philippines. The researchers have also gathered data from the latest results coming from international and local assessment programs, including the PISA, TIMSS, SEA-PLM, and NAT.

Experts on education policy and policy implementation have provided insights regarding the Philippines’ current education status and the Department of Education as the mandated spearhead for education policy implementation. The criteria for choosing the Department of Education as a respondent were embedded in Section 5 of RA 10533. As for the educational policy experts, they should at least attain a master’s degree in Educational Administration or Education Management and Leadership with 10-year experience in the field. In addition, the experts should also reach Level 7 or Level 8 of education following the Philippines Qualifications Framework, which is responsible for establishing the national standards for education and training outcomes (Resolution No. 2014-03, 2014).

Content analysis was used to simplify the data collected from statements and documents from government agencies and congressional committees. The researchers read through the documents collected from the various data sources to create a margin note in formulating initial codes using Microsoft Excel and a code book. This was applied for qualitative data analysis to help the researchers look for a thematic analysis of the study to have effective data management.

The data from the semi-structured interviews and document analysis were categorized according to variables. Hence, the data analysis concentrated on answering each research objective by focusing on the data collected from all methods of data collection.

The data gathered from the three education experts and the representatives of the Department of Education’s Bureau of Education Assessment and Office of the Undersecretary for Curriculum and Instructions have conveyed responses to the research objectives, classified as the following: (a) incoherent and disorganized system of implementations; (b) confound policy interpretation due to system instability; (c) assessment programs as performance indicators for policy improvement.

Incoherent and Disorganized System of Implementation

The experts have agreed upon the necessity of a holistic overview of implementing the education system, with Expert 1 mentioning that “It should be a chain. So, CHED’s teacher training should also be safeguarded there. The research skills, the critical analysis, should be focused and not memorization, the identification of frameworks, or memorization of valence or atomic number.” Expert 2 added, “My first issue is the language used for assessment. I think language plays a very vital role,” which emphasizes the factor of using the mother-tongue language in assessing the quality of education (Masaazi, Ssentanda, & Ngaka, 2018). While Expert 3 focused on the external factors that may have affected the student’s performance.

In response to the lack of a holistic education system, the Department of Education asserted its commitment to improving the implementation and the education system itself. The Office of the Undersecretary for Curriculum and Instruction (OUCI) stated that “…we are always mindful of the need to improve, so we have a very strong monitoring mechanism that allows us to continue to refine the existing programs and projects”, which is manifested on the “Sulong Edukalidad initiative which is our banner initiative to push for a higher attention to the need for quality education that is in the K to 12 program that was launched even before the release of the PISA results.”

The amount of emphasis that the Department of Education puts on the objectives of RA 10533 heavily affects the quality of education being imparted among students, resulting in difficulty maximizing capacity at the grassroots level (Barrot, 2018). Unfortunately, the Philippines is currently challenged by the disorganization and incoherence of the system of implementation of the Department of Education, manifested in many ways.

A gap between the intended curriculum and implementation of the national agencies based on their interpretation was raised by Expert 2, saying:

The curriculum is very beautiful. However, when it comes to the implementation, in the middle of the 3rd and 4th year, the expectation versus reality was far, that is one. I am saying that in that sense, there are quite some problems in terms of interpretation, even among regions and divisions; there are confusions in terms of interpretation, most especially in the classroom.

This has been seconded by Expert 3, who bureaucratized this interpretation system, pointing out the discretionary freedom of teachers within the classroom in interpreting the curriculum based on what they inferred as the best viable manner of teaching. 

The absence of an authentic assessment, as defined by Expert 2 as “the assessments that bring you into concretizing the knowledge into practical knowledge.” is also observable. This emphasizes the importance of veering away from the strictly theoretical focus of understanding into more applicative learning should be further enhanced by encouraging the students’ demonstration of higher-order thinking skills and better problem-solving skills (Koh, 2017).

However, amidst the vast agreement between the Department of Education and the Education experts, they have exhibited a certain level of a dispute regarding the cause and effect of frequent reformations in the education system. In defense of the DepEd, the OUCI has exclaimed the necessity of frequent reformations to cope with the dynamic system of education and cater to the rising needs of the department towards different aspects of education as time passes. They, therefore, see this as a necessity rather than an obstruction, with which Expert 1 disagreed. Expert 1 stated, “Because of so many reforms, is something happening? Yes, something is happening. However, I felt like it was just going to happen again and again that there will be a change once every six years.” This only means that the previous challenges were not used as a deterrent, causing the country to miss many opportunities. Expert 2 recommends having a road map to secure a more consistent and continuous implementation of the curriculum regardless of who is seated as the Department Secretary or the President. At large, the agreements still managed to outweigh the disagreements that occurred.

To further solidify the statements given, government documents have shown several points leading to the claims of the experts and the DepEd representatives regarding the aspects that need to be addressed. For example, the Transition Report on Enhanced Basic Education raised the need to strengthen the curriculum further regarding contextualization, learning opportunities, and inclusive participation. Moreover, the DepEd also ensures the actualization of the intended curriculum, as evident in the Curriculum Guides through a strong Curriculum Support System. Also, the Basic Education Monitoring and Evaluation Framework presented key education objectives with the learner’s characteristics as the leading indicators of success.

Confound Policy Interpretation Due to System Instability

The quality of education, as manifested in different assessment programs, has been compromised due to the impact caused by problems plaguing the implementation process of DepEd and other agencies regarding policy interpretation. As stated, it is likely to face challenges regarding ensuring consistency in its delivery at the subnational level (Norris et al., 2014).

The data gathered shows that there are significant disagreements in some critical respects between the Department of Education and the experts since, according to the Department of Education, liaising between agencies is not a problem but more of a challenge “in terms of unifying the focus of everyone on the more essential aspects that will help to develop high performing teachers, highly committed and highly competent teachers.” Also, for the DepEd, it is necessary to intensify capacity-building, and “there is still room for improvement in terms of current efforts at coordinating and harmonizing the priorities of CHED, TESDA, and even the PRC.” As for the experts, the coordination between DepEd and CHED was seen as both a challenge and a problem because, as Expert 3 stated, even if “the DepEd restructures the system, and they fix the governance system to make sure there is cooperation among agencies. The communication between DepEd and CHED should still be strengthened”. After all, the expected knowledge, skills, and competencies that should develop in the students’ basic education deemed necessary for higher education are not adequately achieved.

Furthermore, to be as impactful as possible, educational policies should move beyond mere “paper compliance,” which only aims to meet the minimal requirements. The Department of Education acknowledged a problem regarding policy implementation, stating that implementation is their weakest point that needs to be addressed immediately.

Although the DepEd acknowledges the effort to change its ways, Expert 2 reiterated the focus of DepEd on paper compliance, stating that:

The government agencies are paper champions. They produce reports, but it is not validated on the ground. The problem is, there is a report, they were able to submit the reports, we can read the reports, some are quite acceptable, some are not so good, but the gap is what is happening? In the context of the ground.

With, Expert 1 further explained that it is not enough that we only look at the structures alone or the policies. We should also look at the policy actors since, as agents of policies, there should be an enhancement of leadership development to move away from the culture of mere compliance towards a culture of excellence and accountability. Also, according to Expert 2, “the only flaw is in terms of implementation, and there are qualified and good educators in the Philippines, the problem is in the learning transfer,” which can be seen in the lack of training in terms of usage which is a part of leadership management. Therefore, to have an effective educational reform, a strategic policy that is holistic and long-term is needed (Miço, 2019).

One factor that the experts also mentioned hinders the progress of the Philippines in terms of monitoring is the lack of necessary mechanisms that will monitor and categorize the data on a much larger scale. Fortunately, both the Experts and DepEd agreed that the country has not yet reached its limit in terms of implementation, therefore manifesting opportunities that will improve the implementing system.

Lastly, although the Midterm Report of the Department of Education and the Evaluation Report of the Curriculum Consultative Committee lean more toward supporting DepEd’s agenda towards compliance with RA 10533, House Resolution No. 473 generally backs up the experts toward a confounded policy implementation.

Performance Indicators for Policy Improvement

The Philippines’ participation in different international assessment programs, and the facilitation of the local ones, play an essential part in gauging the performance to determine the current and immediate condition of Philippine education quality.

Identifying the importance of local and international assessment programs with the current condition of education quality shows that as performance indicators for policy improvement, assessment programs are vital since they provide evidence that should be a part of the decision-making process in the government. However, the problem lies in the resistance of those in position to the results. According to Expert 2, “if you were given feedback, it means you have something to do,” and “they should not be threatened by a low score or a low ranking because it does not entirely reflect that you have failed, but simply that there is something that you need to address right now.” Therefore, for Expert 3, “you cannot start the learning process if you do not own up to the mistake or failure.” Moreover, even the Department of Education agreed that:

We have to continue providing benchmarks to determine whether what we are doing is slowly delivering the impact or the results that we want to accomplish. Otherwise, we would not have the basis to say that improvements are being recorded, although we would still have the national assessments as a mechanism to measure on my part, although the secretary’s open to the idea of resting for a while in terms of taking part in the PISA but my take is we must continue because the benchmark has to be there.

Moreover, assessment programs as a problem indicator are essential for policymakers because the results of assessments are “a good measurement in determining the immediate condition of our system, and it is also a predictor” as Expert 2. In addition, indicators have a significant role in policy monitoring by producing unbiased and objective observations on the progress toward policy objectives. Assessment programs as problem indicators are a quantitative presentation of the conditions in a policy field that can be used as an instrument to inspect further and delve into the effects of policies and provide information for policymakers to determine the effectiveness of policies and to make any adjustments where it is required (Schumann, 2016). Hence, for Expert 3, “for a reasonable and logical policy maker, all evidence should be part of the decision-making process, what to do, what not to do” since it shows the problem in the educational system and assessment programs also provide straightforward suggestions. Also, the Department of Education (DepEd) stated that “if those flaws are eliminated, potentially, the quality of education that we have might also improve.”

Also, assessment programs are necessary for evidence-based policymaking because they generate policy recommendations. For Expert 3, “we need to emphasize that when we talk about curriculum implementation, assessment, especially third-party assessments, these are part of the evidence-based policymaking and being a responsible policy maker. You should not omit evidence simply because it does not sit well on you on a personal level”. Therefore, assessment programs empowered the education system by providing evidence-based analysis of students’ academic performance to improve the country’s educational policies, as evidence-based policymaking has seen significant advancements even at the local levels. Even the DepEd recognizes the importance of both international and local assessment programs because:

These assessments, their objective, are external to the learning delivery, and they are external to the department. Besides they follow high-quality protocols, like, following the line of testing and measurement, have protocols that we follow, and they are fair because of their objective. They want to improve SDG 4, or sustainable development goal 4, which is quality education.

This study concludes that there are still numerous challenges afflicting the implementation process, hence a hindrance to achieving the objectives of the Enhanced Basic Education Act of 2013. Despite the pieces of evidence provided by the documents, implying the commitment of the different agencies to achieving a good quality of education, the data coming from the experts have directed the root of the problems towards the misalignment and misinterpretation of the process of implementing and monitoring of the policies and not on the policy per se. The researchers have therefore navigated towards the role of the involved government agencies in the achievement of an enhanced basic education curriculum and a significant improvement of the Philippines in both international and local assessment programs since, per the premises of Top-Down theory, the weight of developing the policy and evaluation is on the educational institutions. Therefore, by enhancing the attention of national agencies in charge of the implementation process, the country’s ranking in assessment programs can significantly increase. This sheds light on a possible suggestion for the recalibration of the implementation and monitoring system to ensure that there is an existing universal understanding of the objectives and principles of both the Republic Act 10533 itself and other released orders from the Department of Education as an extension of their duty under the law. 

This study recommends that for subsequent research on educational policy, the gaps that the researchers identified in the literature should be addressed, which includes further research on the following: (1) the role of teachers in curriculum development and enhanced outcomes in assessment programs; (2) the gap between understanding the intended curriculum and implemented curriculum; (3) the detrimental effect of mere paper compliance about educational policies; and (4) future studies on other policies that focus on aspects that might affect the quality of education in the country. Also, as a recommendation to the Department of Education for the Improvement of the Policy Implementation Mechanisms, the following are being emphasized by the researchers: (a) creation of a roadmap for the implementation process of the Enhanced Basic Education Curriculum to ensure its continuity despite the inevitable change of administrators; (b) formation of leadership development training on structural leadership; (c) strengthening of the communication and cooperation of DepEd and CHED to achieve the goals of RA 10533; and (d) continuation of the Philippines’ participation in international assessment programs. Furthermore, to highlight the development of a more inclusive learning system, the following are also recommended: (a) establishment of different learning action cells; (b) adjustments in terms of the manner of training these teachers; and (c) refocusing and rechecking of Assessments Tasks to go beyond the traditional and theoretical forms of assessments, including Pen and Paper Tests, and adopt Authentic Assessments as a significant part of the curriculum.

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Author’s Bionote

Louie Benedict R. Ignacio, PhD is the Chair and an Assistant Professor in the Department of Sociology, University of Santo Tomas. He also teaches in the Department of Political Science of the same University and is a former President of the Philippine Sociological Society.

Andrea Gaile A. Cristobal is currently taking the Juris Doctor program at the University of Santo Tomas with developing interests in the field of public law and educational policy. She graduated Magna Cum Laude from the same University with the degree of Bachelor of Arts in Political Science and was awarded the Best Thesis.

Paul Christian David is currently taking the Juris Doctor program at the University of Santo Tomas with developing interests in the field of public law, and environmental and educational policy. He graduated Magna Cum Laude from the same University with the degree of Bachelor of Arts in Political Science and was awarded the Best Thesis.

ASIAN JOURNAL ON PERSPECTIVES IN EDUCATION

Far Eastern University Institute of Education FEU Campus, Nicanor Reyes Street, Sampaloc Manila, Philippines, 1015 Email:  [email protected]

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• Open access
• Published: 22 April 2024

Artificial intelligence and medical education: application in classroom instruction and student assessment using a pharmacology & therapeutics case study

• Kannan Sridharan 1 &
• Reginald P. Sequeira 1  

BMC Medical Education volume  24 , Article number:  431 ( 2024 ) Cite this article

Metrics details

Artificial intelligence (AI) tools are designed to create or generate content from their trained parameters using an online conversational interface. AI has opened new avenues in redefining the role boundaries of teachers and learners and has the potential to impact the teaching-learning process.

In this descriptive proof-of- concept cross-sectional study we have explored the application of three generative AI tools on drug treatment of hypertension theme to generate: (1) specific learning outcomes (SLOs); (2) test items (MCQs- A type and case cluster; SAQs; OSPE); (3) test standard-setting parameters for medical students.

Analysis of AI-generated output showed profound homology but divergence in quality and responsiveness to refining search queries. The SLOs identified key domains of antihypertensive pharmacology and therapeutics relevant to stages of the medical program, stated with appropriate action verbs as per Bloom’s taxonomy. Test items often had clinical vignettes aligned with the key domain stated in search queries. Some test items related to A-type MCQs had construction defects, multiple correct answers, and dubious appropriateness to the learner’s stage. ChatGPT generated explanations for test items, this enhancing usefulness to support self-study by learners. Integrated case-cluster items had focused clinical case description vignettes, integration across disciplines, and targeted higher levels of competencies. The response of AI tools on standard-setting varied. Individual questions for each SAQ clinical scenario were mostly open-ended. The AI-generated OSPE test items were appropriate for the learner’s stage and identified relevant pharmacotherapeutic issues. The model answers supplied for both SAQs and OSPEs can aid course instructors in planning classroom lessons, identifying suitable instructional methods, establishing rubrics for grading, and for learners as a study guide. Key lessons learnt for improving AI-generated test item quality are outlined.

Conclusions

AI tools are useful adjuncts to plan instructional methods, identify themes for test blueprinting, generate test items, and guide test standard-setting appropriate to learners’ stage in the medical program. However, experts need to review the content validity of AI-generated output. We expect AIs to influence the medical education landscape to empower learners, and to align competencies with curriculum implementation. AI literacy is an essential competency for health professionals.

Peer Review reports

Artificial intelligence (AI) has great potential to revolutionize the field of medical education from curricular conception to assessment [ 1 ]. AIs used in medical education are mostly generative AI large language models that were developed and validated based on billions to trillions of parameters [ 2 ]. AIs hold promise in the incorporation of history-taking, assessment, diagnosis, and management of various disorders [ 3 ]. While applications of AIs in undergraduate medical training are being explored, huge ethical challenges remain in terms of data collection, maintaining anonymity, consent, and ownership of the provided data [ 4 ]. AIs hold a promising role amongst learners because they can deliver a personalized learning experience by tracking their progress and providing real-time feedback, thereby enhancing their understanding in the areas they are finding difficult [ 5 ]. Consequently, a recent survey has shown that medical students have expressed their interest in acquiring competencies related to the use of AIs in healthcare during their undergraduate medical training [ 6 ].

Pharmacology and Therapeutics (P & T) is a core discipline embedded in the undergraduate medical curriculum, mostly in the pre-clerkship phase. However, the application of therapeutic principles forms one of the key learning objectives during the clerkship phase of the undergraduate medical career. Student assessment in pharmacology & therapeutics (P&T) is with test items such as multiple-choice questions (MCQs), integrated case cluster questions, short answer questions (SAQs), and objective structured practical examination (OSPE) in the undergraduate medical curriculum. It has been argued that AIs possess the ability to communicate an idea more creatively than humans [ 7 ]. It is imperative that with access to billions of trillions of datasets the AI platforms hold promise in playing a crucial role in the conception of various test items related to any of the disciplines in the undergraduate medical curriculum. Additionally, AIs provide an optimized curriculum for a program/course/topic addressing multidimensional problems [ 8 ], although robust evidence for this claim is lacking.

The existing literature has evaluated the knowledge, attitude, and perceptions of adopting AI in medical education. Integration of AIs in medical education is the need of the hour in all health professional education. However, the academic medical fraternity facing challenges in the incorporation of AIs in the medical curriculum due to factors such as inadequate grounding in data analytics, lack of high-quality firm evidence favoring the utility of AIs in medical education, and lack of funding [ 9 ]. Open-access AI platforms are available free to users without any restrictions. Hence, as a proof-of-concept, we chose to explore the utility of three AI platforms to identify specific learning objectives (SLOs) related to pharmacology discipline in the management of hypertension for medical students at different stages of their medical training.

Study design and ethics

The present study is observational, cross-sectional in design, conducted in the Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Kingdom of Bahrain, between April and August 2023. Ethical Committee approval was not sought given the nature of this study that neither had any interaction with humans, nor collection of any personal data was involved.

Study procedure

We conducted the present study in May-June 2023 with the Poe© chatbot interface created by Quora© that provides access to the following three AI platforms:

Sage Poe [ 10 ]: A generative AI search engine developed by Anthropic © that conceives a response based on the written input provided. Quora has renamed Sage Poe as Assistant © from July 2023 onwards.

Claude-Instant [ 11 ]: A retrieval-based AI search engine developed by Anthropic © that collates a response based on pre-written responses amongst the existing databases.

ChatGPT version 3.5 [ 12 ]: A generative architecture-based AI search engine developed by OpenAI © trained on large and diverse datasets.

We queried the chatbots to generate SLOs, A-type MCQs, integrated case cluster MCQs, integrated SAQs, and OSPE test items in the domain of systemic hypertension related to the P&T discipline. Separate prompts were used to generate outputs for pre-clerkship (preclinical) phase students, and at the time of graduation (before starting residency programs). Additionally, we have also evaluated the ability of these AI platforms to estimate the proportion of students correctly answering these test items. We used the following queries for each of these objectives:

Specific learning objectives

Can you generate specific learning objectives in the pharmacology discipline relevant to undergraduate medical students during their pre-clerkship phase related to anti-hypertensive drugs?

Can you generate specific learning objectives in the pharmacology discipline relevant to undergraduate medical students at the time of graduation related to anti-hypertensive drugs?

A-type MCQs

In the initial query used for A-type of item, we specified the domains (such as the mechanism of action, pharmacokinetics, adverse reactions, and indications) so that a sample of test items generated without any theme-related clutter, shown below:

Write 20 single best answer MCQs with 5 choices related to anti-hypertensive drugs for undergraduate medical students during the pre-clerkship phase of which 5 MCQs should be related to mechanism of action, 5 MCQs related to pharmacokinetics, 5 MCQs related to adverse reactions, and 5 MCQs should be related to indications.

The MCQs generated with the above search query were not based on clinical vignettes. We queried again to generate MCQs using clinical vignettes specifically because most medical schools have adopted problem-based learning (PBL) in their medical curriculum.

Write 20 single best answer MCQs with 5 choices related to anti-hypertensive drugs for undergraduate medical students during the pre-clerkship phase using a clinical vignette for each MCQ of which 5 MCQs should be related to the mechanism of action, 5 MCQs related to pharmacokinetics, 5 MCQs related to adverse reactions, and 5 MCQs should be related to indications.

We attempted to explore whether AI platforms can provide useful guidance on standard-setting. Hence, we used the following search query.

Can you do a simulation with 100 undergraduate medical students to take the above questions and let me know what percentage of students got each MCQ correct?

Integrated case cluster MCQs

Write 20 integrated case cluster MCQs with 2 questions in each cluster with 5 choices for undergraduate medical students during the pre-clerkship phase integrating pharmacology and physiology related to systemic hypertension with a case vignette.

Write 20 integrated case cluster MCQs with 2 questions in each cluster with 5 choices for undergraduate medical students during the pre-clerkship phase integrating pharmacology and physiology related to systemic hypertension with a case vignette. Please do not include ‘none of the above’ as the choice. (This modified search query was used because test items with ‘None of the above’ option were generated with the previous search query).

Write 20 integrated case cluster MCQs with 2 questions in each cluster with 5 choices for undergraduate medical students at the time of graduation integrating pharmacology and physiology related to systemic hypertension with a case vignette.

Integrated short answer questions

Write a short answer question scenario with difficult questions based on the theme of a newly diagnosed hypertensive patient for undergraduate medical students with the main objectives related to the physiology of blood pressure regulation, risk factors for systemic hypertension, pathophysiology of systemic hypertension, pathological changes in the systemic blood vessels in hypertension, pharmacological management, and non-pharmacological treatment of systemic hypertension.

Write a short answer question scenario with moderately difficult questions based on the theme of a newly diagnosed hypertensive patient for undergraduate medical students with the main objectives related to the physiology of blood pressure regulation, risk factors for systemic hypertension, pathophysiology of systemic hypertension, pathological changes in the systemic blood vessels in hypertension, pharmacological management, and non-pharmacological treatment of systemic hypertension.

Write a short answer question scenario with questions based on the theme of a newly diagnosed hypertensive patient for undergraduate medical students at the time of graduation with the main objectives related to the physiology of blood pressure regulation, risk factors for systemic hypertension, pathophysiology of systemic hypertension, pathological changes in the systemic blood vessels in hypertension, pharmacological management, and non-pharmacological treatment of systemic hypertension.

Can you generate 5 OSPE pharmacology and therapeutics prescription writing exercises for the assessment of undergraduate medical students at the time of graduation related to anti-hypertensive drugs?

Can you generate 5 OSPE pharmacology and therapeutics prescription writing exercises containing appropriate instructions for the patients for the assessment of undergraduate medical students during their pre-clerkship phase related to anti-hypertensive drugs?

Can you generate 5 OSPE pharmacology and therapeutics prescription writing exercises containing appropriate instructions for the patients for the assessment of undergraduate medical students at the time of graduation related to anti-hypertensive drugs?

Both authors independently evaluated the AI-generated outputs, and a consensus was reached. We cross-checked the veracity of answers suggested by AIs as per the Joint National Commission Guidelines (JNC-8) and Goodman and Gilman’s The Pharmacological Basis of Therapeutics (2023), a reference textbook [ 13 , 14 ]. Errors in the A-type MCQs were categorized as item construction defects, multiple correct answers, and uncertain appropriateness to the learner’s level. Test items in the integrated case cluster MCQs, SAQs and OSPEs were evaluated with the Preliminary Conceptual Framework for Establishing Content Validity of AI-Generated Test Items based on the following domains: technical accuracy, comprehensiveness, education level, and lack of construction defects (Table  1 ). The responses were categorized as complete and deficient for each domain.

The pre-clerkship phase SLOs identified by Sage Poe, Claude-Instant, and ChatGPT are listed in the electronic supplementary materials 1 – 3 , respectively. In general, a broad homology in SLOs generated by the three AI platforms was observed. All AI platforms identified appropriate action verbs as per Bloom’s taxonomy to state the SLO; action verbs such as describe, explain, recognize, discuss, identify, recommend, and interpret are used to state the learning outcome. The specific, measurable, achievable, relevant, time-bound (SMART) SLOs generated by each AI platform slightly varied. All key domains of antihypertensive pharmacology to be achieved during the pre-clerkship (pre-clinical) years were relevant for graduating doctors. The SLOs addressed current JNC Treatment Guidelines recommended classes of antihypertensive drugs, the mechanism of action, pharmacokinetics, adverse effects, indications/contraindications, dosage adjustments, monitoring therapy, and principles of monotherapy and combination therapy.

The SLOs to be achieved by undergraduate medical students at the time of graduation identified by Sage Poe, Claude-Instant, and ChatGPT listed in electronic supplementary materials 4 – 6 , respectively. The identified SLOs emphasize the application of pharmacology knowledge within a clinical context, focusing on competencies needed to function independently in early residency stages. These SLOs go beyond knowledge recall and mechanisms of action to encompass competencies related to clinical problem-solving, rational prescribing, and holistic patient management. The SLOs generated require higher cognitive ability of the learner: action verbs such as demonstrate, apply, evaluate, analyze, develop, justify, recommend, interpret, manage, adjust, educate, refer, design, initiate & titrate were frequently used.

The MCQs for the pre-clerkship phase identified by Sage Poe, Claude-Instant, and ChatGPT listed in the electronic supplementary materials 7 – 9 , respectively, and those identified with the search query based on the clinical vignette in electronic supplementary materials ( 10 – 12 ).

All MCQs generated by the AIs in each of the four domains specified [mechanism of action (MOA); pharmacokinetics; adverse drug reactions (ADRs), and indications for antihypertensive drugs] are quality test items with potential content validity. The test items on MOA generated by Sage Poe included themes such as renin-angiotensin-aldosterone (RAAS) system, beta-adrenergic blockers (BB), calcium channel blockers (CCB), potassium channel openers, and centrally acting antihypertensives; on pharmacokinetics included high oral bioavailability/metabolism in liver [angiotensin receptor blocker (ARB)-losartan], long half-life and renal elimination [angiotensin converting enzyme inhibitors (ACEI)-lisinopril], metabolism by both liver and kidney (beta-blocker (BB)-metoprolol], rapid onset- short duration of action (direct vasodilator-hydralazine), and long-acting transdermal drug delivery (centrally acting-clonidine). Regarding the ADR theme, dry cough, angioedema, and hyperkalemia by ACEIs in susceptible patients, reflex tachycardia by CCB/amlodipine, and orthostatic hypotension by CCB/verapamil addressed. Clinical indications included the drug of choice for hypertensive patients with concomitant comorbidity such as diabetics (ACEI-lisinopril), heart failure and low ejection fraction (BB-carvedilol), hypertensive urgency/emergency (alpha cum beta receptor blocker-labetalol), stroke in patients with history recurrent stroke or transient ischemic attack (ARB-losartan), and preeclampsia (methyldopa).

Almost similar themes under each domain were identified by the Claude-Instant AI platform with few notable exceptions: hydrochlorothiazide (instead of clonidine) in MOA and pharmacokinetics domains, respectively; under the ADR domain ankle edema/ amlodipine, sexual dysfunction and fatigue in male due to alpha-1 receptor blocker; under clinical indications the best initial monotherapy for clinical scenarios such as a 55-year old male with Stage-2 hypertension; a 75-year-old man Stage 1 hypertension; a 35-year-old man with Stage I hypertension working on night shifts; and a 40-year-old man with stage 1 hypertension and hyperlipidemia.

As with Claude-Instant AI, ChatGPT-generated test items on MOA were mostly similar. However, under the pharmacokinetic domain, immediate- and extended-release metoprolol, the effect of food to enhance the oral bioavailability of ramipril, and the highest oral bioavailability of amlodipine compared to other commonly used antihypertensives were the themes identified. Whereas the other ADR themes remained similar, constipation due to verapamil was a new theme addressed. Notably, in this test item, amlodipine was an option that increased the difficulty of this test item because amlodipine therapy is also associated with constipation, albeit to a lesser extent, compared to verapamil. In the clinical indication domain, the case description asking “most commonly used in the treatment of hypertension and heart failure” is controversial because the options listed included losartan, ramipril, and hydrochlorothiazide but the suggested correct answer was ramipril. This is a good example to stress the importance of vetting the AI-generated MCQ by experts for content validity and to assure robust psychometrics. The MCQ on the most used drug in the treatment of “hypertension and diabetic nephropathy” is more explicit as opposed to “hypertension and diabetes” by Claude-Instant because the therapeutic concept of reducing or delaying nephropathy must be distinguished from prevention of nephropathy, although either an ACEI or ARB is the drug of choice for both indications.

It is important to align student assessment to the curriculum; in the PBL curriculum, MCQs with a clinical vignette are preferred. The modification of the query specifying the search to generate MCQs with a clinical vignette on domains specified previously gave appropriate output by all three AI platforms evaluated (Sage Poe; Claude- Instant; Chat GPT). The scenarios generated had a good clinical fidelity and educational fit for the pre-clerkship student perspective.

The errors observed with AI outputs on the A-type MCQs are summarized in Table  2 . No significant pattern was observed except that Claude-Instant© generated test items in a stereotyped format such as the same choices for all test items related to pharmacokinetics and indications, and all the test items in the ADR domain are linked to the mechanisms of action of drugs. This illustrates the importance of reviewing AI-generated test items by content experts for content validity to ensure alignment with evidence-based medicine and up-to-date treatment guidelines.

The test items generated by ChatGPT had the advantage of explanations supplied rendering these more useful for learners to support self-study. The following examples illustrate this assertion: “ A patient with hypertension is started on a medication that works by blocking beta-1 receptors in the heart (metoprolol)”. Metoprolol is a beta blocker that works by blocking beta-1 receptors in the heart, which reduces heart rate and cardiac output, resulting in a decrease in blood pressure. However, this explanation is incomplete because there is no mention of other less important mechanisms, of beta receptor blockers on renin release. Also, these MCQs were mostly recall type: Which of the following medications is known to have a significant first-pass effect? The explanation reads: propranolol is known to have a significant first pass-effect, meaning that a large portion of the drug is metabolized by the liver before it reaches systemic circulation. Losartan, amlodipine, ramipril, and hydrochlorothiazide do not have significant first-pass effect. However, it is also important to extend the explanation further by stating that the first-pass effect of propranolol does not lead to total loss of pharmacological activity because the metabolite hydroxy propranolol also has potent beta-blocking activity. Another MCQ test item had a construction defect: “A patient with hypertension is started on a medication that can cause photosensitivity. Which of the following medications is most likely responsible?” Options included: losartan, amlodipine, ramipril, hydrochlorothiazide, hydrochlorothiazide/triamterene. The explanation states that hydrochlorothiazide (HCTZ) can cause photosensitivity, which is increased sensitivity to sunlight that can cause skin rashes and sunburns. Losartan, amlodipine, ramipril, and HCTZ/triamterene are less likely to cause photosensitivity. However, it is irrational to claim that HCTZ/triamterene, one of the wrong options, is less likely to cause photosensitivity. The difficulty index of such test items is likely unacceptable in high-stake tests to make equitable psychometric decisions.

The responses from Sage Poe, Claude-Instant, and ChatGPT on guidance for standard-setting methods are listed in the electronic supplementary materials 13 – 15 . Sage Poe offered this information with the caveat that “the results of this simulation were purely hypothetical and do not reflect the actual performance of any real students”. The simulation estimates of examinees correctly answering test items ranged from 60 to 90% for the mechanism of action, 65–85% for pharmacokinetics, 60–80% for adverse reactions, and 75–90% for clinical indications of antihypertensives.

In contrast, Claude-Instant admitted that “Performing a full simulation with 100 medical students is beyond the scope of what I can do as an AI assistant. I can generate sample MCQ questions and answers, but I do not have access to a population of medical students to administer the questions. A true simulation that administers questions to real students and analyzes the results would require access to a database of medical students, a platform to deliver the questions, and code to analyze the responses. As an AI assistant, I lack these capabilities. While I cannot perform a full simulation, here are some considerations for administering MCQ questions to medical students: provide details on the purpose and instructions for the test to ensure students understand what is expected out of them; consider including some easier questions in addition to more challenging ones to boost students’ confidence and motivation; avoid ambiguous wording and ensure each question has only one unambiguously correct answer option; when analyzing results, look for questions factors that may have impacted performance, like unclear wording or answer options that are too similar. Focusing on weak questions can help improve future tests; compare performance across different student groups to identify areas where more teaching may be needed; provide detailed answer explanations and review sessions after the test to help students learn from any errors and reinforce correct concepts”. However, ChatGPT offered the simulation result estimates for the 20 MCQ on antihypertensive drugs: mechanism of action ranged from 67 to 92%, pharmacokinetics 63–86%, adverse effects 65–82%, and clinical indications 64–89%. Furthermore, it also stated that “Overall, the performance of the students was quite good, with most questions having a response rate of over 70%. However, there were some questions where the projected correct response rate was rather low, such as Question #5 (Mechanism of Action of Hydrochlorothiazide; see Electronic Supplementary Material 12 ) and Question 18 (Indications for Verapamil; see Electronic Supplementary Material 10 ). This may suggest areas where students need more focused education or review.”

We asked AI assistants to generate 20 integrated case cluster MCQs with 2 test items in each cluster with five options for undergraduate medical students in the pre-clerkship phase integrating pharmacology and physiology related to systemic hypertension with a case vignette and the responses by Sage Poe, Claude-Instant, and ChatGPT are listed in the electronic supplementary materials ( 16 – 18 ). In all instances, the test items generated had focused case descriptions in the form of a clinical vignette, and horizontal integration across the pathophysiology of hypertension and pharmacology of antihypertensive drugs. These test items mostly targeted the ‘knows (knowledge)’ or ‘knows how (competence)’ level on Miller’s pyramid and are suitable for assessing the clinical competence of pre-clerkship medical students, especially in an integrated PBL curriculum. Both the AI assistants generated excellent clinical vignettes and themes; however, most of the cluster MCQs by ChatGPT had “None of the above” as an option, which is often considered a test item construction flaw. Notwithstanding these limitations, case cluster integrated test items are valuable for learners to integrate their knowledge of different basic medical sciences and their application to clinical sciences. This integrated approach can be used for both instructional and student assessment purposes to make the course more meaningful. Indeed, one of the basic tenets of PBL is curriculum integration.

In the next query, we asked AI assistants to write integrated case cluster MCQs with 2 test items in each cluster with 5 options for undergraduate medical students at the time of graduation integrating pharmacology and physiology of hypertension with a case vignette. The responses are listed in the electronic supplementary materials 19 – 21 . Claude-Instant has provided only partial responses to both the queries. Overall, the information provided in case vignettes requires the learner to interpret the clinical information and make therapeutic decisions. Such test items are appropriate for assessing the minimum competency of medical school graduates to start internship or residency programs; these MCQs are generally comparable to test items used in USMLE Part 2. The evaluation of the integrated case cluster test items provided by all the AI platforms is summarized in Table  3 . In general, the AI outputs had at least one construction defect, and did not include all the core sub-topics to a sufficient degree.

When asked to simulate the above-generated test items to 100 undergraduate medical students at the time of graduation and provide a percentage of students who are likely to correctly answer each item, the AI assistant responded:

“ As an AI language model, I cannot simulate the responses of 100 undergraduate medical students likely to obtain the correct answer for each question. However, I can provide some general information about the difficulty level of each question based on the complexity of the concepts being tested and the level of integration between pharmacology and physiology ”.

AI assistant went on to clarify that questions that require knowledge of basic pharmacology principles, such as the mechanism of action of specific drugs, are likely to be easier for students to answer correctly. Test items that require an understanding of the physiological mechanisms underlying hypertension and correlating with symptoms are likely to be more challenging for students. The AI assistant sorted these test items into two categories accordingly. Overall, the difficulty level of the test item is based on the level of integration between pharmacology and pathophysiology. Test items that require an understanding of both pharmacological and physiological mechanisms are likely to be more challenging for students requiring a strong foundation in both pharmacology and physiology concepts to be able to correctly answer integrated case-cluster MCQs.

Short answer questions

The responses to a search query on generating SAQs appropriate to the pre-clerkship phase Sage Poe, Claude-Instant, and ChatGPT generated items are listed in the electronic supplementary materials 22 – 24 for difficult questions and 25–27 for moderately difficult questions.

It is apparent from these case vignette descriptions that the short answer question format varied. Accordingly, the scope for asking individual questions for each scenario is open-ended. In all instances, model answers are supplied which are helpful for the course instructor to plan classroom lessons, identify appropriate instructional methods, and establish rubrics for grading the answer scripts, and as a study guide for students.

We then wanted to see to what extent AI can differentiate the difficulty of the SAQ by replacing the search term “difficult” with “moderately difficult” in the above search prompt: the changes in the revised case scenarios are substantial. Perhaps the context of learning and practice (and the level of the student in the MD/medical program) may determine the difficulty level of SAQ generated. It is worth noting that on changing the search from cardiology to internal medicine rotation in Sage Poe the case description also changed. Thus, it is essential to select an appropriate AI assistant, perhaps by trial and error, to generate quality SAQs. Most of the individual questions tested stand-alone knowledge and did not require students to demonstrate integration.

The responses of Sage Poe, Claude-Instant, and ChatGPT for the search query to generate SAQs at the time of graduation are listed in the electronic supplementary materials 28 – 30 . It is interesting to note how AI assistants considered the stage of the learner while generating the SAQ. The response by Sage Poe is illustrative for comparison. “You are a newly graduated medical student who is working in a hospital” versus “You are a medical student in your pre-clerkship.”

Some questions were retained, deleted, or modified to align with competency appropriate to the context (Electronic Supplementary Materials 28 – 30 ). Overall, the test items at both levels from all AI platforms were technically accurate and thorough addressing the topics related to different disciplines (Table  3 ). The differences in learning objective transition are summarized in Table  4 . A comparison of learning objectives revealed that almost all objectives remained the same except for a few (Table  5 ).

A similar trend was apparent with test items generated by other AI assistants, such as ChatGPT. The contrasting differences in questions are illustrated by the vertical integration of basic sciences and clinical sciences (Table  6 ).

Taken together, these in-depth qualitative comparisons suggest that AI assistants such as Sage Poe and ChatGPT consider the learner’s stage of training in designing test items, learning outcomes, and answers expected from the examinee. It is critical to state the search query explicitly to generate quality output by AI assistants.

The OSPE test items generated by Claude-Instant and ChatGPT appropriate to the pre-clerkship phase (without mentioning “appropriate instructions for the patients”) are listed in the electronic supplementary materials 31 and 32 and with patient instructions on the electronic supplementary materials 33 and 34 . For reasons unknown, Sage Poe did not provide any response to this search query.

The five OSPE items generated were suitable to assess the prescription writing competency of pre-clerkship medical students. The clinical scenarios identified by the three AI platforms were comparable; these scenarios include patients with hypertension and impaired glucose tolerance in a 65-year-old male, hypertension with chronic kidney disease (CKD) in a 55-year-old woman, resistant hypertension with obstructive sleep apnea in a 45-year-old man, and gestational hypertension at 32 weeks in a 35-year-old (Claude-Instant AI). Incorporating appropriate instructions facilitates the learner’s ability to educate patients and maximize safe and effective therapy. The OSPE item required students to write a prescription with guidance to start conservatively, choose an appropriate antihypertensive drug class (drug) based on the patients’ profile, specifying drug name, dose, dosing frequency, drug quantity to be dispensed, patient name, date, refill, and caution as appropriate, in addition to prescribers’ name, signature, and license number. In contrast, ChatGPT identified clinical scenarios to include patients with hypertension and CKD, hypertension and bronchial asthma, gestational diabetes, hypertension and heart failure, and hypertension and gout (ChatGPT). Guidance for dosage titration, warnings to be aware, safety monitoring, and frequency of follow-up and dose adjustment. These test items are designed to assess learners’ knowledge of P & T of antihypertensives, as well as their ability to provide appropriate instructions to patients. These clinical scenarios for writing prescriptions assess students’ ability to choose an appropriate drug class, write prescriptions with proper labeling and dosing, reflect drug safety profiles, and risk factors, and make modifications to meet the requirements of special populations. The prescription is required to state the drug name, dose, dosing frequency, patient name, date, refills, and cautions or instructions as needed. A conservative starting dose, once or twice daily dosing frequency based on the drug, and instructions to titrate the dose slowly if required.

The responses from Claude-Instant and ChatGPT for the search query related to generating OSPE test items at the time of graduation are listed in electronic supplementary materials 35 and 36 . In contrast to the pre-clerkship phase, OSPEs generated for graduating doctors’ competence assessed more advanced drug therapy comprehension. For example, writing a prescription for:

(1) A 65-year- old male with resistant hypertension and CKD stage 3 to optimize antihypertensive regimen required the answer to include starting ACEI and diuretic, titrating the dosage over two weeks, considering adding spironolactone or substituting ACEI with an ARB, and need to closely monitor serum electrolytes and kidney function closely.

(2) A 55-year-old woman with hypertension and paroxysmal arrhythmia required the answer to include switching ACEI to ARB due to cough, adding a CCB or beta blocker for rate control needs, and adjusting the dosage slowly and monitoring for side effects.

(3) A 45-year-old man with masked hypertension and obstructive sleep apnea require adding a centrally acting antihypertensive at bedtime and increasing dosage as needed based on home blood pressure monitoring and refer to CPAP if not already using one.

(4) A 75-year-old woman with isolated systolic hypertension and autonomic dysfunction to require stopping diuretic and switching to an alpha blocker, upward dosage adjustment and combining with other antihypertensives as needed based on postural blood pressure changes and symptoms.

(5) A 35-year-old pregnant woman with preeclampsia at 29 weeks require doubling methyldopa dose and consider adding labetalol or nifedipine based on severity and educate on signs of worsening and to follow-up immediately for any concerning symptoms.

These case scenarios are designed to assess the ability of the learner to comprehend the complexity of antihypertensive regimens, make evidence-based regimen adjustments, prescribe multidrug combinations based on therapeutic response and tolerability, monitor complex patients for complications, and educate patients about warning signs and follow-up.

A similar output was provided by ChatGPT, with clinical scenarios such as prescribing for patients with hypertension and myocardial infarction; hypertension and chronic obstructive pulmonary airway disease (COPD); hypertension and a history of angina; hypertension and a history of stroke, and hypertension and advanced renal failure. In these cases, wherever appropriate, pharmacotherapeutic issues like taking ramipril after food to reduce side effects such as giddiness; selection of the most appropriate beta-blocker such as nebivolol in patients with COPD comorbidity; the importance of taking amlodipine at the same time every day with or without food; preference for telmisartan among other ARBs in stroke; choosing furosemide in patients with hypertension and edema and taking the medication with food to reduce the risk of gastrointestinal adverse effect are stressed.

The AI outputs on OSPE test times were observed to be technically accurate, thorough in addressing core sub-topics suitable for the learner’s level and did not have any construction defects (Table  3 ). Both AIs provided the model answers with explanatory notes. This facilitates the use of such OSPEs for self-assessment by learners for formative assessment purposes. The detailed instructions are helpful in creating optimized therapy regimens, and designing evidence-based regimens, to provide appropriate instructions to patients with complex medical histories. One can rely on multiple AI sources to identify, shortlist required case scenarios, and OSPE items, and seek guidance on expected model answers with explanations. The model answer guidance for antihypertensive drug classes is more appropriate (rather than a specific drug of a given class) from a teaching/learning perspective. We believe that these scenarios can be refined further by providing a focused case history along with relevant clinical and laboratory data to enhance clinical fidelity and bring a closer fit to the competency framework.

In the present study, AI tools have generated SLOs that comply with the current principles of medical education [ 15 ]. AI tools are valuable in constructing SLOs and so are especially useful for medical fraternities where training in medical education is perceived as inadequate, more so in the early stages of their academic career. Data suggests that only a third of academics in medical schools have formal training in medical education [ 16 ] which is a limitation. Thus, the credibility of alternatives, such as the AIs, is evaluated to generate appropriate course learning outcomes.

We observed that the AI platforms in the present study generated quality test items suitable for different types of assessment purposes. The AI-generated outputs were similar with minor variation. We have used generative AIs in the present study that could generate new content from their training dataset [ 17 ]. Problem-based and interactive learning approaches are referred to as “bottom-up” where learners obtain first-hand experience in solving the cases first and then indulge in discussion with the educators to refine their understanding and critical thinking skills [ 18 ]. We suggest that AI tools can be useful for this approach for imparting the core knowledge and skills related to Pharmacology and Therapeutics to undergraduate medical students. A recent scoping review evaluating the barriers to writing quality test items based on 13 studies has concluded that motivation, time constraints, and scheduling were the most common [ 19 ]. AI tools can be valuable considering the quick generation of quality test items and time management. However, as observed in the present study, the AI-generated test items nevertheless require scrutiny by faculty members for content validity. Moreover, it is important to train faculty in AI technology-assisted teaching and learning. The General Medical Council recommends taking every opportunity to raise the profile of teaching in medical schools [ 20 ]. Hence, both the academic faculty and the institution must consider investing resources in AI training to ensure appropriate use of the technology [ 21 ].

The AI outputs assessed in the present study had errors, particularly with A-type MCQs. One notable observation was that often the AI tools were unable to differentiate the differences between ACEIs and ARBs. AI platforms access several structured and unstructured data, in addition to images, audio, and videos. Hence, the AI platforms can commit errors due to extracting details from unauthenticated sources [ 22 ] created a framework identifying 28 factors for reconstructing the path of AI failures and for determining corrective actions. This is an area of interest for AI technical experts to explore. Also, this further iterates the need for human examination of test items before using them for assessment purposes.

There are concerns that AIs can memorize and provide answers from their training dataset, which they are not supposed to do [ 23 ]. Hence, the use of AIs-generated test items for summative examinations is debatable. It is essential to ensure and enhance the security features of AI tools to reduce or eliminate cross-contamination of test items. Researchers have emphasized that AI tools will only reach their potential if developers and users can access full-text non-PDF formats that help machines comprehend research papers and generate the output [ 24 ].

AI platforms may not always have access to all standard treatment guidelines. However, in the present study, it was observed that all three AI platforms generally provided appropriate test items regarding the choice of medications, aligning with recommendations from contemporary guidelines and standard textbooks in pharmacology and therapeutics. The prompts used in the study were specifically focused on the pre-clerkship phase of the undergraduate medical curriculum (and at the time of their graduation) and assessed fundamental core concepts, which were also reflected in the AI outputs. Additionally, the recommended first-line antihypertensive drug classes have been established for several decades, and information regarding their pharmacokinetics, ADRs, and indications is well-documented in the literature.

Different paradigms and learning theories have been proposed to support AI in education. These paradigms include AI- directed (learner as recipient), AI-supported (learner as collaborator), and AI-empowered (learner as leader) that are based on Behaviorism, Cognitive-Social constructivism, and Connectivism-Complex adaptive systems, respectively [ 25 ]. AI techniques have potential to stimulate and advance instructional and learning sciences. More recently a three- level model that synthesizes and unifies existing learning theories to model the roles of AIs in promoting learning process has been proposed [ 26 ]. The different components of our study rely upon these paradigms and learning theories as the theoretical underpinning.

Strengths and limitations

To the best of our knowledge, this is the first study evaluating the utility of AI platforms in generating test items related to a discipline in the undergraduate medical curriculum. We have evaluated the AI’s ability to generate outputs related to most types of assessment in the undergraduate medical curriculum. The key lessons learnt for improving the AI-generated test item quality from the present study are outlined in Table  7 . We used a structured framework for assessing the content validity of the test items. However, we have demonstrated using a single case study (hypertension) as a pilot experiment. We chose to evaluate anti-hypertensive drugs as it is a core learning objective and one of the most common disorders relevant to undergraduate medical curricula worldwide. It would be interesting to explore the output from AI platforms for other common (and uncommon/region-specific) disorders, non-/semi-core objectives, and disciplines other than Pharmacology and Therapeutics. An area of interest would be to look at the content validity of the test items generated for different curricula (such as problem-based, integrated, case-based, and competency-based) during different stages of the learning process. Also, we did not attempt to evaluate the generation of flowcharts, algorithms, or figures for generating test items. Another potential area for exploring the utility of AIs in medical education would be repeated procedural practices such as the administration of drugs through different routes by trainee residents [ 27 ]. Several AI tools have been identified for potential application in enhancing classroom instructions and assessment purposes pending validation in prospective studies [ 28 ]. Lastly, we did not administer the AI-generated test items to students and assessed their performance and so could not comment on the validity of test item discrimination and difficulty indices. Additionally, there is a need to confirm the generalizability of the findings to other complex areas in the same discipline as well as in other disciplines that pave way for future studies. The conceptual framework used in the present study for evaluating the AI-generated test items needs to be validated in a larger population. Future studies may also try to evaluate the variations in the AI outputs with repetition of the same queries.

Notwithstanding ongoing discussions and controversies, AI tools are potentially useful adjuncts to optimize instructional methods, test blueprinting, test item generation, and guidance for test standard-setting appropriate to learners’ stage in the medical program. However, experts need to critically review the content validity of AI-generated output. These challenges and caveats are to be addressed before the use of widespread use of AIs in medical education can be advocated.

Data availability

All the data included in this study are provided as Electronic Supplementary Materials.

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RPS– Conceived the idea; KS– Data collection and curation; RPS and KS– Data analysis; RPS and KS– wrote the first draft and were involved in all the revisions.

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Sridharan, K., Sequeira, R.P. Artificial intelligence and medical education: application in classroom instruction and student assessment using a pharmacology & therapeutics case study. BMC Med Educ 24 , 431 (2024). https://doi.org/10.1186/s12909-024-05365-7

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Received : 26 September 2023

Accepted : 28 March 2024

Published : 22 April 2024

DOI : https://doi.org/10.1186/s12909-024-05365-7

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