title: Tablet versus paper marking in assessment: feedback matters.
abstract: BACKGROUND
  The Objective Structured Clinical Examination (OSCE) is a cornerstone in healthcare assessment. As a potential tool for providing learner-centred feedback on a large scale, the use of tablet devices has been proposed for the recording of OSCE marks, moving away from the traditional, paper-based checklist.
  
  
  METHODS
  Examiner-recorded comments were collated from successive first year formative and summative OSCE examinations, with paper-based checklists used in 2012 and iPad-based checklists used in 2013. A total of 558 and 498 examiner-candidate interactions took place in the January OSCE examinations, and 1402 and 1344 for the May OSCE examination for 2012 and 2013 respectively. Examiner comments were analyzed for quantity and quality. A tool was developed and validated to assess the quality of the comments left by examiners for use as feedback (Kappa = 0.625).
  
  
  RESULTS
  A direct comparison of paper-based checklists and iPad-recorded examinations showed an increase in the quantity of comments left from 41 to 51 % (+ 10 %). Furthermore, there was an increase in the number of comments left for students deemed 'borderline': + 22 %. In terms of the quality of the comments for feedback, there was a significant improvement (p < 0.001) between comments left in written-recorded and iPad-recorded examinations.
  
  
  CONCLUSIONS
  iPad-marked examinations resulted in a greater quantity and quality of examiner comment for use as feedback, particularly for students performing less well, enabling tutors to direct further learning for these students.
authors.affiliation: Institute of Education in Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. Alan.denison@abdn.ac.uk.
authors.forename: Alan
authors.initials: A
authors.lastname: Denison
authors.affiliation: Institute of Education in Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Bate
authors.affiliation: Institute of Education in Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Thompson
keywords: Assessment; Feedback; OSCE; Technology; Undergraduate medical education