Harnessing Oral Examinations as an Effective Performance-Based Assessment Tool

Why oral exams still matter

Oral examinations, known as viva voce, have been utilized since at least the early 19th century to evaluate learners through spoken questioning. Unlike written tests, oral exams allow examiners to explore a candidate’s depth of understanding, communication skills, and ability to articulate thoughts. They evaluate real-time reasoning, organization, and decisiveness, which are essential in fields like medicine and engineering. In contemporary health-professions education, most students have a positive view of structured oral exams: a 2024 survey of medical students revealed that 73% found their oral exam fair, and 80% stated it enhanced their understanding of clinical reasoning.

Problems with unstructured viva voce

Traditional, unscripted oral exams have issues with poor content validity and low inter-rater reliability. In the absence of a clear blueprint or scoring rubric, questions differ among candidates, and unconscious biases can affect scores. Meta-analytic data indicate that conventional viva exams typically have a Cronbach’s α of approximately 0.50, suggesting unreliable measurement. Students also express that unclear grading criteria and examiner subjectivity render unstructured oral exams stressful and unfair.

Structured and hybrid oral examinations

To tackle these challenges, educators have implemented structured and hybrid formats. In structured vivas, examiners use pre-set questions and a standardized rubric. Faculty who tested these exams found them to be significantly more objective and beneficial than traditional vivas. A meta-analysis spanning various disciplines showed a combined Cronbach’s α of 0.80 for structured vivas, compared to 0.50 for conventional ones, with about 80% of examinees considering them fair. Hybrid exams incorporate a standardized set of questions followed by a period of open dialogue. A study conducted in 2025 revealed that hybrid vivas provided better inter-examiner consistency (α ≈ 0.66) and were favored by 56% of students for balancing fairness with flexibility.

Structured oral exams may also help address inequities. At one U.S. medical school, students from underrepresented groups in medicine scored lower than their white peers on unstructured oral exams. After the school adopted a standardized format, the grading gap was eliminated. This indicates that transparent scoring rubrics and standardized questions can reduce bias and enhance fairness for all candidates.

Implementing better oral exams – and how technology can help

To update oral exams, educators should follow these steps:

• Define competencies and create a blueprint: Identify the areas to be assessed and develop a set of key questions with sample answers and clear scoring criteria.

• Provide examiner training: Faculty should be trained to consistently apply the rubric and avoid leading questions or unconscious biases.

• Use hybrid formats when appropriate: Integrating standardized questions with a short period of open questioning can mix objectivity with authentic dialogue.

• Give meaningful feedback: Oral exams allow for immediate formative feedback; examiners should discuss strengths and areas for improvement to support learning.

Need help with this? Contact Atomic Medical Education's Curriculum Team.

Atomic Examiner

Atomic Examiner by Atomic Medical Education is a cloud-based platform designed to modernize oral and OSCE-style exams. Instead of relying on impromptu viva questions, the software allows educators to create structured or hybrid assessments using standardized question sets and rubrics. Exams can be administered either remotely or on campus. Real-time feedback and analytics dashboards provide faculty with immediate insights into individual and class-wide performance, while secure cloud delivery and an accessibility-compliant design ensure fairness for all learners. For more information or to schedule a demonstration, visit Atomic Examiner.

Conclusion

Oral examinations are crucial for assessing communication skills, clinical reasoning, and professionalism. While unscripted viva voce can suffer from inconsistency and bias, structured and hybrid formats enhance reliability and fairness. Recent studies indicate that structured oral exams achieve high reliability (α ≈ 0.80) and are perceived as fair by most students. By using clear rubrics, providing examiner training, and employing tools like Atomic Examiner for automation and analytics, educators can create rigorous and equitable oral assessments. In the context of competency-based education, well-designed oral exams, bolstered by modern technology, serve as a powerful complement to written tests.

References

1. BMC Medical Education. Medical student perceptions of assessments of clinical reasoning in a general surgery clerkship (2024).

2. PMC. Faculty perspectives on the use of standardized versus non-standardized oral examinations to assess medical students.

3. PMC. Structured viva validity, reliability, and acceptability as an assessment tool in health professions education: a systematic review and meta-analysis.

4. BMC Medical Education. Enhancing medical assessment strategies: a comparative study between structured, traditional and hybrid viva-voce assessment (2025).

5. PMC. Standardized Oral Examinations Allow for Assessment of Medical Student Clinical Knowledge and Decrease Racial Grading Differences in a Surgery Clerkship.

6. PMC. Objective Structured Clinical Examination: The Assessment of Choice.