Medical students have taken unsupervised exams from home for what could be the first time, as universities move to new ways of assessing final-year students during the coronavirus shutdown.

Imperial College London put 280 sixth-year medicine undergraduates through two online exams last week, in what the university believes is a world first.

The move came amid growing clamour from students generally for final-year assessments to be postponed, with many expressing fears they would be disadvantaged by plans for wholesale online testing while campuses are locked down to prevent further spread of Covid-19.

Students from Oxford, Edinburgh, Bristol and University College London have followed an initial push by Cambridge undergraduates in calling for an overhaul of final-year assessments, proposing that they be given a choice between taking a mark based on work completed to date or sit exams later on. Yet with employers and professional bodies insisting that measures taken during the pandemic must not lead to lower standards, universities are likely to see Imperial’s strategy as a way forward.

“To the best of our knowledge, this is the first digital ‘open book’ exam delivered remotely for final-year students,” said Dr Amir Sam, Imperial’s head of undergraduate medicine. Open-book exams allow students access to any resource material they may need during the exam.

Students in their sixth year of medical studies logged in at 1pm on Wednesday and Friday to demonstrate their ability to diagnose a patient’s condition. They were presented with a patient and given their history, findings from clinical examination and data from investigations such as blood tests. They then had to answer 150 questions in three hours, meaning they had 72 seconds to answer each one.

“It wasn’t possible to answer questions that require putting all this information together by simply looking things up online,” Dr Sam said. “This is exactly like having a patient in front of you.”

Dr Sam said the medical profession had been nervous about open-book exams, fearing that students would cheat. “No one has ever been able to run these things before. No university has been brave enough,” he said. “The other thing we did was randomise the order of questions for each student. That made it impossible for them to help each other.”

No one has ever been able to run these things before. No university has been brave enough. Dr Amir Sam, head of undergraduate medicine

The papers are marked automatically online. “We are looking at the psychometric analysis of the data and comparing it with previous exams that were closed-book. If we show it has behaved in a similar way to a closed-book exam, then that is a new era for medical assessment.”

Online learning has become the new standard for education in just a few days, after Boris Johnson announced last Wednesday that all schools were to shut.

GCSEs and A-levels have been cancelled, but universities run their own exam systems independently, and many are struggling with the problem of how to assess students, particularly those due to graduate this year.

Some, including Glasgow, Birmingham, Bristol and Exeter, have said they will use online exams and other forms of remote assessment.

Some students believe that online exams are flawed. In an open letter to Professor Martin Williams, Oxford University’s pro-vice chancellor for education, more than 1,200 students, including almost 30% of this year’s finalists, warned: “Some students may not have a quiet environment in their homes to take a timed online exam and would prefer take-home exams. Yet others may need to take care of their ailing family members and have to delay their exams entirely.”

They called on the university to allow those due to graduate this summer to restart the final year in September or at Easter 2021, and to offer alternative assessments, such as vivas conducted via video, a portfolio of essays or coursework instead of exams, or postponing deadlines until after social distancing and quarantine measures have been relaxed.

Similar letters signed by 1,200 students at Edinburgh University and 1,000 from the Bristol University said students should be able to choose to take a mark based on their existing assessments or do an exam or essay if they wanted to improve it.

Those concerns were echoed by David Laws, the former education minister and now executive chairman of the Education Policy Institute. EPI research shows that by the time students finish their GCSEs, those eligible for free school meals are 18.1 months behind their classmates in English and maths attainment.

“Children from disadvantaged backgrounds are the ones who benefit the most from being in a school environment, where their needs can be supported,” Laws said. “They are the children who, when they go home because of the school closures, will face the most challenging learning circumstances because of a comparative lack of books, learning resources, IT and parents with the capacity to help. There is a real risk that if there is a prolonged school closure, it is going to hit the more vulnerable children the most.”

Yet universities also need to keep high standards, according to Katrina Smyth, head of quality and recognition at the Association of Chartered Certified Accountants, a position shared by other professional bodies, such as the Royal College of Veterinary Surgeons.

“We were very clear to universities that we will be flexible in our approach,” Smyth said. “What we would say is that standards have to be maintained. There must still be an assurance that students have met the learning outcomes in the modules.”

The University and College Union, which represents lecturers, said they needed to be involved in designing the new system.

“Staff, rather than managers with little or no experience in the classroom, must be central to the designing of any new systems as they know what will work best,” said Jo Grady, UCU’s general secretary. “As well as dealing with the academic challenges, we need to consider the extra demands on staff time for pastoral care and student welfare.”