Abstract
 Background: The study aimed to describe the procedures implemented by medical colleges in Pakistan to assure quality in their assessment system. Method: A qualitative study was conducted from March 2015-December 2017 in medical colleges of Pakistan using grounded theory design. The medical colleges were selected by using non-probability convenient sampling technique. Out of the total 93 PMDC (Pakistan Medical and Dental Council) recognized medical colleges, 49 were selected from all four provinces of Pakistan as well as Azad Kashmir. An open-ended questionnaire was filled by one faculty member from each participating medical college after obtaining informed consent. Data was analyzed using SPSS version 21 (IBM). Results: Majority participants appreciated their institution�s assessment policy and wished improvement in terms of comparability to national organization�s assessment systems. For about 1/3rd of participants developing standardized tools, their grading (e.g. SEQs), and faculty�s unwillingness to devote time for quality MCQ were the challenges. Recommendations by > 1/3rd to overcome barriers included one assessment per year, improvement in teaching methods, standardized assessment, and structured viva exams. In >1/2 institutions no audit of assessment process was conducted. Around 1/3rd confirmed audit was an irregular unplanned activity and no report published. Around 1/4th of participants highlighted that a formal audit report stemmed in improving teaching & examination methods. Conclusions: Overall Quality Assurance (QA) procedures in assessment system in Pakistan were poorly implemented. Lack of QA and Monitoring & Evaluation (M&E), feedback mechanism, benchmarks for assessors, and formal auditing was noted. Student�s involvement, & semester system was recommended.
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