Preclinical Medical Students' Perceptions of Integrated Practical Examinations in a Resource-Limited Setting

Abstract

Background: Research on the use of structured assessments, such as the Integrated Practical Examination (IPE), in medical education in resource-limited settings remains limited, despite their crucial role in developing competencies. Little is known about the impact of IPEs on preclinical medical students in Iraq, particularly given the challenges posed by staffing and infrastructure constraints in this setting. Objectives: This study examined the perspectives of preclinical medical students toward IPE at Koya University, Iraq, with emphasis on its educational and psychological effects. Methods: First- and second-year medical students (n = 211) enrolled in a 2024 - 2025 IPE assessment were evaluated in a cross-sectional mixed-methods study. In the quantitative phase, a validated questionnaire (Cronbach's α = 0.74) was used to measure perceptions of organization, fairness, stress, and skill relevance. Data were analyzed using descriptive statistics, t tests, and chi-square tests. In the qualitative phase, free-text responses were collected using an open-ended question and analyzed thematically to capture students' perspectives. Results: Overall, students rated the IPE program highly, particularly with respect to staff helpfulness, organization, and clarity of directions. Second-year students reported significantly lower stress than first-year students (P = 0.032). Students preparing for foreign licensing examinations reported greater stress before the test (P = 0.0028) but rated the program's skill coverage more highly (P = 0.047). Qualitative analysis identified overarching themes highlighting key areas for improvement, particularly time limitations, station authenticity, and infrastructural inadequacies. Conclusions: The IPE was not merely an academic assessment; it also educated students about health, enhanced their resilience, improved their communication skills, and increased their awareness of health issues. Strengthening logistical support and optimizing station design could further improve the effectiveness of the IPE as a learning tool in resource-limited settings.