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Amir H Sam,1 Emilia Peleva,1 Chee Yeen Fung,1 Nicki Cohen,2 Emyr W Benbow,3 Karim Meeran1 1Imperial College School of Medicine, Imperial College London, London, UK; 2King’s College London, London, UK; 3University of Manchester, Manchester, UKCorrespondence: Karim MeeranDepartment of Endocrinology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UKEmail k.meeran@imperial.ac.ukBackground: A solid understanding of the science underpinning treatment is essential for all doctors. Pathology teaching and assessment are fundamental components of the undergraduate medicine curriculum. Assessment drives learning and the choice of assessments influences students’ learning behaviours. The use of multiple-choice questions is common but is associated with significant cueing and may promote “rote learning”. Essay-type questions and Objective Structured Clinical Examinations (OSCEs) are resource-intensive in terms of delivery and marking and do not allow adequate sampling of the curriculum. To address these limitations, we used a novel online tool to administer Very Short Answer questions (VSAQs) and evaluated the utility of the VSAQs in an undergraduate summative pathology assessment.Methods: A group of 285 medical students took the summative assessment, comprising 50 VSAQs, 50 single best answer questions (SBAQs), and 75 extended matching questions (EMQs). The VSAQs were machine-marked against pre-approved responses and subsequently reviewed by a panel of pathologists, with the software remembering all new marking judgements.Results: The total time taken to mark all 50 VSAQs for all 285 students was 5 hours, compared to 70 hours required to manually mark an equivalent number of questions in a paper-based pathology exam. The median percentage score for the VSAQs test (72%) was significantly lower than that of the SBAQs (80%) and EMQs (84%), p