Background: Computer-based assessments can improve quality and economy of university exams. Using the 'Online Examination System' (OES), for the first time questions can be implemented which are specifically designed to test the examinees' voice-related knowledge and skills in electronic exams of History, Theory and Ethics of Medicine on all taxonomy levels.

Aims: To meet the specific learning objectives and to increase exam quality and economy with regard to testing student pronunciation and listening skills, the OES was to be prepared to handle sound output and vocal input.

Method: The usage of headsets reduces the inevitably occurring acoustical disturbances caused by sound file replay. Problems of acoustic disturbances during vocal recordings can be overcome by introducing synchronized micro-exams at the beginning of the assessments.

Results: The majority of participating students accept these types of electronic exams. Evaluation procedures of the respective items still require human intervention, but are increased in objectivity due to anonymity. Accelerated exam compilation, less staff interaction and assessments on a high taxonomic level increase the exam efficiency and quality.

Conclusions: The integration of sound in- and output facilities in electronic assessment systems is capable of increasing both test economy and objectivity.