In the medical curriculum, viva voce is a crucial component of formative and summative assessment. However, despite many advantages, it also has some pitfalls. The primary objective of this study is to ascertain whether there is a significant difference in assessment between viva voce conducted using extempore questions and viva voce conducted using structured viva voce cards.This prospective observational study took place over a period of 3 months. Viva voce was conducted by four examiners in internal medicine among final-year students pursuing MBBS, initially in an unstructured manner using extempore questions, and later using structured questions of increasing difficulty in the form of printed cards. A theory examination was conducted before the viva voce. In addition, a feedback survey using a Likert scale questionnaire was conducted among the students and examiners to assess their perception.Students scored the best in unstructured viva, followed by theory and structured viva. There was a moderately positive correlation between unstructured and structured viva and theory scores. There was a poor correlation between viva and perception scores for both unstructured and structured viva. The examiners had a slightly more positive perception toward the unstructured viva method than the structured method.Unlike most studies in preclinical and paraclinical subjects, this study is a contradiction, with students scoring better in the unstructured method and faculty also showing a preference for the same. Further research is required on the effectiveness of both unstructured and structured viva in clinical settings.