Influence of open- and closed-book tests on medical students' learning approaches

Med Educ. 2008 Oct;42(10):967-74. doi: 10.1111/j.1365-2923.2008.03125.x.


Context: Two learning approaches are consistently distinguished in the literature: deep and surface learning. The deep learning approach is considered preferable. Open-book tests are expected to stimulate deep learning and to offer a possible way of handling the substantial growth in medical knowledge. In this study we test the hypothesis that open-book tests stimulate deep learning more than closed-book tests.

Methods: Medical students in Years 2 (n = 423) and 3 (n = 306) participated in this study. They evaluated their preparation for open- and closed-book tests using the test for Deep Information Processing (DIP). This questionnaire consists of 24 items divided into three subscales: Critical Reading; Broaden One's Context, and Structuring. A paired t-test was used to analyse the data.

Results: Both cohorts scored significantly higher when preparing for closed-book tests for the overall DIP score and on the Broaden One's Context and Structuring scales. Year 3 students also scored significantly higher on the Critical Reading scale when preparing for closed-book tests. Gender differences were found: women used deeper learning approaches than men.

Conclusions: Our hypothesis was not supported. In fact, the opposite was found: closed-book tests stimulated a deep learning approach more than open-book tests. Three possible explanations are: deep learning is particularly necessary for remembering and recalling knowledge; students feel more confident when preparing for closed-book tests, and students are more motivated to study for closed-book tests. The debate on the concept of deep learning in higher education should probably be renewed.

MeSH terms

  • Adult
  • Cohort Studies
  • Education, Medical, Undergraduate / methods*
  • Educational Measurement / methods*
  • Educational Measurement / standards
  • Humans
  • Statistics as Topic
  • Students, Medical / psychology*
  • Surveys and Questionnaires
  • Textbooks as Topic