A systematic review to compare open and closed book examinations in medicine and dentistry

Abstract

INTRODUCTION The COVID-19 pandemic resulted in a global lockdown of many countries, causing disruption in medicine and dentistry educational programmes. Examination formats were adapted to open book assessments to allow student progression. The aim of this review was to determine whether open book examinations (OBEs) have suitable evidence to support their inclusion alongside (or as a substitute for) closed book examinations (CBEs). METHODS In this systematic review, searches were conducted using the ERIC (Education Resources Information Center), MEDLINE® and Embase™ databases as well as the grey literature to identify articles that provided primary data on OBEs in medicine and dentistry programmes globally. In addition, reference lists of key papers were searched. Quality assessment was undertaken through an adapted appraisal tool. RESULTS Seven studies were included in the review. These comprised three randomised controlled trials, three non-randomised trials and one retrospective cohort study. All investigated OBEs in medicine. No studies were identified in dentistry. Learners reported a preference for OBEs. The use of resources was variable. However, this examination format resulted in higher mean scores than for CBEs. Clinicians reported using the same resources in OBEs as they do in their clinical practice, meaning the exam format may accurately represent the working environment. CONCLUSIONS OBEs can improve learner satisfaction, test higher order thinking skills and be a more accurate reflection of challenges encountered in clinical practice. They can help educators design assessments to fulfil regulatory requirements of students demonstrating independent clinical practice and their value should not be underestimated.

Assessment of an online open‐book examination in postgraduate dentistry

“…There are clear benefits to running examinations online for students and the academic institution, as identified in several systematic reviews. [13][14][15] The results of this analysis support the use of the OBO format.…”

“…A higher grade would be expected due to the format of online and open book being easier to access information, with less reliance on memory, and there being less stress and time pressure on candidates. 14,16 The data indicated that the difference between the written exam score and the assignment grade, which has always been in openbook format, reduced when the examinations also moved to the open-book format. This is as expected, as the two formats became similar.…”

“…There was a modest increase in grades with the open book by 2.2%, which was not statistically significant. A higher grade would be expected due to the format of online and open book being easier to access information, with less reliance on memory, and there being less stress and time pressure on candidates 14,16 …”

Evolving Assessment in Medical Education: Exploring the Role of Open-Book Examinations

“…While most of these educational transformations occurred out of urgency, many will probably remain, in a more refined form, as preferred methods of teaching and assessment in the future [22]. Furthermore, Dave and Durning [25] assert that the window of opportunity afforded during this period should be exploited to advance our comprehension of holistic student assessment.…”