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

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.