Comparison of Open-Book versus Closed-Book Assessments in Medical Students

Abstract

Background: In medical education, assessment is crucial as it quantifies student learning and helps direct their future academic growth. Closed-book assessment is typically used to evaluate memory and recall, and open-book assessment gives students access to the learning materials they will be studying, which may lead to understanding, application, and clinical reasoning among students. A comparison of both assessments can be used to determine the better approach to support medical student learning.

Objective: To compare open-book and closed-book assessments in medical students in terms of academic performance, cognitive-level performance, stress, satisfaction, and perceived usefulness for learning.

Methodology: The cross sectional comparative study was carried out from January 2025 to June 2025 at Frontier Medical and Dental College Abbottabad. The selection of the medical students was not random, but rather done through non-probability sampling that employed convenience sampling, which included a total of 75 students. The students were split into two groups as per the type of assessment - open-book assessment and closed-book assessment. The two groups were tested on the same academic content and a structured paper was used containing recall, concept, application and clinical reasoning questions. Academic performance was evaluated using mean score, pass/fail and performance categories. A structured questionnaire was used to collect students' perceptions about stress, fairness, satisfaction, difficulty, usefulness for learning and preference for future use. Data were analyzed based on SPSS, and p-value < 0.05 were regarded as statistically significant.

Results: The open-book assessment group achieved a higher mean score than the closed-book assessment group. Students in the open-book group performed better in conceptual understanding, application-based questions, and clinical reasoning questions, while the closed-book group showed slightly better performance in recall-based questions. Open-book assessment was also associated with lower stress, higher satisfaction, and greater perceived usefulness for learning. A higher proportion of students preferred open-book assessment for future examinations.

Conclusion: Open-book assessment was associated with better academic performance, improved higher-order cognitive performance, reduced stress, and greater student satisfaction compared with closed-book assessment. Closed-book assessment remained useful for evaluating recall-based knowledge. A balanced assessment strategy using both formats may provide a more comprehensive evaluation of medical students’ learning.