Comparison of Academic Performance and Perceptions of Medical Students in Open Book and Close Book Examination

Abstract

Background: Assessment plays a critical role in medical education as it is a crucial tool used to assess what students know, understand, and have the ability to apply concepts learned. Closed books tests are usually employed in medical colleges and primarily test recall and memorisation. Open book exams on the other hand, provide students with the means to use learning tools during the assessment process and may promote conceptual understanding, critical thinking and problem-solving.

Objective: To compare academic performance and perceptions of medical students regarding open-book and closed-book examinations.

Methodology: This is a comparative cross sectional study carried out in Akhtar Saeed Medical College, Rawalpindi. The total number of medical students involved in the study were 85. Students took two exams, one open book and one closed book, on similar academic material. The assessment of academic performance was done by comparing examination scores, pass rate and grade distribution. A structured questionnaire was used to evaluate the perceptions of students on the preference, stress level, fairness, confidence, conceptual understanding, memorization, and critical thinking. SPSS version 25 was used to analyze data. Results with p value < 0.05 was taken as statistically significant.

Results: The mean score was higher in the open-book examination (78.42 ± 8.36) compared with the closed-book examination (70.58 ± 9.21), and the difference was statistically significant (p < 0.001). The pass rate was also higher in the open-book examination (92.9%) than in the closed-book examination (81.2%). Most students preferred open-book examinations (62.4%) and reported that they were less stressful, improved conceptual understanding, encouraged critical thinking, and increased confidence during assessment. Closed-book examinations were more commonly associated with memorization and higher stress.

Conclusion: Open-book examinations were associated with better academic performance, lower examination stress, and more favorable student perceptions compared with closed-book examinations. However, both assessment methods have educational value. A balanced assessment approach using open-book and closed-book formats may provide a more comprehensive evaluation of medical students’ knowledge, understanding, and clinical reasoning skills.