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

Abstract

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). 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. 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. 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.