title: Influence of open- and closed-book tests on medical students' learning approaches.
abstract: BACKGROUND
  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.
authors.affiliation: Institute for Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands. m.penninga@med.umcg.nl
authors.forename: Marjolein
authors.initials: M
authors.lastname: Heijne-Penninga
authors.forename: Jan B M
authors.initials: JB
authors.lastname: Kuks
authors.forename: W H Adriaan
authors.initials: WH
authors.lastname: Hofman
authors.forename: Janke
authors.initials: J
authors.lastname: Cohen-Schotanus
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D006801:Humans; D013223:Statistics as Topic; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D013782:Textbooks as Topic