title: Directing students to profound open-book test preparation: the relationship between deep learning and open-book test time.
abstract: BACKGROUND
  Considering the growing amount of medical knowledge and the focus of medical education on acquiring competences, using open-book tests seems inevitable. A possible disadvantage of these tests is that students underestimate test preparation.
  
  
  OBJECTIVE
  We examined whether students who used a deep learning approach needed less open-book test time, and how students performed on open-book questions asked in a closed-book setting.
  
  
  METHODS
  Second- (N = 491) and third-year students (N = 325) prepared half of the subject matter to be tested closed-book and half to be tested open-book. In agreement with the Board of Examiners, some questions in the closed-book test concerned open-book subject matter, and vice versa. Data were gathered about test time, deep learning and preparation time. Repeated measurement analysis, t-tests and partial correlations were used to analyse the data.
  
  
  RESULTS
  We found a negative relationship between deep learning and open-book test time for second-year students. Students scored the lowest on closed-book questions about open-book subject matter.
  
  
  CONCLUSIONS
  Reduction of the available test time might force students to prepare longer and deeper for open-book tests. Further research is needed to identify variables that influence open-book test time and to determine how restrictive this time should be.
authors.affiliation: Institute for Medical Education, University of Groningen and University Medical Center Groningen, The Netherlands. m.penninga@med.umcg.nl
authors.forename: M
authors.initials: M
authors.lastname: Heijne-Penninga
authors.forename: J B M
authors.initials: JB
authors.lastname: Kuks
authors.forename: W H A
authors.initials: WH
authors.lastname: Hofman
authors.forename: J
authors.initials: J
authors.lastname: Cohen-Schotanus
mesh_terms: D004504:Education, Medical, Undergraduate / Q000379:methods; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D009426:Netherlands; D013337:Students, Medical; D013782:Textbooks as Topic; D055815:Young Adult