Comparing Open-Book and Closed-Book Examinations: A Systematic Review

Steven J. Durning*, Ting Dong, Temple Ratcliffe, Lambertus Schuwirth, Anthony R., Jr. Artino, John R. Boulet, Kevin Eva

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


Purpose To compare the relative utility of openbook examinations (OBEs) and closedbook examinations (CBEs) given the rapid expansion and accessibility of knowledge. Method A systematic review of peer-reviewed articles retrieved from MEDLINE, ERIC, Embase, and PsycINFO (through June 2013). In 2013-2014, articles that met inclusion criteria were reviewed by at least two investigators and coded for six outcome categories: (1) examination preparation, (2) test anxiety, (3) exam performance, (4) psychometrics and logistics, (5) testing effects, and (6) public perception. Results From 4,192 identified studies, 37 were included. The level of learner and subject studied varied. The frequency of each outcome category was as follows: (1) exam preparation (n = 20; 54%); (2) test anxiety (n = 14; 38%); (3) exam performance (n = 30; 81%); (4) psychometrics and logistics (n = 5; 14%); (5) testing effects (n = 24; 65%); and (6) public perception (n = 5; 14%). Preexamination outcome findings were equivocal, but students may prepare more extensively for CBEs. For during-examination outcomes, examinees appear to take longer to complete OBEs. Studies addressing examination performance favored CBE, particularly when preparation for CBE was greater than for OBE. Postexamination outcomes suggest little difference in testing effects or public perception. Conclusions Given the data available, there does not appear to be sufficient evidence for exclusively using CBE or OBE. As such, a combined approach could become a more significant part of testing protocols as licensing bodies seek ways to assess competencies other than the maintenance of medical knowledge.
Original languageEnglish
Pages (from-to)583-599
JournalAcademic Medicine
Issue number4
Publication statusPublished - Apr 2016

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