Assessing Medical Student Perceptions of Open-Book Exams for Self-Directed Learning

Abstract

Introduction The landscape of medical education is constantly evolving, with innovative assessment methods being integrated to better align with the requirements of modern healthcare education. Among these, open-book exams (OBEs) represent a significant shift from traditional closed-book exams (CBEs), promising to enhance learning outcomes and better evaluate students' understanding of medical concepts. This study aims to explore the multifaceted impact of OBEs on medical students, including their perceptions, study behaviors, stress levels, and the cultivation of critical thinking and self-directed learning skills. Methodology This is a cross-sectional study, which utilized a mixed-methods approach, conducted at Al Baha University's College of Medicine, to explore the impact of OBEs on self-directed learning among 129 medical students over a 15-day period in October 2023. The research combined quantitative data from online questionnaires, assessing students' experiences, stress, understanding, and study strategies, with qualitative insights from in-depth interviews and open-ended survey questions. Participants were final-year medical students with prior experience in OBEs, selected to minimize bias. Data analysis was performed using Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk), focusing on descriptive and inferential statistics, while qualitative data underwent thematic analysis to identify patterns in students' perceptions of self-directed learning opportunities. The study was ethically approved, ensuring participant confidentiality and informed consent. Result Regarding the medical student perspectives on OBEs, the study revealed that the majority of medical students strongly perceive OBEs as less stressful (77, 59.69%) and easier to prepare for (79, 61.24%) compared to traditional exams. A significant proportion also believe OBEs accurately assess their comprehension (106, 82.17%) and prefer them as a mode of assessment (106, 82.17%). Furthermore, most students (87, 67.44%) reported performing better on OBEs compared to CBEs. Regarding the assessment of self-directed learning using the OBE method, students predominantly utilized highlighting important points (70, 54.26%) as a preparation method for OBEs. A large majority (85, 65.89%) considered OBEs as a fair assessment of self-directed learning and believed that they encourage self-directed learning (114, 88.37%). Conclusion OBEs represent a promising direction for medical education, offering a way to better prepare students for the complexities of real-world medical practice. Future strategies should include not only the refinement of OBE methodologies but also the integration of practice opportunities that enable students to hone their skills in applying knowledge effectively.

Keywords: assessment fairness; assessment strategies strategies; exam preparation methods; open-book exams; self-directed learning; stress reduction; student performance analysis.

Figure 1. Participants' views on the disadvantages of open-book exams (OBEs)

The numbers on the X-axis represent the following. (1) It may lead to over-reliance on reference materials rather than understanding. (2) It could make the exam too time-consuming for some students. (3) It may not effectively assess a student's ability to retain information. (4) It might not be suitable for subjects that require strict memorization. (5) It may create a sense of ambiguity about what is allowed during the exam. The Y-axis represents the number of participants.

Figure 2. Participants' views on the advantages of open-book exams (OBEs)

The numbers in the X-axis represent the following. (1) It promotes a deeper understanding of the subject matter. (2) It encourages students to develop critical thinking skills. (3) It simulates real-world problem-solving scenarios. (4) It reduces the pressure associated with memorization. (5) It allows students to access and apply reference materials, mimicking real-life situations. (6) It allows for greater flexibility and creativity in answering questions. (7) It encourages students to develop strong note-taking and organizational skills. (8) It promotes critical thinking and problem-solving abilities. (9, 10) Other. The Y-axis represents the number of participants.