Which Performs Better: Open Book Versus Closed Book Online Gross Anatomy Practical Examination
Authors: Vasan Cheryl , Huff Susan , Vasan Nagaswami 
Published: May 2022

The COVID‐19 pandemic resulted in rapid changes to delivery of medical school exams during the height of the pandemic. Remote, online exams quickly became the norm, with many schools initially allowing open book (OB) exams due to a lack of policies and resources to monitor for cheating and as a means of reducing student anxiety that was heightened by the uncertainty of the pandemic and its effect on their education. A 2016 review by Durning, et al. concluded that there was no significant difference in exam performance between OB and closed book (CB) exams; however, a recent study found significantly higher scores on an OB exam, compared to a CB exam (Eurboonyanun, et al., 2021).

At Cooper Medical School of Rowan University (CMSRU), gross anatomy practical examinations are taken using cadavers and are CB. As a result of the pandemic, the Class of 2023 was administered the Skin and Musculoskeletal (SMS) midcourse and final practical examinations as remote, online OB exams. The next year, the Class of 2024 took the same exams remotely online, as CB exams. The aim of this study was to evaluate the impact of OB exam conditions on students' online practical exam performance. We hypothesized that the Class of 2023’s mean score on both exams would be significantly higher than the Class of 2024.

We compared the Class of 2023’s (n = 111) remote, online OB mean scores for the midcourse and final gross anatomy practical summative exams to the Class of 2024’s (n = 110) remote, online CB exam scores for the same practical exams. The SMS course is the last course for 1st year medical students at CMSRU. For both classes, the midcourse and final practical exam questions were delivered remotely online using cadaveric atlas images. Questions were open‐ended and consisted of a mixture of 1st, 2nd and 3rd order questions. The number of questions on the midcourse and final practical exams for both classes were equivalent. A one‐tailed, non‐paired t‐test was used to compare mean class performance on both the midcourse and final practical exams.

The Class of 2023 had a significantly higher summative mean score on the midcourse practical exam, compared to the Class of 2024 (96.91 v 90.24, p<0.000). The summative mean score for the final practical exam was significantly higher for the Class of 2023 compared to the Class of 2024 (93.21 v 89.26, p<0.000).

First year medical students who took remote online OB midcourse and final practical exams in the SMS course outperformed 1st year medical students who took equivalent exams that were CB.

The COVID‐19 pandemic has opened a window for educators to give greater consideration to and allow for exploration of the use of OB exams in anatomy, regardless of whether exams are delivered online or in‐person. In a world where knowledge is available instantaneously with just a few strokes of a keypad, why is it we still expect students to commit detailed anatomical knowledge to memory for testing? As practicing clinicians, they will have access to resources to help them answer questions they are unsure about. Why not afford students the same opportunity when taking an exam? The time has come to determine the feasibility of OB exams in anatomical sciences education and determine how best they can be used to enhance the learning and long‐term retention of anatomical knowledge.