CONTEXT: 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 higheron 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.
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