Impact of open‐book examination in a pathology course on medical students' learning experiences and long‐term academic performance

While interest in open-book examinations (OBE) has increased significantly in recent years, research comparing its impacts on academic performance and learning approaches with those of closed-book examinations (CBE) remains mixed. Against this background, this study investigates the impact of OBE on second-year medical students' learning experiences and academic performance in an undergraduate Introduction to Pathology course, comparing these outcomes with those of CBE. The OBE format was introduced in 2020 at Yonsei University College of Medicine during the coronavirus pandemic. Data from five cohorts (2018-2022) comprising 582 students were analyzed. Learning experiences were evaluated through surveys and open-ended responses, and academic performance was measured using pathology scores from the nationwide Comprehensive Basic Medical Sciences Examination, which students completed 8 months after the pathology course. Findings showed that students in the OBE group reported higher satisfaction and engagement. Qualitative analysis of open-ended responses indicated improved self-directed learning and reduced rote memorization. Academically, OBE students outperformed their CBE counterparts, particularly among lower-achieving students, suggesting that OBE enhances knowledge retention. Despite these positive effects, students identified challenges with the OBE format, including short examination time and insufficient pre-exam guidance, which hindered their exam preparation. These results imply that while OBE can improve educational outcomes, further refinements are needed to ensure successful implementation. Future research should focus on evaluating the long-term impacts of OBE on clinical competency and knowledge application in real-world situations.