Effect of Changing From Closed-Book to Formulary-Allowed Examinations.

Objective. To determine whether allowing final-year Bachelor of Pharmacy students to use a medicines formulary during examinations modified their learning behaviors and performance, and to investigate students' perceptions about having this resource available during examinations.Methods. Student performance and examination difficulty (as measured by classification of examination questions as high or low according to Bloom's taxonomy of learning) in second semester examinations (formulary allowed) was compared with first semester examinations (closed book) in successive years. Students completed a survey regarding their study and examination approaches and experiences after both semesters.Results. Examinations in semester two had more questions rated higher on Bloom's taxonomy than did examinations in semester one. Data were collected from student surveys for closed book examinations (response rate of 25% and 19% in 2015 and 2016, respectively) and open book examinations (response rate of 22% and 15% in 2015 and 2016, respectively). Students' study approaches, hours studied per week, and anxiety (all self-reported) did not differ between semesters one and two, but students in semester two spent more time studying with a formulary compared with students in semester one. Qualitative analysis of student comments revealed students preferred the formulary-allowed examinations over the closed-book examinations. The majority of students (68%) agreed with the statement: "Knowing that I will have access to the AMH [Australian Medicines Handbook] during the exams allowed me to pay more attention to higher level skills such as analysis and evaluation."Conclusion. When students were allowed to use a formulary for examinations, they studied more using their formulary prior to the examination. Students performed similarly on examinations with a greater proportion of questions addressing higher levels of Bloom's taxonomy and on closed-book examinations that were comparatively less cognitively challenging.