https://doi.org/10.15218/ejnm.2020.16 Erbil j. nurs. midwifery, Vol. 3, No. (2), Nov 2020 Original Article Attitudes of Faculty and Students toward Open-book Examination as a Teaching Strategy in Nursing Education at Hawler Medical University ABSTRACT INTRODUCTION Open-book examinations (OBEs) are one of the tools progressively offered today in or- der to diminish test anxiety and to help students show their information and abili- ties and, correspondingly, have a more optimistic attitude towards tests. An ideal meaning of a classroom OBE is one in which test takers (students) are allowed to access their notes, textbooks, and other approved reading material while answer- ing examination questions. It may be oral or written, a component of, or a complete exam. To be effectively used for assess- ment, OBEs have to be part of the learning experience (formative assessment).[1] OBEs emphasize problem solving, Background and objectives: Open-book examinations (OBEs) is a non-traditional teaching strategy increasingly offered today in nursing education programs. Open-book examina- tion is one in which students are allowed to use their notes, textbooks, and other ap- proved material (preferably not electronic) while answering examination questions. The purpose of this study was to evaluate the attitudes of faculty and students towards open- book examinations as a teaching strategy in nursing education. Methods: A descriptive study was carried out at College of Nursing in Hawler Medical Uni- versity. A self-administered questionnaire was used to collected data. The validity of the questionnaire was confirmed because it produced accurate results of the study. Also, the questionnaire was reliable because it gave a consistent result throughout the study. Total of 100 nursing students and 35 teaching staff were participated in the study. Data were analyzed by using frequency and percentage for students and teachers. Results: The majority of the students (45%) and faculties (45.7%) agreed that OBEs facili- tate thinking at higher cognitive levels. Most of the students (61%) and teachers (51.4%) agreed that OBEs decreases students’ test anxiety. Also, teachers (48.6%) and students (41%) agreed that OBEs promote critical thinking regarding the contents of the course. Teachers and students agreed that OBEs encourage self-directed learning, decrease mem- orizing contents, promote student-centered approach to education, encourage students to read textbooks and articles more, and help students to be long-life learners. Conclusion: This study confirmed that open-book examinations when used as a teaching strategy in nursing education programs played an important role in improving nursing cur- riculum. To decrease students’ anxiety regarding examinations, this study pointed out that OBEs can minimize the students’ anxiety during examinations. Key words: open-book examination, nursing education, teaching strategy, critical thinking, faculty Dlzar Sedeeq Anwer; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. (Correspondence: dlzar.anwer@valpo.edu) Asma Mamhusseini; Civil Engineering Department College of Engineering/ Tishk International University, Erbil, Iraq. Yousif Bakr Omar; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. Murad Sherzad Othman; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. 136 Erbil Journal of Nursing & Midwifery Received: 04/11/2019 Accepted: 22/12/2019 Published: 30/11/2020 https://doi.org/10.15218/ejnm.2020.16 Erbil j. nurs. midwifery, Vol. 3, No. (2), Nov 2020 Original Article creativity or deep knowledge rather than a simple recall. OBEs have achieved both the requirements of an assessment tool and a student-centered method to education, as a technique that reduces the level of testing anxiety experienced by students. [2]Studies have presented that students identify five key benefits in OBEs, specifi- cally practice in the creative use of course content, course content ability, increased chance for student self-evaluation and feedback, less test anxiety and more stu- dent regulation of content studied. [3]OBEs have been recommended as a proper alter- native because they lessen anxiety in stu- dents, who feel less worried by the need to rote memorize information and inspire stu- dents to apply their information to realistic problems that they might encounter in real life. Also, OBEs encourage a broader read- ing around a subject and combination of information from several sources and facili- tate thinking at higher cognitive levels, such as problem solving and reasoning. OBEs, which appear to foster self-directed learning by promoting deep learning, criti- cal thinking, and interdisciplinary problem solving—are a form of authentic assess- ment. [4]OBEs may also encourage more accurate learning opportunities that em- phasize higher order thinking skills. Closed book examinations test only what students can memorize, while OBEs have an in- creased potential to measure higher level thinking skills and relate more closely to real-world work environments. OBEs is one method for integrating realistic, open- ended tasks into higher education[5]. Authentic assessment is based on students’ abilities to perform meaningful tasks they may have to do in the “real world and also requires students to apply what they have learned. [6]OBEs push student to read more and places a higher emphasis on un- derstanding thoughts and principles. How- ever, it mentioned that the grades achieved by students who did OBEs were lower than those obtained by traditional manner possibly due to the higher level of difficulty and difficulty of the questions, thus required higher order of critical think- ing [7]. The purpose of this study was to evaluate the attitudes of faculty and stu- dents towards open-book examinations as a teaching strategy in nursing education. A quantitative, descriptive study was used to evaluate the attitudes of faculty and stu- dents regarding open-book examinations among teachers and students. The partici- pants of this study were selected from stu- dents and faculty of College of Nursing at Hawler Medical University. This study was conducted from June 2019 until October 2019. A non-probability-convenience sam- ple (N =35) of faculty and (N=100) because it was easier to collect data and catch sam- ples. Fourth stage students of Midwifery and Nursing department in College of Nursing at Hawler Medical University were sampled in this study. All teachers and fourth stage students of midwifery and nursing department from College of Nurs- ing at Hawler Medical University were in- cluded. The reason why chose fourth stage students because they had more experi- ences with formats and types of examina- tions than first, second, and third stage students. This study was submitted to the scientific committee of College of Nursing to get approval prior to beginning of this study. Also, the oral informed consent of the participants was taken as an ethical requirement to participate the study. Sta- tistical Package for the Social Sciences (SPSS) was used (frequency and percent- age) in this study. Participants were re- cruited by explaining the purpose of the study. A questionnaire was developed by researchers and the questionnaires’ validi- ty and reliability were confirmed 137 Erbil Journal of Nursing & Midwifery METHODS https://doi.org/10.15218/ejnm.2020.16 Erbil j. nurs. midwifery, Vol. 3, No. (2), Nov 2020 Original Article moderately agreed that open-book exami- nations facilitate thinking at higher cogni- tive levels, such as problem solving and reasoning. 36% students moderately agreed that open-book examinations make student-centered approach to education while 34 %n teachers strongly agreed that open-book examinations make student- centered approach to education. The majority of the students and teachers agreed (strongly & moderately) that open- book examinations encourage students to decrease memorizing contents. The major- ity of the students strongly (40%) and moderately (40%) agreed that open-book examinations are preferable way to teach- ing and learning than closed-book exami- nations, while the majority of the teachers moderately (31.4%) and somewhat (31.4%) agreed that open-book examinations are preferable way to teaching and learning than closed-book examinations. The high- est percentage of the teachers (60%) and students (48%) strongly agreed that open- book examinations encourage students more reading textbooks and articles. Also, both students (47%) and teachers (37.1%) strongly agreed that open-book examina- tions help students to be long- life learn- ers. The majority of the teachers (28.6%) moderately agreed that open-book exami- nations are less time-consuming for prepa- ration, while the majority of the students (46%) strongly agreed that open-book ex- aminations are less time-consuming for preparation. The perspective of overall stu- dents and teachers toward open-book ex- aminations as a teaching strategy in the classroom were relatively very close. before collecting data. The questionnaire consisted of two parts; part one is demo- graphic data (age, gender, and occupation) and the second part is about students’ and teachers’ attitudes regarding open-book examinations. This part consisted of 10 items, each with the following options: strongly agree, moderately agree, some- what agree, and disagree. Researchers dis- tributed questionnaire among students and teachers in order to fill them out. Prior to collecting data collection, participants were informed of methods to ensure confi- dentiality and his/her right to refuse partic- ipation at any time. After collecting data, all data were secured in locked box in or- der to protect participants’ confidentiality. The majority of the teachers between ages 36-55 years old (62.9%), were male (54.3 %). The majority of occupations of the study sample were students (74.07%). While the majority of the students were between 20-22 years old (70 %), 78 % were female. More than half of the students (60%) strongly agreed that open-book ex- aminations are believed to be able to re- duce students’ anxiety, while more than half of the teachers (51.4%) moderately agreed that open-book examinations are believed to be able to reduce students’ anxiety. The highest percentage (41.0%) of students and teachers (48.6%) strongly agreed that open-book examinations en- courage students to think critically regard- ing the contents of the course. Most of the students (42 %) and teachers (40%) strong- ly agreed open-book examinations encour- age self-directed learning by promoting deep learning and critical thinking. The ma- jority of the students (45%) strongly agreed that open-book examinations facilitate thinking at higher cognitive levels, such as problem solving and reasoning. While the majority of the teachers (45.7%) 138 Erbil Journal of Nursing & Midwifery RESULTS https://doi.org/10.15218/ejnm.2020.16 Erbil j. nurs. midwifery, Vol. 3, No. (2), Nov 2020 Original Article 139 Erbil Journal of Nursing & Midwifery Table 1: Demographic data of the study sample Variables No. (%) Teacher Age 25-35 10 (28.6) 36-55 22 (62.8) ≤ 56 3 (8.6) Students Age 20-22 70 (70) 23-29 22 (22) ≤30 8 (8) Teacher Gender Male 19 (54.3) Female 16 (45.7) Students Gender Male 22 (22) Female 78 (78) Occupation Teacher 35 (25.92) Students 100 (74.08) https://doi.org/10.15218/ejnm.2020.16 Erbil j. nurs. midwifery, Vol. 3, No. (2), Nov 2020 Original Article 140 Erbil Journal of Nursing & Midwifery Table 2: Students’ and teachers’ perspective regarding open-book examinations SN Items Strongly Agree Moderately agree Somewhat agree Disagree F (%) Students F (%) Teachers F (%) Students F (%) Teachers F (%) Students F (%) Teachers F(%) Students F (%) Teachers 1 Open-book examinations are believed to be able to reduce students’ anxiety 60 (60) 12 (34.3) 23 (23) 18 (51.4) 13 (13) 3 (8.6) 4 (4) 2 (5.7) 2 Open-book examinations encourage students to think critically regarding the contents of the course. 41 (41) 17 (48.6) 36 (36) 5 (14.3) 9 (9) 11 (31.4) 14 (14) 2 (5.7) 3 Open-book examinations encourage self-directed learning by promoting deep learning and critical thinking. 42 (42) 14 (40) 30 (30) 12 (34.3) 14 (14) 8 (22.9) 14 (14) 1 (2.9) 4 Open-book examinations facilitate thinking at higher cognitive levels, such as problem solving and rea- soning. 45 (45) 11 (31.4) 31 (31) 16 (45.7) 13 (13) 7 (20) 11 (11) 1 (2.9) 5 Open-book examinations make student-centered approach to education. 35 (35) 12 (34.3) 36 (36) 12 (34.3) 13 (13) 8 (22.9) 16 (16) 3 (8.6) 6 Open-book examinations encourage students to decrease memorizing contents. 49 (49) 19 (54.3) 26 (26) 9 (25.7) 12 (12) 7 (20) 13 (13) 0 (0) 7 Open-book examinations are preferable way to teaching and learning than closed-book examinations 40 (40) 9 (25.7) 40 (40) 11 (31.4) 14 (14) 11 (31.4) 6 (6) 4 (11.4) 8 Open-book examinations encourage students more reading textbooks and articles. 48 (48) 21 (60) 24 (24) 6 (17.1) 17 (17) 5 (14.3) 11 (11) 3 (8.6) 9 Open-book examinations help students to be long- life learner 47 (47) 13 (37.1) 29 (29) 9 (25.7) 15 (15) 12 (34.3) 9 (9) 1 (2.9) 10 Open-book examinations are less time-consuming for preparation 46 (46) 9 (25.7) 35 (35) 10 (28.6) 12 (12) 7 (20) 7 (7) 9 (25.8) https://doi.org/10.15218/ejnm.2020.16 Erbil j. nurs. midwifery, Vol. 3, No. (2), Nov 2020 Original Article The majority of the students and teachers agreed (strongly & moderately) that open- book examinations encourage students to decrease memorizing contents. The pre- sent study is supported by another study conducted in Hong Kong which indicated that open-book examinations are believed to be able to reduce students’ anxiety and rote memorizing of facts. The purpose of the study was to assess what preparations students have undertaken before taking open-book examinations and what learning style they adopted during the preparation of this non-traditional approach to subject testing. The results of the study indicated that students had a positive perception to- wards open-book examinations. [8]In this study, the highest percentage of the teach- ers (60%) and students (48%) strongly agreed that open-book examinations en- courage students more reading textbooks and articles. This finding is supported by a study conducted in the United States of America; the findings indicated that stu- dents taking open-book pre-quizzes per- formed better on open book final exams. This research approach also showed pre- liminary indications that the students value their textbooks more, and used them more frequently and broadly, to prepare for class using open-book testing protocols as op- posed to using traditional closed-book testing procedures. [9]In this study, the majority of the teachers (28.6%) moderate- ly agreed that open-book examinations are less time-consuming for preparation, while the majority of the students (46%) strongly agreed that open-book examinations are less time-consuming for preparation. A study had been conducted in Finland, which does not support this study, indicat- ed that the students used approximately the same time to study for an online exam- ination as for faculty examination, but over half of them reported using more time for responding and learning more from an online examination compared to a faculty examination. The purpose of this study was to investigate university students’ ex- periences of open-book and open-web online examinations compared to tradi- tional class examinations regarding prepar- ing, responding, and learning. The data (N = 110) were collected by an online survey from the university students who took an online examination. [10]In this study, the majority of the students strongly (40%) and moderately (40%) agreed that open- book examinations are preferable way to teaching and learning than closed-book examinations, while the majority of the teachers moderately (31.4%) and some- what (31.4%) agreed that open-book ex- aminations are preferable way to teaching and learning than closed-book examina- tions. These findings are supported by the results of a study conducted in Singapore which evaluated the influence of open book examinations on the learning habits of students in the Nanyang Technological University in Singapore. A survey was con- ducted in order to determine whether stu- dents preferred open book examination and the reasons for their preference. The results of the survey exhibited that almost two-thirds of the students preferred open book examinations despite being more fa- miliar with closed book examinations. They felt that preparations for open book exam- inations were less time-consuming and that they required less memorization and left more room for logical thinking. [11] Another study results indicated that stu- dents preparing for a closed book exami- nation tend to delay their study at the end of the semester, focus on the given texts and memorize information. Students pre- paring for an open-book examination tend to access various sources and interrelate the information acquired; when taking the exam, they work innovatively while, 141 Erbil Journal of Nursing & Midwifery DISCUSSION https://doi.org/10.15218/ejnm.2020.16 Erbil j. nurs. midwifery, Vol. 3, No. (2), Nov 2020 Original Article [5] Rakes GC. Open book testing in online learn- ing environments. Journal of Interactive Online Learning 2008; 7(1): 1541-4914. [6] Dale VH, Wieland B, Pirkelbauer B, Nevel A.Value and benefits of open-book examina- tions as assessment for deep learning in a post-graduate animal health course. Journal of Veterinary Medical Education 2009; 36(4): 403-410. [7] Abdul Jalal MF, Ain Fadhil SS, Hasini H. Stu- dents, assessment through open-book con- cept for final exam. International Journal of Asian Social Science 2014; 2(1): 217-225. [8] Linda DH, Snyder J. Authentic assessment of teaching in context. Teaching and Teacher Education 2000; 16: 523-545. [9] Green SG, Ferrante Cj, Heppard KA. Using open-book exams to enhance student learn- ing, performance, and motivation. The Jour- nal of Effective Teaching 2016; 16(1): 19-35. [10] Myyry L, Joutsenvirta T. Open-book, open- web online examinations: Developing exami- nation practices to support university stu- dents’ learning and self-efficacy 2015; Active Learning in Higher Education 2015; 16(2): 119-132. [11] Loi SL, Chuah JC. The Impact of Open Book Examinations on Student Learning 1999. Nanyang Technological University. [12] Theophilides C, Koutselini M. Study behav- ior in the closed-book and the open-book examination: a comparative analysis. Educa- tional Research and Evaluation 2010; 6 (4):379-393. at the same time, they probe deeply into the knowledge gained. [12]There are sev- eral potential limitations to the study: (a) small sample size, (b) geographical area consisting only of College of Nursing- Hawler Medical University, (c) dependence on students’ and teachers’ attitude regard- ing OBEs, and (d) the inexperience of the researchers could introduce researchers’ bias. This study supports the use of open-book examinations as a teaching strategy in nursing education programs and open- book examinations have an important role on improving nursing curriculum. Also, stu- dents and faculty stated that open-book examination encourages students’ critical thinking, decrease students’ test anxiety, encourage self-directed learning, decrease memorizing contents, make student- centered approach to education, encour- age students more reading textbooks and articles, and help students to be long-life learners. The authors declared that there is no conflict of interest with this study. [1] Doghonadze N, Demir H. Critical analysis of open-book exams for university stu- dents.2018. International Black Sea Universi- ty. [2] Chan MY. The use of open-book examina- tions to motivate students: a case study from Hong Kong. World Transactions on Engineer- ing and Technology Education 2004; 3(1): 111-114. [3] Gujral S, Gupta M. A study of attitude of teachers and students towards open book and closedbook assessment. International Journal of Scientific Research and Manage- ment 2015; 5(7): 6034-6038. [4] Brightwell R, Daniel J, Stewart A. Evaluation: is an open book examination easier. Biosci- ence Education e-Journal 2004; 3. 142 Erbil Journal of Nursing & Midwifery CONCLUSION CONFLICT OF INTREST REFERENCES