Open Access Highly Accessed Research article

Does Medical Students' Preference of Test Format (Computer-based vs. Paper-based) have an Influence on Performance?

Achim Hochlehnert1*, Konstantin Brass2, Andreas Moeltner2 and Jana Juenger12

Author Affiliations

1 Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Medical Clinic, Heidelberg, Germany

2 Center of Excellence for Medical Assessment, University of Heidelberg, Medical School, Heidelberg, Germany

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BMC Medical Education 2011, 11:89  doi:10.1186/1472-6920-11-89

Published: 25 October 2011



Computer-based examinations (CBE) ensure higher efficiency with respect to producibility and assessment compared to paper-based examinations (PBE). However, students often have objections against CBE and are afraid of getting poorer results in a CBE.

The aims of this study were (1) to assess the readiness and the objections of students to a CBE vs. PBE (2) to examine the acceptance and satisfaction with the CBE on a voluntary basis, and (3) to compare the results of the examinations, which were conducted in different formats.


Fifth year medical students were introduced to an examination-player and were free to choose their format for the test. The reason behind the choice of the format as well as the satisfaction with the choice was evaluated after the test with a questionnaire. Additionally, the expected and achieved examination results were measured.


Out of 98 students, 36 voluntarily chose a CBE (37%), 62 students chose a PBE (63%). Both groups did not differ concerning sex, computer-experience, their achieved examination results of the test, and their satisfaction with the chosen format. Reasons for the students' objections against CBE include the possibility for outlines or written notices, a better overview, additional noise from the keyboard or missing habits normally present in a paper based exam. The students with the CBE tended to judge their examination to be more clear and understandable. Moreover, they saw their results to be independent of the format.


Voluntary computer-based examinations lead to equal test scores compared to a paper-based format.

computer-based examination; paper-based examination; usability