<p>Abstract</p> <p>Background</p> <p>To see if there is a difference in performance when students switch from traditional paper-and-pencil examinations to computer-based examinations, and to determine whether there are gender differences in student performance in these two examination formats.</p> <p>Methods</p> <p>This study involved first year medical students at the University of Illinois at Urbana-Champaign over three Academic Years 2002–03/2003–04 and 2003–05. Comparisons of student performance by overall class and gender were made. Specific comparisons within courses that utilized both the paper-and-pencil and computer formats were analyzed.</p> <p>Results</p> <p>Overall performance scores for students among the various Academic Years revealed no differences between exams given in the traditional pen-and-paper and computer formats. Further, when we looked specifically for gender differences in performance between these two testing formats, we found none.</p> <p>Conclusion</p> <p>The format for examinations in the courses analyzed does not affect student performance. We find no evidence for gender differences in performance on exams on pen-and-paper or computer-based exams.</p>