Influence of Test Anxiety on Academic Performance in the Anatomical Sciences

Abstract

IntroductionMedical students often experience some level of anxiety during their training, particularly concerning exams. In addition to tests within the medical curriculum, students and residents must pass high stakes United States Medical Licensing Examination (USMLE) standardized exams to earn their degree and for licensure. Test anxiety can severely impact a person’s ability to perform. Identification of those who struggle with test anxiety early in their training may be useful in implementing targeted interventions that will be beneficial beyond graduation from medical school. The Westside Test Anxiety Scale (WTAS) is an assessment that measures performance impairment and worry as these factors relate to exams.AimThe aim of this study was to examine how test anxiety, as determined by the WTAS assessment, contributes to academic performance of first year medical students. Based on previous studies, we hypothesized that overall test anxiety would negatively correlate with academic performance.MethodsAt the Medical College of Georgia, medical students (n =131 out of 191) completed a preclinical anxiety questionnaire at the end of the first year curriculum. The survey consisted of the 10‐question WTAS along with Likert scale and narrative response questions assessing students’ experiences with anxiety in the curriculum. Students were subdivided into tiers of low anxiety (WTAS range: 1.0–1.9; n=33), normal anxiety (WTAS range: 2.0–2.9; n=75), and high anxiety (WTAS range: 3.0–5.0; n=23). Academic performance from multiple choice quizzes and exams, fill‐in‐the‐blank lab practicals, and overall weighted first year average were compared between low, normal, and high anxiety cohorts using one‐way ANOVA and Tukey’s post‐hoc analysis. IRB approval was obtained from Augusta University.ResultsWhen subdivided into tiers of low anxiety (avg. WTAS score 1.6 ± 0.3), normal anxiety (avg. WTAS score 2.5 ± 0.3), and high anxiety (avg. WTAS score 3.4 ± 0.4), students with high anxiety had a significantly lower overall grade (80.5 ± 5.5) than students with normal (84.1 ± 4.9) or low anxiety (85.5 ± 4.2) (p<0.05). Anatomy, histology, and neuroanatomy lab practical averages were not significantly different among students in the three WTAS tiers. However, performance on gross anatomy and histology multiple choice questions on quizzes (Q) and module exams (ME) were significantly lower for students with high anxiety (Q: 77.5 ± 7.5; ME: 78.1 ± 8.2) than students with low (Q: 83.4 ± 6.4; ME: 85.9 ± 5.2) or normal (Q: 82.4 ± 8.0; ME: 84.7 ± 6.9) anxiety (p<0.05).ConclusionsThis preliminary study found that increased test anxiety has a negative association with academic performance in the first year curriculum. Test anxiety negatively impacts performance on gross anatomy and histology written multiple choice exam questions but not fill‐in‐the‐blank timed station lab practicals, suggesting that modality of question and/or exam type may negate the effect of anxiety on exam performance. Future studies will examine whether other factors are implicated in this discrepancy. The results of this study may be useful in facilitating the development of alternative curricular assessments and/or targeted interventions for medical students to mitigate the effects of anxiety on academic performance.