Relationship between anxiety and standardized patient test performance in the medicine clerkship

PURPOSE: Anxiety is thought to affect test performance. Studies have shown that students with low levels of test anxiety achieve higher scores on multiple choice question (MCQ) examinations than those with high anxiety levels. Female students have been shown to have higher test anxiety levels than male students. Standardized patient (SP) examinations are being used in medical schools and for licensing purposes. As SP exams are relatively new, there are few studies measuring anxiety levels for the SP test. The purpose of this study was to measure and compare medicine clerkship student SP versus MCQ examination anxiety levels and to determine if level affected test performance. METHODS: The Spielberger test attitude inventory was used to measure anxiety in 150 students rotating through the clerkship. Students completed questionnaires after the MCQ and SP examinations. Mean examination scores and anxiety levels were compared. Based on questionnaire scores, students were divided into 3 groups: low, moderate, and high anxiety. The MCQ and SP examination scores were analyzed to determine if male/female anxiety-level affected test performance. RESULTS: There were no meaningful anxiety-level differences between the SP and MCQ examinations. An inverse relationship between anxiety level and test scores was not identified. Female students had higher anxiety levels but sex differences did not influence examination performance. DISCUSSION: Medicine clerkship student test performance is not affected by anxiety level. Implications of the findings for incorporating stress management training in medical school curricula and suggestions for future research are discussed.