title: Characteristics of test anxiety among medical students and congruence of strategies to address it.
abstract: BACKGROUND
  Medical students may experience test anxiety associated with 'high stakes' exams, such as Step 1 of the United States Medical Licensing Examination.
  
  
  METHODS
  We collected qualitative responses about test anxiety at three points in time from 93 second-year medical students engaged in studying for and taking Step 1.
  
  
  RESULTS
  Causes of test anxiety as reported by students were related to negative self-talk during preparation for the exam. Effects of anxiety had to do with emotional well-being, cognitive functioning, and physical well-being. Strategies included socializing with others and a variety of cognitive and physical approaches. Comparison of individuals' strategies with causes and effects showed some congruence, but substantial incongruence between the types of strategies chosen and the reported causes and effects of test anxiety.
  
  
  CONCLUSIONS
  Students' adoption of a 'menu' of strategies rather than one or two carefully selected strategies suggest inefficiencies that might be addressed by interventions, such as advisor-directed conversations with students and incorporating student self-assessment and strategies for managing anxiety within courses on test-taking. Such interventions are in need of further study. An annotated list of evidence-based strategies would be helpful to students and educators. Most important, test anxiety should be viewed by medical educators as a 'real' experience, and students would benefit from educator support.
authors.affiliation: Teaching and Learning Center, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; john.encandela@yale.edu.
authors.forename: John
authors.initials: J
authors.lastname: Encandela
authors.affiliation: Teaching and Learning Center, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Gibson
authors.affiliation: Office of Student Affairs, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Angoff
authors.affiliation: Teaching and Learning Center, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Leydon
authors.affiliation: Teaching and Learning Center, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Green
mesh_terms: D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D006801:Humans; D008007:Licensure, Medical; D060805:Performance Anxiety / Q000517:prevention & control*; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology*; D014481:United States
keywords: high-stakes exams; medical students; test anxiety; test-taking