title: Does academic assessment system type affect levels of academic stress in medical students? A cross-sectional study from Pakistan.
abstract: BACKGROUND
  Stress among medical students induced by academic pressures is on the rise among the student population in Pakistan and other parts of the world. Our study examined the relationship between two different systems employed to assess academic performance and the levels of stress among students at two different medical schools in Karachi, Pakistan.
  
  
  METHODS
  A sample consisting of 387 medical students enrolled in pre-clinical years was taken from two universities, one employing the semester examination system with grade point average (GPA) scores (a tiered system) and the other employing an annual examination system with only pass/fail grading. A pre-designed, self-administered questionnaire was distributed. Test anxiety levels were assessed by The Westside Test Anxiety Scale (WTAS). Overall stress was evaluated using the Perceived Stress Scale (PSS).
  
  
  RESULTS
  There were 82 males and 301 females while four did not respond to the gender question. The mean age of the entire cohort was 19.7 ± 1.0 years. A total of 98 participants were from the pass/fail assessment system while 289 were from the GPA system. There was a higher proportion of females in the GPA system (85% vs. 59%; p < 0.01). Students in the pass/fail assessment system had a lower score on the WTAS (2.4 ± 0.8 vs. 2.8 ± 0.7; p = 0.01) and the PSS (17.0 ± 6.7 vs. 20.3 ± 6.8; p < 0.01), indicating lower levels of test anxiety and overall stress than in students enrolled in the GPA assessment system. More students in the pass/fail system were satisfied with their performance than those in the GPA system.
  
  
  CONCLUSIONS
  Based on the present study, we suggest governing bodies to revise and employ a uniform assessment system for all the medical colleges to improve student academic performance and at the same time reduce stress levels. Our results indicate that the pass/fail assessment system accomplishes these objectives.
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan.
authors.forename: Madiha
authors.initials: M
authors.lastname: Ali
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan.
authors.forename: Hamna
authors.initials: H
authors.lastname: Asim
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan.
authors.forename: Ahmed Iqbal
authors.initials: AI
authors.lastname: Edhi
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan.
authors.forename: Muhammad Daniyal
authors.initials: MD
authors.lastname: Hashmi
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan.
authors.forename: Muhammad Shahjahan
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan.
authors.forename: Farah
authors.initials: F
authors.lastname: Naz
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan.
authors.forename: Kanza Noor
authors.initials: KN
authors.lastname: Qaiser
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan.
authors.forename: Sidra Masud
authors.initials: SM
authors.lastname: Qureshi
authors.affiliation: Medical Graduate, Aga Khan University, Karachi, Pakistan; faizanzahid91@hotmail.com.
authors.forename: Mohammad Faizan
authors.initials: MF
authors.lastname: Zahid
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: Imtiaz
authors.initials: I
authors.lastname: Jehan
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000523:psychology; D003430:Cross-Sectional Studies; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012737:Sex Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult
keywords: academic stress; assessment system; medical education; medical students; stress