Test anxiety and United States Medical Licensing Examination scores

Abstract

Background: Many medical students experience test anxiety, which may impair their performance in examinations. We examined the relationship between test anxiety and United States Medical Licensing Examination (USMLE) step-1 scores and determined the effect of a test-taking course on anxiety and USMLE scores.

Methods: We randomly chose second-year students to take a test-taking strategies course (cases) from among volunteers. The remainder of the class served as controls. We measured test anxiety with the Westside Test Anxiety Scale (with possible scores of 1-5). The cases completed the Westside Test Anxiety scale at baseline, after completing the course (4 weeks) and again after taking the USLME step 1 (10 weeks). The controls completed the instrument at baseline and after taking the USMLE step 1 (10 weeks).

Results: Ninety-three of 101 (92%) students participated in the study. The baseline test anxiety score for all students was 2.48 (SD 0.63). Test anxiety was inversely correlated with USMLE step 1 (β = -0.24, p = 0.01), adjusting for Medical College Admission Test (MCAT) scores. The test anxiety score of the participants decreased from 2.79 to 2.61 after the course (p = 0.09), and decreased further to 2.53 after the USMLE (p = 0.02), whereas the scores of the controls increased. The mean USMLE step-1 score was 234 for the cases and 243 for the controls (p = 0.03). Many medical students experience test anxiety, which may impair their performance in examinations

Discussion: Test anxiety is modestly inversely correlated with USMLE step-1 scores. A test-taking strategy course modestly reduced anxiety, but did not improve USMLE scores. More robust interventions that achieve greater reductions in text anxiety may improve test scores.