Medical students' perception of test anxiety triggered by different assessment modalities

Mood states and academic performance in the objective structured clinical examination. The mediating effect of self-efficacy

BACKGROUND

The role of self-efficacy on academic outcomes in clinical simulation evaluations is well-known. However, no previous studies have reported the mediating effect of self-efficacy in the link between mood state and academic performance in the Objective Structured Clinical Examination (OSCE).

OBJECTIVES

This study explores the following aims: i) to determine the effects of mood states on academic performance; ii) to assess the effect of mood states on self-efficacy; and iii) to analyze whether self-efficacy mediates the relationship between mood state and academic performance in the OSCE.

DESIGN

This quantitative and cross-sectional study received Institutional Review Board approval.

SETTINGS

A private university in Santiago, Chile.

PARTICIPANTS

A convenience sample of 117 nursing students from fourth and sixth semester.

METHODS

Data were collected using two questionnaires (the short version of the Profile of Mood State, and the General Self-Efficacy Scale), and the objective structured clinical examination in adult medical-surgical nursing and pediatric nursing courses.

RESULTS

Mood state has a significant effect on self-efficacy β = -0.068 p = .001. There was, however, no significant relationship between mood and academic performance (= - 0.004 p = .114). Similarly, Sobel's test indicated a non-significant mediation effect for self-efficacy-0.000544; 95 %; CI (-0.00256, 0.00148) p = .597.

CONCLUSIONS

The results of this study improve the understanding of students' self-efficacy and academic performance. Further investigation regarding the use of the self-efficacy construct as a mediating variable in different high-stakes evaluations and in students with varying training levels is needed.

Evaluation of the effectiveness of using flipped classroom in puncture skills teaching

BACKGROUND

The effectiveness of flipped classroom (FC) on puncture skills in medical education is still uncertain. This study aimed to assess the role of the FC model in puncture skills and investigate the acceptance and approval of FC among medical students and instructors.

METHODS

A mixed research approach of quasi-experimental research design and descriptive qualitative research was conducted in September 2022 for one month, using an FC teaching method that combined instructional videos and group learning. The study participants were 71 fifth-year medical students from two classes at a Chinese medical school and four instructors. The medical students were randomly divided into two groups: the traditional classroom (TC) group (Group A) and the FC group (Group B). For teaching, Group B used FC, and Group A used PowerPoint-based TC. The effectiveness of the two teaching models was assessed with Objective Structured Clinical Examination (OSCE), and questionnaires were distributed to the medical students and instructors after the assessment. Two independent sample t-tests were used to analyse the differences in demographic data and the OSCE scores of the two groups of medical students.

RESULTS

Group B scored higher in puncture skills than Group A, especially regarding abdominal puncture (p = 0.03), thoracentesis (p < 0.001), bone marrow puncture (p < 0.001) and average performance of puncture skills (p < 0.001). For lumbar puncture, no difference in skill scores was observed between groups A and B (p > 0.409). The medical students thought that the FC improved their self-learning ability and helped them acquire knowledge. Regarding the OSCE of their skills, most medical students thought that it was more innovative and objective than traditional examinations and that it was better for assessing their overall abilities. Both the FC and OSCE were supported by the medical students. The instructors were also satisfied with the students' performance in the FC and supported the teaching model, agreeing to continue using it.

CONCLUSIONS

This study shows that FC teaching that combines instructional videos and group learning is a reliable and well-received teaching method for puncture skills, which supplements and expands existing teaching methods in the medical field.

Feedback, fairness, and validity: effects of disclosing and reusing multiple-choice questions in medical schools

BACKGROUND

Disclosure of items used in multiple-choice-question (MCQ) exams may decrease student anxiety and improve transparency, feedback, and test-enhanced learning but potentially compromises the reliability and fairness of exams if items are eventually reused. Evidence regarding whether disclosure and reuse of test items change item psychometrics is scarce and inconclusive.

METHODS

We retrospectively analysed difficulty and discrimination coefficients of 10,148 MCQ items used between fall 2017 and fall 2019 in a large European medical school in which items were disclosed from fall 2017 onwards. We categorised items as 'new'; 'reused, not disclosed'; or 'reused, disclosed'. For reused items, we calculated the difference from their first ever use, that is, when they were new. Differences between categories and terms were analysed with one-way analyses of variance and independent-samples t tests.

RESULTS

The proportion of reused, disclosed items grew from 0% to 48.4%; mean difficulty coefficients increased from 0.70 to 0.76; that is, items became easier, P < .001, η_p² = 0.011. On average, reused, disclosed items were significantly easier (M = 0.83) than reused, not disclosed items (M = 0.71) and entirely new items (M = 0.66), P < .001, η_p² = 0.087. Mean discrimination coefficients increased from 0.21 to 0.23; that is, item became slightly more discriminating, P = .002, η_p² = 0.002.

CONCLUSIONS

Disclosing test items provides the opportunity to enhance feedback and transparency in MCQ exams but potentially at the expense of decreased item reliability. Discrimination was positively affected. Our study may help weigh advantages and disadvantages of using previously disclosed items.

Excellent Agreement of In-Person Scoring versus Scoring of Digitally Recorded Simulated Suture Skills Examination

This study's objective was to evaluate the agreement between in-person performance scores and digitally recorded assessment scores by the same examiner using a simulated suturing skill examination. With ethics approval, veterinary students underwent a simulated skills examination proctored by an in-person examiner and simultaneously digitally recorded using two wide-angle cameras mounted overtop and to the side of the surgical field. Performance scores were based on a nine-item rubric. In-person examination scores were compared for agreement with those obtained by blind review of the digital recording of the same session, by the same examiner, 6-18 months following the in-person examination. Thirty-nine students were enrolled. All rubric categories could be assessed during digital assessment of the recording from the camera mounted above the surgical area. In two instances, the side digital recording had to be reviewed to confirm correct needle holder grip. Concordance correlation between performance scores from in-person and post hoc digital assessment was excellent (r = .93). The excellent agreement between in-person and digital assessment suggests that digitally recording skills examinations can provide adequate suturing skills assessment, presenting several benefits. Digitally recorded assessment allows for anonymity, which can reduce assessor bias/favoritism, provide a record of performance that students can review and critically self-reflect upon, and reduce the number of in-person examiners required to complete surgical skills examinations. Additionally, digitally recorded assessment could become an option for students who experience anxiety performing a skills exam in the presence of an examiner.

Assessing metacognitive beliefs in test anxiety: Psychometric properties of the metacognitions questionnaire, 30 (MCQ-30) among university students

The Metacognitions Questionnaire-30 (MCQ-30) measures maladaptive metacognitive beliefs considered central to the metacognitive model of psychopathology. However, the psychometric properties of the MCQ-30 in test anxiety (TA) among university students are unknown. This study examined the MCQ-30 factor structure and concurrent validity in both trait and state TA. Confirmatory and exploratory factor analyses support the previously established five-factor structure of the MCQ-30 in both state and trait TA, with factors having good internal consistency. Structural equation modeling of the relationships between MCQ-30 subscales and TA found ‘Negative beliefs about uncontrollability and danger of worry’ to have the strongest association. The MCQ-30 appears a robust measure of metacognitive beliefs in TA and provides a basis for further testing of the validity of the metacognitive model in TA. Extending the reach of metacognitive therapy, which is based upon the metacognitive model, to TA could help to improve both student wellbeing and academic performance.

Factors affecting test anxiety: a qualitative analysis of medical students' views

BACKGROUND

Medical students are vulnerable to test anxiety (TA), which impacts their professional lives and jeopardizes the optimal health care of their patients. The qualitative exploration of TA among medical students is crucial to understanding the problem. Hence, this study examined medical students' insights into TA and their suggestions on how to reduce it.

METHODS

We conducted a phenomenological study on medical students at a public university. We utilized focus group discussions (FGDs) to investigate their experiences of TA. The FGDs were transcribed verbatim, and these transcripts were analyzed using Atlas.ti software. The thematic analysis followed the recommended guidelines.

RESULTS

Seven FGD sessions were conducted with 45 students. Three major themes emerged: the students, their academic resources, and the examiner. Each theme comprised mutually exclusive subthemes. The "students" theme was divided into negative vs. positive thoughts and self-negligence vs. self-care, "academic recources" into heavy curriculum vs. facilitative curricular aids, and "examiner" into criticism vs. feedback and strict vs. kind approaches.

CONCLUSION

This study provides a solid foundation for policymakers and decision makers in medical education to improve current assessment practices and student well-being. Medical students will be able to significantly alter and reduce TA if they are provided with additional psychological support and their examiners are trained on how to deal with examinees.

Introduction of the Modified Neuroanatomy Motivation Questionnaire and Its Role in Comparing Medical Student Attitudes Towards Learning Neuroanatomy Between Neuro-enthusiasts and Standard Students

BACKGROUND

Neurophobia has been identified as a potential barrier to adequate knowledge of neurology in the medical community, and therefore to patient safety. There is a drive to identify the source of neurophobia, in the hope of tackling it. Comparing the learning motivations of standard medical students with those who enjoy neuroanatomy may be a way of doing this.

METHODS

The science motivation questionnaire (SMQ) was modified for neuroanatomy. It was distributed to three cohorts of second year medical students and students attending the extracurricular National Undergraduate Neuroanatomy Competition (NUNC). Cohen's D test for effect size was used to compare standard medical students and those attending the NUNC.

RESULTS

Five hundred ninety-seven questionnaires were completed by second year students, and 320 by NUNC attendees. The differences in motivation to learn neuroanatomy between the 2 groups mainly fell into themes of career motivation, personal relevance, intrinsic motivation and assessment anxiety.

CONCLUSION

This study has demonstrated the use of the SMQ in neuroanatomy, and found differences in motivators to learn neuroanatomy between self-selecting "neurophiles" and standard medical students, mainly relating to intrinsic motivation and its role in their lives. More research is needed to further explore these differences and how they might apply to interventions in medical school curricula.

Effect of Detailed OSCE Score Reporting on Learning and Anxiety in Medical School

INTRODUCTION

There is growing literature on increasing feedback from Objective Structured Clinical Examinations (OSCEs) and one approach is a score report. The purpose of this study was to implement and evaluate a score report for a second and fourth-year medical school OSCE.

METHODS

We developed an electronic OSCE score report that displayed comments and performance by domain within and across stations (checklist items and rating scales were tagged to each domain). Our initial pilot released the score report after pass/fail decisions but subsequent iterations released the score report the same day as the exam. Our evaluation approach included both student surveys and focus groups.

RESULTS

Students felt the OSCE score report was accurate, identified strengths and weaknesses, and would likely cause them to take future action, with second-year students more likely to act on the report than fourth year students. The thematic analysis revealed barriers and enablers to utilizing feedback as well as the power of the score report to reduce anxiety.

CONCLUSIONS

Our OSCE score report was simple to develop and implement the same day as an OSCE with an overall positive response from students with respect to accuracy and ability to use the information for future learning.

Perceived educational impact of the medical student long case: a qualitative study

BACKGROUND

The long case is a traditional method of clinical assessment which has fallen out of favour in certain contexts, primarily due to psychometric concerns. This study explored the long case's educational impact, an aspect which has been neglected in previous research.

METHODS

Three focus groups of medical students (20 in total) and semi-structured interviews of six examiners were conducted. Cook and Lineberry's framework for exploring educational impact was used as a sensitising tool during thematic analysis of the data.

RESULTS

Participants described the long case and its scoring as having influence on student learning. Engaging in the activity of a long case had an essential role in fostering students' clinical skills and served as a powerful driving force for them to spend time with patients. The long case was seen as authentic, and the only assessment to promote a holistic approach to patients. Students had concerns about inter-case variability, but there was general consensus that the long case was valuable, with allocation of marks being an important motivator for students.

CONCLUSIONS

This study offers a unique focus on the traditional long case's educational consequences; the extent of its positive impact would support its place within a program of assessment.

Avaliação dos graus de ansiedade em acadêmicos de uma faculdade privada

Objetivo: este estudo teve como objetivo avaliar o grau de ansiedade dos acadêmicos de uma instituição de ensino superior privada.Métodos: foi realizada uma pesquisa de corte transversal com abordagem descritiva, quantitativa e observacional em 366 alunos aleatoriamente escolhidos que estavam matriculados no primeiro semestre do ano de 2019. A coleta de dados foi realizada por meio de um questionário com questões sociodemográficas-comportamentais e questões do Inventário de Ansiedade Beck. Os graus de ansiedade (mínimo ou ausente, leve, moderado e grave) foram determinados pelo somatório dos escores do inventário de Beck.Resultados: do total da amostra, 62,3% apresentou algum grau de ansiedade, sendo os cursos da área de saúde os que mais apresentaram estudantes com graus de ansiedade. O sexo e a idade foram as variáveis que apresentaram correlação significativa com os graus de ansiedade.Conclusão: este estudo alerta sobre a ocorrência de transtornos de ansiedade em estudantes universitários, o que implica em uma necessidade crescente de estratégias, dentro do ambiente acadêmico, para reverter e evitar o desencadeamento de patologias de saúde mental nos universitários.