Pharmacy Student Anxiety and Success With Objective Structured Clinical Examinations

Impact of Student Pharmacist State Anxiety on Vasopressor Calculation Accuracy in Advanced Cardiac Life Support Simulations

OBJECTIVE

To assess the impact of student pharmacist state anxiety on vasopressor calculation accuracy in advanced cardiac life support (ACLS) simulations.

METHODS

Third-year professional students participated in 2 ACLS-related simulation laboratory sessions. In week 1, students completed 3 calculations at their workstation with no stressors. Students were then randomized into teams for a bedside simulation where they independently completed 3 additional calculations either with or without stressors. Team assignments were maintained for week 2 where all participants completed a high-fidelity ACLS simulation that included a team vasopressor calculation. At both encounters, calculation accuracy was assessed as well as pre- and post-state anxiety using the Spielberger State-Trait Anxiety Inventory (STAI) survey tool.

RESULTS

Students' (N = 145) trait anxiety aligned with normative data for similarly aged professional students. Post-simulation state anxiety in week 1 was found to be higher for those completing the activity with stressors than without (STAI score 44.7 vs 36.9) paired with lower bedside calculation accuracy, despite similar initial workstation calculation accuracy. In week 2, pre-simulation state anxiety score and calculation accuracy were not significantly different between the 2 groups. However, the state anxiety score significantly increased post-simulation for those exposed to stress in the previous week.

CONCLUSION

Stress negatively impacted student pharmacist vasopressor calculation accuracy. However, the repeated exposure to a stressed simulation did not result in a significant difference in pre- or post-simulation state anxiety score or calculation accuracy when compared to a non-stressed control. Consideration should be made whether to include more "real-life" simulations in student pharmacist education.

Shifting to Authentic Assessments? A Systematic Review of Student Perceptions of High-Fidelity Assessments in Pharmacy

OBJECTIVE

Despite becoming increasingly popular, there is no comprehensive review on high-fidelity assessments in pharmacy education that has a focus on the perceptions and experiences of students. This systematic review investigates the student acceptability of high-fidelity simulation for summative assessments in pharmacy education and provides recommendations regarding high-fidelity simulation practices.

FINDINGS

The search yielded 37 studies in total. The articles fell into 3 distinct categories: objective structured clinical examinations (N = 25); face-to-face simulation assessments (N = 9), and augmented reality assessments (N = 3). Most high-fidelity assessments were well received with most students agreeing they had a vital role in assessing the application of clinical knowledge, even though they are stressful. Students prefer high-fidelity assessments to be face-to-face rather than online and also prefer when simulated patients whom they are unfamiliar with are used. Students also expressed a need to be well-prepared for the assessment regarding the logistics of the exam and technology use.

SUMMARY

High-fidelity simulation is likely to be increasingly important in the assessment of the knowledge and skills of pharmacy students and student perception is an important factor to consider when developing such assessments. Reducing stress associated with high-fidelity assessments could include familiarizing students with task logistics or technology used prior to the assessment, using external simulated patients, and having face-to-face assessments and practice sessions.

The Impact of COVID-19 on Pharmacy Student Stress During High-Stakes, Performance-Based Assessments in Skills-Based Courses

Objective. To compare stress levels of pharmacy students in high-stakes, performance-based assessments administered during skills-based laboratory courses in normal classroom environments versus pandemic classroom environments impacted by COVID-19.Methods. In 2019, prior to the start of the COVID-19 pandemic, Doctor of Pharmacy (PharmD) students' stress levels were assessed via a voluntary, paper-based survey before and after performance-based assessments. Students were given a modified version of this survey in 2020 during the pandemic. The 2019 and 2020 survey responses were compared using Wilcoxon rank sum tests.Results. Pharmacy students reported higher perceived stress levels before performance-based assessments (3.8 vs 3.5) and after performance-based assessments (2.8 vs 2.5) prior to the pandemic compared to during the pandemic. Students identified stress as negatively impacting their performance-based assessment performance in both years (3.4 vs 3.1). Students had similar interest in wellness activities in both phases.Conclusion. Colleges of pharmacy should consider implementing stress relief programs around high-stakes assessments as well as prioritizing wellness initiatives within curricula.

The predictors of nursing students' clinical competency in pre-internship objective structured clinical examination: The roles of exam anxiety and academic success

BACKGROUND

Identifying the predictors of nursing students' clinical competency in objective structured clinical examination (OSCE) is of utmost importance. Therefore, the present study was to investigate the predictive roles of exam anxiety and academic success in nursing students' clinical competency in the pre-internship OSCE.

METHODS

In this descriptive-analytical study, a total number of 102 nursing students, meeting the inclusion criteria and enrolled in the sixth semester (third year) of the graduate nursing program in Iran, were firstly selected by the census method. The pre-internship OSCE was then implemented at eight stations based on a pre-designed schedule template. The required data were also collected through a demographic-academic characteristics questionnaire and the State-Trait Anxiety Inventory to determine the exam anxiety score, the nursing program grade point average (GPA) to reflect on the levels of academic success, and the OSCE score to control clinical competency. The data analysis was also performed at the significance level of 0.05.

RESULTS

The linear regression model, in which the exam anxiety, the nursing program GPA, and the demographic-academic characteristics variables had been imported, could explain 33.52% of the variance of the nursing students' clinical competency in the pre-internship OSCE (R² = 0.616). Of the variables concerned, only the nursing program GPA could be a significant predictor of the nursing students' clinical competency scores in the OSCE, so that 0.8 points were added to the clinical competency scores in the OSCE as the nursing program GPA increased by one unit (p = 0.000, β = 0.717), but no significant relationship was observed between exam anxiety and clinical competency in the pre-internship OSCE among the nursing students.

CONCLUSIONS

The results of this study endorsed the use of the OSCE in assessing the nursing students' clinical competency and implementing learning strategies to strengthen the levels of academic success in such individuals.

Evaluation of anxiety in doctor of pharmacy students in their first through fourth professional years

INTRODUCTION

Doctor of pharmacy (PharmD) student anxiety is not well accounted for in the literature. Anxiety carries the potential to cause impairment in functioning, worsen mental health outcomes, and adversely impact cognition, academic performance, and professionalism. The purpose of this study was to characterize anxiety among PharmD students in their first through fourth professional years. Secondary aims were to compare the prevalence of clinically significant anxiety and severity of anxiety among classes.

METHODS

A cross-sectional, observational analysis was performed surveying 198 pharmacy students completing professional coursework. A survey shared via social media containing the Zung Self-Anxiety Scale and general demographic questions was distributed to pharmacy students to assess the prevalence and severity of anxiety in first through fourth professional year students. Clinically significant anxiety was defined as a raw score ≥ 36. A one-way analysis of variance was performed to compare the means of all classes and Tukey's honestly significant differences test was performed to evaluate for statistical differences between individual classes.

RESULTS

Clinically significant anxiety was evident in 65% of respondents. The second professional year class reported the highest rate of anxiety with 84% meeting the threshold for clinically significant anxiety. The fourth professional year class reported the lowest rates with 51% reporting clinically significant anxiety.

CONCLUSIONS

Anxiety is prevalent in pharmacy students with higher levels of anxiety observed in earlier years. This work highlights opportunities to expand student mental health resources. Further studies are warranted to identify factors contributing to pharmacy student anxiety.

Systematic review of student anxiety and performance during objective structured clinical examinations

INTRODUCTION

Test anxiety is well studied in higher education, but studies primarily concern traditional assessments, such as written examinations. As use of objective structured clinical examination (OSCE) in pharmacy education increases, a closer examination of non-cognitive factors such as test anxiety is warranted. The purpose of this review was to determine the association between OSCE-associated test anxiety with OSCE performance in health professional students.

METHODS

A literature search was conducted to identify peer-reviewed literature concerning test anxiety in health professional students associated with OSCE. Investigators searched for a combination of OSCE-related terms with anxiety-related terms using PubMed. Articles were included if they assessed OSCE-related anxiety by quantitative or qualitative methods. Data extracted from eligible articles included demographic data, type of the anxiety survey, associations between OSCE-related anxiety and performance, and other student-factors associated with OSCE-related anxiety.

RESULTS

The literature search yielded 339 articles. Nine articles met eligibility criteria and were included in the review. Results included students from medical, pharmacy, dental, and nursing professional programs. Anxiety was assessed via multiple scales. Six out of the eight studies assessing the relationship OSCE-related anxiety and OSCE performance found no association between the two measures. Contrary to literature concerning test anxiety in higher education, female gender was not associated with OSCE-related anxiety.

CONCLUSION

OSCE-related anxiety appears to have minimal to no influence on student performance. Future studies should utilize standardized anxiety assessments and should seek to understand anxiety's effects on student wellbeing and burnout.

An exploratory analysis of factors contributing to resident pass rates on a national licensure OSCE in the United Arab Emirates

Purpose

To explore resident perceptions of factors contributing to pass rates on a high-stake licensing objective structured clinical exam (OSCE).

Materials and Methods

A cross-sectional survey was administered to all 51 applicants of the April 2019 internal medicine Arab Board OSCE examination in Abu Dhabi, United Arab Emirates (UAE), and included questions on preparedness, stress level, and prior educational experiences. Exposures were evaluated for correlation against Arab Board pass rates using Pearson correlation and the two-tailed significance was recorded.

Results

All 51 examinees completed the survey (100% response rate). Participants were primarily female n = 35 (67%) and all completed residency training in the UAE. Gender differences were noted, with higher pass rates for the male residents (13/35, 37% females vs. 8/16, 50% males, P < 0.05). Further, 65% (P < 0.001) of female examinees reported higher levels of anxiety than male residents. Examinees reported regular exposure during residency to clinical skills training (74%), standardized patients (71%), simulation (66%), and OSCEs (72%) but none of these educational modalities correlated with higher pass rates. Of multiple exam preparation modalities, only self-directed learning with deliberate practice, the intentional repetition of a task with feedback, was associated with higher pass rates.

Conclusion

Clinical exam skills are vital for trainees to deliver high-quality primary healthcare services. National licensure OSCEs have become the norm in the Arab world for assessing resident clinical exam skills. Our results suggest that residency programs should encourage residents' intentional deliberate practice and mastery learning in the acquisition and retention of physical examination techniques.

Effects of anxiety on dental students' noncognitive performance in their first objective structured clinical examination

Patient-dentist discourse is a core nonoperational competency in dental education. The skills of querying patients and responding to questions are noncognitive attributes, and their evaluation by the standardized patient objective structured clinical examination (OSCE) is particularly necessary. However, it is not clear whether students' test anxiety affects these attributes. This study aims to examine the relationship between dental students' state-trait anxiety, noncognitive performance, and examination results during their first OSCE. A single dental school cohort (n = 226) of 5 year students attending their first clinical examination from 2014 to 2017 was studied. Participants completed the Chinese Mandarin Version State-Trait Anxiety Inventory Y form before taking the OSCE. The difference between state and trait anxiety levels was compared by paired t test. Gender differences and the effect of age group in these anxiety levels were analyzed using multivariate analysis of variance. Moreover, gender, age group, state anxiety, and trait anxiety scores were compared with the OSCE items of noncognitive performance using a chi-square test. Students showed significantly higher state anxiety than trait anxiety levels; moreover, women showed significantly higher state anxiety than men. Furthermore, gender, age group, state anxiety, and trait anxiety had no association with the noncognitive performance examination results. Most participants showed moderate state and trait anxiety levels during their first OSCE. Further, the state-trait anxiety had no significant effect on their noncognitive performance. However, 26.5% of participants did not pass the examination; therefore, dental educators should increase communication skill training courses during clerkship training to improve students' noncognitive attributes.

A Questionnaire Study to Investigate Stress among Future Pharmacists by Gender and Year Group

BACKGROUND

This work aimed to ascertain future pharmacists' stressors and stress-coping practices.

METHODS

Queens' University Belfast Year 2 and 4 pharmacy students were invited to participate in an ethically approved, pre-piloted questionnaire study. Section A was the 10-item Perceived Stress Scale, Sections B and C related to stressors and stress-coping mechanisms, and Section D gathered non-identifiable demographic information. Data analysis largely took the form of descriptive statistics.

RESULTS

A response rate of 94.2% (213/226) was obtained. The mean Perceived Stress Scale score was 19.94 [standard deviation (SD) 6.37], with females having a higher mean score than males (20.55 SD 5.67 versus 18.16 SD 7.42). Common general stressors were career choice, employment opportunities, and finance. Common degree-specific stressors were particular assessments (objective structured clinical examinations and one-off written examinations) and the amount of course material. Popular stress-coping practices included getting emotional support from friends and family and using self-distractions.

CONCLUSION

Stress appears to be an issue among these future pharmacists, and potentially more so for females. While the main stressors are unsurprising, this UK data enables comparisons to be made and helps inform support mechanisms within the university.