Yale SCHOOL OF MEDICINE
TEACHING AND LEARNING CENTER
J. Encandela, PhD, C. Gibson, MPH, M. Green, MD, G. Leydon, MA, N. Angoff, MD
OBJECTIVE
RESULTS
CONCLUSIONS
I.
• In spite of YSM students capabilities, many
still do worry about high-stakes exams like
Step 1.
BACKGROUND
A. Many medical students experience test anxiety
that may affect test performance.
B. 2nd-year YSM students studied to determine:
• The relationship between test anxiety &
USMLE Step 1.
• Effect of a test-taking strategies course on
anxiety and Step 1 scores.
Three major categories of findings about test-anxiety
“My main worry is how much this exam is
1. Causes of anxiety (all having to do with students’ self-talk): supposed to mean and how much I’m doing
compared with those around me. I realize I
should not be comparing myself or listening
• Focus on “high-stakes” of the exam
to the worries of my peers, but it’s hard to
• Focus on past academic performance
shut that out—especially when people very
• Focus on time constraints and amount of material to cover close to me (and who I believe to be much
smarter than me) have been studying head
• Comparison of self with peers
over heals for the exam for a long time. I’m
definitely afraid I won’t have studied enough,
and have not done enough these past two
years to prepare me for this test.“
2. Effects of anxiety:
• On emotional or mental well-being
C.
Brief synopsis of our quantitative results
(presented
in detail elsewhere):
• According to a validated test-anxiety scale,*
study participants (n=85) had “moderately to
high-normal” test anxiety at the beginning of
Step 1study period.
• A weak to modest inverse relationship
existed between test anxiety after Step 1 and
exam scores.
• A test-taking strategy course modestly
reduced test anxiety but did not noticeably
affect Step 1 scores.
• On cognition (memory and concentration)
“It’s hard to concentrate on material due
to racing worry thoughts going through
my mind.”
• A test-taking strategies course may help
reduce anxiety in students.
• The course may be improved by reducing the
number of days it is offered and concentrating
more on the components addressing anxietyreduction and effective studying strategies.
This concentration may, in fact, create a more
robust intervention that not only reduces
anxiety but positively affects performance.
• On physical well-being, including sleep and appetite
disturbance
3. Strategies for addressing anxiety:
• Socializing with friends and family
• Cognitive strategies:
- Mindfulness, re-orientation of thinking
- Placing the importance of Step 1 in context with
the rest of life
- Prayer, yoga, spirituality
• Physical strategies:
“Sometimes I think that I worry too much
about how I will do and could instead
direct that energy and time spent
worrying to just buckling down and
studying more. As someone who has
generally done very well on tests (in
school and standardized), but also as a
worrier, I have come to accept more as
I've gotten older that I will do well as long
as I study (and that I can only do the best
that I can).”
- Managing sleep and eating patterns
METHODS
A. Survey administered at 3 time points:
• Time 1: Beginning of the Step 1 study period
(n=85).
• Time 2: Directly after a test-taking course by
24 students randomly selected from 40
volunteers.
• Time 3: 10 weeks from baseline after most
students had taken Step 1 (n=85).
• Past experiences with test anxiety (at Time
1).
• Perceptions of the test-taking course (at
Time 2).
• Experiences with test anxiety and strategies
for addressing it (at Time 3).
C. Analysis:
• Electronically generated narrative answers
were organized into Word transcripts.
• 2
investigators
independently
coded
transcripts; organized codes by general
categories; then, developed provisional
coding frame, which they used to again
independently code transcripts.
• Identified like and different coding (.68
kappa); reconciled differences; developed
final coding scheme; then, derived major
themes and findings.
• Causes and effects of anxiety differ for
different students. It may be beneficial to
assist students in identifying causes and
effects particular to them, and to match
strategies
appropriate
for
addressing
causes/effects.
- Planning study breaks
LIMITATIONS
• Study was local and not necessarily
generalizable to other medical students.
• Though students narratively listed strategies
that they have used to address test anxiety,
we did not attempt to study the effectiveness
of these strategies; we only tested the testtaking strategies course in its effect on
anxiety and exam performance.
- Balancing study with fun and activity
- Exercise
Usefulness of the course
II.
MORE INFORMATION
Perceptions of the test-taking strategies course
•
Extremely
useful,
19%
Respondents thought the course was somewhat to
extremely useful.
•
A number thought the course was too long (6 days, 6
hours per day; could have been reduced to 2 to 3 days,
with emphasis on anxiety- reduction and increasing
Somewhat
useful,
52%
•
About the study, contact John Encandela
(see business cards)
•
About the course, contact Nancy Angoff,
Associate Dean for Student Affairs
Useful, 29%,
effectiveness of study time, less emphasis on
practice questions).
“The preparation course helped alleviate most of the anxiety
I felt about the exam.”
“I cannot recommend this course enough. However, I do
recognize that it is designed for a particular type of person.
If someone prefers learning on their own with books, they
shouldn’t do the course. If someone prefers to use
reasoning and not brute force knowledge for standardized
exams, this is perfect.”
ACKNOWLEDGEMENTS
• Thank you to all the students in the Class of
2015 who participated in this study.
• A private training firm, the Institute of Medical
Boards, presented the test-taking strategies
course.
• Poster
template
from
http://colinpurrington.com/tips/academic/post
erdesign.