by Jesse Foster, Pharm.D., PGY1
Pharmacy Practice Resident, Medstar Georgetown University Hospital
When I
was a pharmacy student, I had a friend who seemed to understand the course
content very well. When my friend took the final exam — an exam that weighed a
lot toward our final grade — he failed the exam. It was a classic case of test anxiety. Test
anxiety can be a serious problem for some students. An estimated 15-20% of students feel impaired
by exam stress.2
The
impact of test anxiety can lead to several negative outcomes. Students with test anxiety can have a good
understanding of the material but may be unable to recall what they know. Anxiety can also impair problem solving and
lead to poor decisions on exams. Some learners may develop avoidance behaviors
and pass up learning opportunities. Avoidance behavior develops after past poor
performance. Understandably, students don't want to repeat the negative experience. 4 Further, test anxiety shifts the focus
toward performance and outcomes rather than on learning the subject matter. Lastly, poor performance due to test anxiety
can lead to lost educational and job opportunities.2
At the
heart of test anxiety is stress. In a study by Yusoff, the impact of stress on
exam scores was examined in first year Malaysian medical students. This study
looked at students' mental status immediately after taking a final exam. The
results show that students with severe stress were 2.43 times more likely to
fail the exam compared to students with normal to mild stress.5
Cognitive
interference is a possible cause for exam anxiety. This model postulates that cognitive
processes are occupied by negative and irrelevant thoughts resulting in poor
exam performance.2 Test
anxiety has been correlated to feelings of unpreparedness when students are unfamiliar
with the exam style and content. Students can also feel unprepared when there
is a large amount of content and limited amount of time to review what will be
covered on the exam.5 Poor study habits add to test anxiety as well.
Studies have shown that students with high test anxiety are more likely to
procrastinate and use less effective studying strategies.1
The
perception by the student that the exam or assessment has significant implications
can also increase anxiety and stress. Students
become overly concerned that poor performance on an exam will result in major
negative consequences. If a student has
an unrealistic expectation that he/she will achieve a perfect score on an exam,
then stress and anxiety can increase when he/she is unable to answer an exam
question.6
To help
with cognitive interference, cognitive behavioral therapy can be used to help
reduce stress. Expressive writing is a technique to help with these disruptive
thoughts. Using this technique, the student writes out his/her negative
thoughts for 10 minutes before the exam. This allows the student to vent and
express their concerns on paper before the exam. Expressing their concerns will
clear their mind so they can better focus on the exam. Another approach to help
reduce test anxiety is relaxation techniques. These techniques have the student
focus on deep breathing along with muscle relaxation of the arms, legs and
stomach. Similar to expressive writing, this helps the person clear their mind
of negative thoughts and anxiety.4
Reducing
the perceived significance of the exam can help to alleviate the stress and anxiety
that a student may feel. Both the
learner and teacher can help minimize this type of stressor. Its important not to overemphasize the
importance of an exam and its potential impact. Multiple exams in a course can
help reduce anxiety by minimizing the impact any one exam might have on the overall
outcome.2
Providing
more realistic expectations for the exam will help students who panic
when they don’t know or understand questions. Answering questions where
the answers are known and understood first can improve test anxiety. This
helps to improve confidence and in turn, reduce anxiety during the exam as well
as diminishes the sensation that time is running out.3, 4
For
students who feel unprepared, teachers can provide insight into the exam
content and style to help reduce the fear of the unknown. Study habits can be
improved by providing a clear, regimented course schedule. Study groups can also
be beneficial by helping keep students focused. Having more frequent exams can also improve study habits since students will need to review material more frequently.1,
2
Test
anxiety is a major concern for some students. It can prevent students from
advancing academically and professionally. Test anxiety also causes students to
avoid other educational experiences and to focus more on passing exams instead
of learning the content. However, test anxiety can be minimized if both the student
and teacher employ some proven strategies.
References
1. Sansgiry
SS, Sail K. Effect of Students’ Perceptions of Course Load on Test Anxiety. Am
J Pharm Edu. 2006; 70(2): Article 26.
2. Neuderth
S, Jabs B, Schmidtke A. Strategies for reducing test anxiety and optimizing
exam preparation in German university students: a prevention-oriented pilot
project of the University of Wurzburg. J Neural Transm. 2009; 116: 785–90.
3. Abolafia
J, Lumpkins A, Malandro T. High Stakes Testing: Managing Test Anxiety. [Internet]. Accessed April 27, 2013.
4. Paul A. Relax, It's Only A Test. Time 2013;181(5):42-5.
5. Yusof
M, Associations of Pass-Fail Outcomes with Psychological Health of First-Year
Medical Students in a Malaysian Medical School. Sultan Qaboos University Med.
2013; 13(1): 107-14.
6. Chinta
R. Exam Anxiety Effect on Exam Performance: An Empirical Replication in the Middle East. Aryan Hellas Limited, IRBC Athens, 2005. Accessed 5 May 2013.
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