Skip to main content
Top
Published in: Perspectives on Medical Education 6/2014

Open Access 01-12-2014 | Review Article

The relationship between academic assessment and psychological distress among medical students: a systematic review

Authors: Mataroria P. Lyndon, Joanna M. Strom, Hussain M. Alyami, Tzu-Chieh Yu, Nichola C. Wilson, Primal P. Singh, Daniel P. Lemanu, Jill Yielder, Andrew G. Hill

Published in: Perspectives on Medical Education | Issue 6/2014

Login to get access

Abstract

A systematic review was conducted to determine the relationship between academic assessment and medical student psychological distress with the aim of informing assessment practices. A systematic literature search of six electronic databases (Medline, Medline IN PROCESS, PubMed, EMBASE, Psychinfo, ERIC) from 1991 to May 2014 was completed. Articles focusing on academic assessment and its relation to stress or anxiety of medical students were included. From 3,986 potential titles, 82 full-text articles were assessed for eligibility, and 23 studies met review inclusion criteria. Studies focused on assessment stress or anxiety, and assessment performance. Consistent among the studies was the finding that assessment invokes stress or anxiety, perhaps more so for female medical students. A relationship may exist between assessment stress or anxiety and impaired performance. Significant risks of bias were common in study methodologies. There is evidence to suggest academic assessment is associated with psychological distress among medical students. However, differences in the types of measures used by researchers limited our ability to draw conclusions about which methods of assessment invoke greater distress. More rigorous study designs and the use of standardized measures are required. Future research should consider differences in students’ perceived significance of assessments, the psychological effects of constant exposure to assessment, and the role of assessment in preparing students for clinical practice.
Literature
1.
go back to reference Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73.PubMedCrossRef Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73.PubMedCrossRef
2.
go back to reference Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613–22.PubMedCrossRef Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613–22.PubMedCrossRef
3.
go back to reference Saipanish R. Stress among medical students in a Thai medical school. Med Teach. 2003;25(5):502–6.PubMedCrossRef Saipanish R. Stress among medical students in a Thai medical school. Med Teach. 2003;25(5):502–6.PubMedCrossRef
4.
go back to reference Kidson M, Hornblow A. Examination anxiety in medical students: experiences with the visual analogue scale for anxiety. Med Educ. 1982;16(5):247–50.PubMedCrossRef Kidson M, Hornblow A. Examination anxiety in medical students: experiences with the visual analogue scale for anxiety. Med Educ. 1982;16(5):247–50.PubMedCrossRef
5.
go back to reference de Pablo J, Subira S, Martin MJ, de Flores T, Valdes M. Examination-associated anxiety in students of medicine. Acad Med. 1990;65(11):706–7.PubMedCrossRef de Pablo J, Subira S, Martin MJ, de Flores T, Valdes M. Examination-associated anxiety in students of medicine. Acad Med. 1990;65(11):706–7.PubMedCrossRef
6.
go back to reference Afzal H, Afzal S, Siddique SA, Naqvi SA. Measures used by medical students to reduce test anxiety. J Pak Med Assoc. 2012;62(9):982–6.PubMed Afzal H, Afzal S, Siddique SA, Naqvi SA. Measures used by medical students to reduce test anxiety. J Pak Med Assoc. 2012;62(9):982–6.PubMed
7.
go back to reference Farooqi YN, Ghani R, Spielberger CD. Gender differences in test anxiety and academic performance of medical students. Int J Psychol Behav Sci. 2012;2(2):38–43.CrossRef Farooqi YN, Ghani R, Spielberger CD. Gender differences in test anxiety and academic performance of medical students. Int J Psychol Behav Sci. 2012;2(2):38–43.CrossRef
8.
go back to reference Teigen KH. Yerkes-Dodson: a law for all seasons. Theory & Psychol. 1994;4(4):525–47.CrossRef Teigen KH. Yerkes-Dodson: a law for all seasons. Theory & Psychol. 1994;4(4):525–47.CrossRef
9.
go back to reference Harris A, Martin BJ. Increased abdominal pain during final examinations. Dig Dis Sci. 1994;39(1):104–8.PubMedCrossRef Harris A, Martin BJ. Increased abdominal pain during final examinations. Dig Dis Sci. 1994;39(1):104–8.PubMedCrossRef
10.
go back to reference Maclaughlin BW, Wang D, Noone AM, et al. Stress biomarkers in medical students participating in a mind body medicine skills program. Evid Based Complement Altern Med. 2011;2011:950461.CrossRef Maclaughlin BW, Wang D, Noone AM, et al. Stress biomarkers in medical students participating in a mind body medicine skills program. Evid Based Complement Altern Med. 2011;2011:950461.CrossRef
11.
go back to reference Colbert-Getz JM, Fleishman C, Jung J, Shilkofski N. How do gender and anxiety affect students’ self-assessment and actual performance on a high-stakes clinical skills examination? Acad Med. 2013;88(1):44–8.PubMedCrossRef Colbert-Getz JM, Fleishman C, Jung J, Shilkofski N. How do gender and anxiety affect students’ self-assessment and actual performance on a high-stakes clinical skills examination? Acad Med. 2013;88(1):44–8.PubMedCrossRef
12.
13.
go back to reference Frierson HT Jr, Hoban JD. The effects of acute test anxiety on NBME Part I performance. J Natl Med Assoc. 1992;84(8):686–9.PubMedCentralPubMed Frierson HT Jr, Hoban JD. The effects of acute test anxiety on NBME Part I performance. J Natl Med Assoc. 1992;84(8):686–9.PubMedCentralPubMed
14.
go back to reference Broyles IL, Cyr PR, Korsen N. Open book tests: assessment of academic learning in clerkships. Med Teach. 2005;27(5):456–62.PubMedCrossRef Broyles IL, Cyr PR, Korsen N. Open book tests: assessment of academic learning in clerkships. Med Teach. 2005;27(5):456–62.PubMedCrossRef
15.
go back to reference Bloodgood R, Short JG, Jackson JM, Martindale JR. A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being. Acad Med. 2009;84(5):655–62.PubMedCrossRef Bloodgood R, Short JG, Jackson JM, Martindale JR. A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being. Acad Med. 2009;84(5):655–62.PubMedCrossRef
16.
go back to reference Sharma B, Wavare R, Deshpande A, Nigam R, Chandorkar R. A study of academic stress and its effect on vital parameters in final year medical students at SAIMS Medical College, Indore Madhya Pradesh. Biomed Res. 2011;22(3):361–5. Sharma B, Wavare R, Deshpande A, Nigam R, Chandorkar R. A study of academic stress and its effect on vital parameters in final year medical students at SAIMS Medical College, Indore Madhya Pradesh. Biomed Res. 2011;22(3):361–5.
17.
go back to reference Joshi RM, Sanghavi SJ, Upadhyaya DP, Chauhan A, Halvadia S. Effect of examination stress on the plasma cortisol level. Natl J Med Res. 2012;2(4):435–8. Joshi RM, Sanghavi SJ, Upadhyaya DP, Chauhan A, Halvadia S. Effect of examination stress on the plasma cortisol level. Natl J Med Res. 2012;2(4):435–8.
18.
go back to reference Dayalan H, Subramanian S, Elango T. Psychological well-being in medical students during exam stress-influence of short-term practice of mind sound technology. Indian J Med Sci. 2010;64(11):501–7.PubMedCrossRef Dayalan H, Subramanian S, Elango T. Psychological well-being in medical students during exam stress-influence of short-term practice of mind sound technology. Indian J Med Sci. 2010;64(11):501–7.PubMedCrossRef
19.
go back to reference Shukla N, Verma NS, Tandon SN, et al. Examination stress in medical student: a study. Indian J Med Sci. 1993;47(11):264–6.PubMed Shukla N, Verma NS, Tandon SN, et al. Examination stress in medical student: a study. Indian J Med Sci. 1993;47(11):264–6.PubMed
20.
go back to reference Malathi A, Parulkar VG. Evaluation of anxiety status in medical students prior to examination stress. Indian J Physiol Pharmacol. 1992;36(2):121–2.PubMed Malathi A, Parulkar VG. Evaluation of anxiety status in medical students prior to examination stress. Indian J Physiol Pharmacol. 1992;36(2):121–2.PubMed
21.
22.
go back to reference Katsuura S, Kuwano Y, Yamagishi N, et al. MicroRNAs miR-144/144 and miR-16 in peripheral blood are potential biomarkers for naturalistic stress in healthy Japanese medical students. Neurosci Lett. 2012;516(1):79–84.PubMedCrossRef Katsuura S, Kuwano Y, Yamagishi N, et al. MicroRNAs miR-144/144 and miR-16 in peripheral blood are potential biomarkers for naturalistic stress in healthy Japanese medical students. Neurosci Lett. 2012;516(1):79–84.PubMedCrossRef
23.
go back to reference Kurokawa K, Tanahashi T, Murata A, et al. Effects of chronic academic stress on mental state and expression of glucocorticoid receptor alpha and beta isoforms in healthy Japanese medical students. Stress. 2011;14(4):431–8.PubMed Kurokawa K, Tanahashi T, Murata A, et al. Effects of chronic academic stress on mental state and expression of glucocorticoid receptor alpha and beta isoforms in healthy Japanese medical students. Stress. 2011;14(4):431–8.PubMed
24.
go back to reference Hashmat S, Hashmat M, Amanullah F, Aziz S. Factors causing exam anxiety in medical students. J Pak Med Assoc. 2008;58(4):167–70.PubMed Hashmat S, Hashmat M, Amanullah F, Aziz S. Factors causing exam anxiety in medical students. J Pak Med Assoc. 2008;58(4):167–70.PubMed
25.
go back to reference Hettiarachchi M, Fonseka CL, Gunasekara P, Jayasinghe P, Maduranga D. How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka? Med Educ Online. 2014;19:22772.PubMedCrossRef Hettiarachchi M, Fonseka CL, Gunasekara P, Jayasinghe P, Maduranga D. How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka? Med Educ Online. 2014;19:22772.PubMedCrossRef
26.
go back to reference Yusoff MSB. Associations of pass-fail outcomes with psychological health of first-year medical students in a malaysian medical school. Sultan Qaboos Univ Med J. 2013;13(1):107–14.PubMedCentralPubMedCrossRef Yusoff MSB. Associations of pass-fail outcomes with psychological health of first-year medical students in a malaysian medical school. Sultan Qaboos Univ Med J. 2013;13(1):107–14.PubMedCentralPubMedCrossRef
27.
go back to reference Yusoff MSB. Impact of summative assessment on first year medical students’ mental health. Int Med J. 2011;18(3):172–5. Yusoff MSB. Impact of summative assessment on first year medical students’ mental health. Int Med J. 2011;18(3):172–5.
28.
go back to reference Pamphlett R, Farnill D. Effect of anxiety on performance in multiple choice examination. Med Educ. 1995;29(4):297–302.PubMedCrossRef Pamphlett R, Farnill D. Effect of anxiety on performance in multiple choice examination. Med Educ. 1995;29(4):297–302.PubMedCrossRef
29.
go back to reference Ping LT, Subramaniam K, Krishnaswamy S. Test anxiety: state, trait and relationship with exam satisfaction. Malays J Med Sci. 2008;5(2):8–23. Ping LT, Subramaniam K, Krishnaswamy S. Test anxiety: state, trait and relationship with exam satisfaction. Malays J Med Sci. 2008;5(2):8–23.
30.
go back to reference Mellanby J, Zimdars A. Trait anxiety and final degree performance at the University of Oxford. Higher Educ. 2010;61(4):357–70.CrossRef Mellanby J, Zimdars A. Trait anxiety and final degree performance at the University of Oxford. Higher Educ. 2010;61(4):357–70.CrossRef
31.
go back to reference Spielberger C. Manual for the test anxiety inventory. Palo Alto: Consulting Psychologists Press; 1980. Spielberger C. Manual for the test anxiety inventory. Palo Alto: Consulting Psychologists Press; 1980.
32.
go back to reference Skevington SM, Lotfy M, O’Connell KA. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299–310.PubMedCrossRef Skevington SM, Lotfy M, O’Connell KA. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299–310.PubMedCrossRef
33.
go back to reference Krägeloh C, Henning M, Hawken S, Zhao Y, Shepherd D, Billington R. Validation of the WHOQOL-BREF quality of life questionnaire for use with medical students. Educ Health. 2011;24(2):545. Krägeloh C, Henning M, Hawken S, Zhao Y, Shepherd D, Billington R. Validation of the WHOQOL-BREF quality of life questionnaire for use with medical students. Educ Health. 2011;24(2):545.
34.
go back to reference Leininger S, Skeel R. Cortisol and self-report measures of anxiety as predictors of neuropsychological performance. Arch Clin Neuropsych. 2012;27(3):318–28.CrossRef Leininger S, Skeel R. Cortisol and self-report measures of anxiety as predictors of neuropsychological performance. Arch Clin Neuropsych. 2012;27(3):318–28.CrossRef
35.
go back to reference Zeidner M. Test Anxiety: the state of the art. New York: Plenum; 1998. Zeidner M. Test Anxiety: the state of the art. New York: Plenum; 1998.
36.
go back to reference Huang CY, Liao HY, Chang SH. Social desirability and the clinical self-report inventory: methodological reconsideration. J Clin Psychol. 1998;54(4):517–28.PubMedCrossRef Huang CY, Liao HY, Chang SH. Social desirability and the clinical self-report inventory: methodological reconsideration. J Clin Psychol. 1998;54(4):517–28.PubMedCrossRef
37.
go back to reference James A. Managing Stress in Education: A Comprehensive Guide for Staff and Students. London: Optimus Professional Publishing Ltd; 2011. James A. Managing Stress in Education: A Comprehensive Guide for Staff and Students. London: Optimus Professional Publishing Ltd; 2011.
38.
go back to reference Lazarus R, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984. Lazarus R, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
39.
go back to reference Boyes M, French D. Does appraisal mediate the relationship between neuroticism and maladaptive coping? A pilot study in the context of university exams. Individ Diff Res. 2011;9(3):165–72. Boyes M, French D. Does appraisal mediate the relationship between neuroticism and maladaptive coping? A pilot study in the context of university exams. Individ Diff Res. 2011;9(3):165–72.
40.
go back to reference Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000.PubMedCrossRef Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000.PubMedCrossRef
41.
go back to reference West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306(9):952–60.PubMedCrossRef West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306(9):952–60.PubMedCrossRef
42.
go back to reference Singh G, Hankins M, Weinman JA. Does medical school cause health anxiety and worry in medical students? Med Educ. 2004;38(5):479–81.PubMedCrossRef Singh G, Hankins M, Weinman JA. Does medical school cause health anxiety and worry in medical students? Med Educ. 2004;38(5):479–81.PubMedCrossRef
43.
go back to reference Stewart SM, Lam TH, Betson CL, Wong CM, Wong AM. A prospective analysis of stress and academic performance in the first two years of medical school. Med Educ. 1999;33(4):243–50.PubMedCrossRef Stewart SM, Lam TH, Betson CL, Wong CM, Wong AM. A prospective analysis of stress and academic performance in the first two years of medical school. Med Educ. 1999;33(4):243–50.PubMedCrossRef
44.
go back to reference LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med. 2009;84(10 Suppl):S25–33.PubMedCrossRef LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med. 2009;84(10 Suppl):S25–33.PubMedCrossRef
45.
go back to reference Edelman M, Ficorelli C. A measure of success: nursing students and test anxiety. J Nurses Staff Dev. 2005;21(2):55–9; quiz 60–1. Edelman M, Ficorelli C. A measure of success: nursing students and test anxiety. J Nurses Staff Dev. 2005;21(2):55–9; quiz 60–1.
46.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.PubMedCrossRef Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.PubMedCrossRef
Metadata
Title
The relationship between academic assessment and psychological distress among medical students: a systematic review
Authors
Mataroria P. Lyndon
Joanna M. Strom
Hussain M. Alyami
Tzu-Chieh Yu
Nichola C. Wilson
Primal P. Singh
Daniel P. Lemanu
Jill Yielder
Andrew G. Hill
Publication date
01-12-2014
Publisher
Bohn Stafleu van Loghum
Published in
Perspectives on Medical Education / Issue 6/2014
Print ISSN: 2212-2761
Electronic ISSN: 2212-277X
DOI
https://doi.org/10.1007/s40037-014-0148-6

Other articles of this Issue 6/2014

Perspectives on Medical Education 6/2014 Go to the issue