CHAPTER 3................................................................................................................................ 24
2.7. Tools and methods used in OSCEs
3.7.7. Stress and anxiety due to participating in OSCEs
Many authors agree that all assessment and examination processes have the potential to induce stress and anxiety (Furlong, Fox et al. 2005),and the same applies to an OSCE. Most literature on students’ perceptions of this assessment method reveals that it is the most intimidating and anxiety-provoking method of assessment (Zartman, McWhorter et al. 2002). The study by Baid (2011) reveals that students in critical care perceived the use of OSCE differently; some welcomed its use as they felt it offered them the opportunity to have a clinically-focused, hands-on examination, while others found the exposure to OSCE very intimidating and stressful, and this simulated environment had a negative impact on their studies. In the study by Brand and Schoonheim-Klein (2009) on dental students to measure the level of anxiety during students’ assessments, students perceived OSCE as more stressful than other assessment strategies and indicated that the stress does not decrease with the increase in experience (Brand and Schoonheim-Klein 2009).
Most researchers agree that OSCE is a stressful and intimidating experience, however, Brosman et al.’s (2006) study reveals that the stress is heightened prior to commencing procedures or while in the waiting-room, but that once the students are working at their respective stations their anxiety levels decrease and they are able to
perform well (Brosnan, Evans et al. 2006). This claim is argued by some authors who believe that anxiety persists despite student briefings or mock-OSCEs (Marshall and Jones 2003). El-
58 Nemer and Kandeel (2009) also reveal that a significant amount of first-year students in their study found OSCE to be very stressful and intimidating, compared to the opinions of third-year students (El-Nemer and Kandeel 2009). In the study by Furlong et al. (2005) students agreed that OSCE motivated them to develop clinical skills, but that the experience was very stressful, intimidating and tiring (Pierre, Wierenga et al. 2004). Therefore, Furlong et al. (2005) suggest that for OSCE to be a good learning experience and to help to reduce anxiety related to its format, OSCE preparation is essential. The study done on mental health students reveals that students were grateful for their pre-orientation of score-sheets, as this made them aware of what was expected of them, thus reducing the stress (Anderson and Stickley 2002)
Stress is described by Cox (1978) cited in Furlong et al. (2005:354) as a ”dynamic, complex interaction between human beings and their environment, which is dependent on the perceptions of the demands placed on a person and his/her ability to cope” (Furlong, Fox et al. 2005). Since stress occurs when the demands placed on the individual are too taxing or exceed his/her adjusting resources, it is dependent on the person facing the situation, the stressors, and how the person decides to deal with the situation, as well as cultural factors, childhood experience and hereditary factors (Furlong, Fox et al. 2005).
Clark (1984), cited in Furlong et al. (2005), believes that stress can work in two ways: (1)it can be beneficial (eustress), leading to learning and the ability to cope or,(2)it can be destructive (distress), leading to poor performance and inability to cope (Furlong, Fox et al.
2005). Furlong et al. (2005) believe that many students have high anxiety levels which affect their performance in the examinations. Baid (2010) maintains that some critical care
students have difficulty in expressing their thoughts in a short space of time, and also that
59 some students lack verbal skills which can lead to more anxiety, however, these
disadvantages can also be seen as an opportunity for the students to develop these skills.
This is in line with Byrne and Smyth (2008) who believe that students should learn to
conquer anxiety during OSCE to improve their overall performance (Byrne and Smyth 2008).
Marshall and Jones’s (2003) study aimed at quantifying the anxiety of the post- graduate student prior to assessment by measuring both the state of anxiety using the Spielberger state and also trait anxiety (Marshall and Jones 2003). State anxiety is defined as unpleasant emotional arousal in the face of threatening demands or dangers. Trait anxiety reflects the existence of stable individual differences in the tendency to respond to the state anxiety while anticipating threatening situations (Marshall and Jones 2003). This study revealed that OSCE was threatening and anxiety-provoking, and this could be because OSCE is not done in a real situation, the environment is unfamiliar to students, and also because the students experience a face-to-face encounter with the examiner (Marshall and Jones 2003). Other studies reveal that stress can have a negative effect on student
performance. Street and Hamilton (2010) concur with Duffield and Spencer’s (2002) idea that it is natural to be nervous in an examination and that nervousness helps you to perform at your peak, but that one should be able to control anxiety because, if it is out of control, it can lead to negative outcomes and poor performance. A study on midwifery students reveals that some students actually commented that “a bit of adrenaline always helps to stimulate thinking”, meaning that the stress in the OSCE was necessary or at least conducive to making them think (Jay, 2007:35). Jay’s (2007) study also reveals that OSCE was the most stress-producing method of assessment but suggests that anxiety does not affect the final results of the assessment.
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