Prevalence and Correlation of Stress and Performance in OSCE amongst Medical Students

Abstract

Background: Objective Structured Clinical Examination (OSCE) is a powerful approach in medical education that is used to evaluate clinical skills, communication, decision-making and professional behavior. OSCE is believed to be a structured and fair assessment technique, but a significant number of students are stressed out in the lead-up to and during the OSCE, which can impact their performance.

Objective: To assess student perceptions of OSCE-related stress and its effect on performance among medical students.

Methods: The study was descriptive cross-sectional study which was conducted at Northwest School of Medicine, Peshawar, from January 2025 to June 2025. Non-probability consecutive sampling was used to include a total of 82 medical students. A structured questionnaire was used to gather data which included the following items: Student demographics, prior OSCE experiences, perceived stress level, causes of OSCE stress, OSCE-related symptoms, perceived impact of stress on performance, and student opinions regarding OSCE. Data was analysed using SPSS version 26. Categorical data: Frequencies and percentages were calculated. Continuous data: mean and SD were calculated. Where appropriate, a chi-square test and Pearson correlation were used and a p value of ≤ 0.05 was regarded as statistically significant.

Results: Among 82 students, moderate stress was reported by 44 (53.7%) students, severe stress by 24 (29.2%), and mild stress by 14 (17.1%). The most common causes of stress were fear of forgetting answers 59 (72.0%), time pressure 55 (67.1%), fear of examiner evaluation 51 (62.2%), lack of confidence 47 (57.3%), and inadequate practice 44 (53.7%). Stress negatively affected performance in 47 (57.3%) students. Poor performance was more common among students with severe stress, and the association between stress level and OSCE performance was statistically significant (p=0.018). Previous OSCE experience was also significantly associated with lower stress levels (p=0.011).

Conclusion: OSCE was perceived as a stressful but useful assessment method by most students. Higher stress was associated with poorer performance, while previous OSCE exposure reduced stress. Mock OSCE sessions, repeated practice, proper orientation, and constructive feedback may help reduce stress and improve student performance.