Introduction: Medical students may experience test anxiety associated with 'high stakes' exams, such as Step 1 of the United States Medical Licensing Examination.
Methods: We collected qualitative responses about test anxiety at three points in time from 93 second-year medical students engaged in studying for and taking Step 1.
Results: Causes of test anxiety as reported by students were related to negative self-talk during preparation for the exam. Effects of anxiety had to do with emotional well-being, cognitive functioning, and physical well-being. Strategies included socializing with others and a variety of cognitive and physical approaches. Comparison of individuals' strategies with causes and effects showed some congruence, but substantial incongruence between the types of strategies chosen and the reported causes and effects of test anxiety.
Discussion: Students' adoption of a 'menu' of strategies rather than one or two carefully selected strategies suggest inefficiencies that might be addressed by interventions, such as advisor-directed conversations with students and incorporating student self-assessment and strategies for managing anxiety within courses on test-taking. Such interventions are in need of further study. An annotated list of evidence-based strategies would be helpful to students and educators. Most important, test anxiety should be viewed by medical educators as a 'real' experience, and students would benefit from educator support.
Keywords: high-stakes exams; medical students; test anxiety; test-taking.