A new Yale study conducted on second-year medical students offers a possible course of treatment for test anxiety.

This study focused on medical students preparing for Step 1, an assessment that has a major role in determining their residency program match. The findings suggest that the causes of test anxiety are primarily some forms of negative internal dialogue, while the effects are more widespread, manifesting themselves in emotional, physical and mental domains. The results of the study suggest that selecting fewer stress management strategies rather than more can lead to a better outcome, said John Encandela, Yale professor of psychiatry and study co-author.

“Feeling anxious is normal,” Encandela said. “It is learning how to deal with it that is important.”

The original inspiration for the study comes from Nancy Angoff, associate dean for student affairs at the Yale School of Medicine, after counseling students who were nervous about Step 1. The study utilized the Westside Test Anxiety Scale, a 10-question quantitative measure of anxiety, in order to gauge the wide spectrum of test anxiety among students, said Michael Green, a professor of medicine at the Yale School of Medicine and study co-author. The scale was administered to medical students before and after completing Step 1.

Encandela said the study first explored the causes of test-induced anxiety, as optimal levels are crucial for successful test-taking. The findings suggest that the main cause of test anxiety is the “negative self talk” that many students engage in, both while studying and while taking the actual test. This negative self-talk describes behaviors that include allowing past performance to influence current preparation or comparing perceptions of one’s own skills and preparation to those of peers.

The effects of this test anxiety were observed in three broad categories: emotional and mental wellbeing, physical well-being and cognitive functions. Students experiencing test anxiety often reported feeling as if they were on emotional rollercoasters, with stages of intimidation, uncertainty, anxiety or irritability.

Closely linked with this are the physical effects, including detrimental changes in eating and sleeping habits. While most respondents reported trouble sleeping during the study period and on the night before the test, the changes in eating habits varied more. Some reported significant decreases in diet, whereas others reported uncontrollable consumption of unhealthy foods.

In the realm of cognition, students experienced decreased ability to concentrate and recall information during study periods as well as in testing scenarios.

In response to these effects of text anxiety, students reported a range of coping strategies. Seeking help, eating well, managing a sleep schedule, exercising frequently and balancing responsibilities in one’s life were the most common methods that students utilized to reduce test anxiety and overall stress. Some students reported increased socializing, though others reported that the time commitment made them more anxious.

In addition, a cohort of students said seeking help was beneficial, though advice to look at the “big picture” often increased anxiety, Encandela said.

“However, it is ultimately up to the student to figure out for his- or herself the best way to deal with test anxiety.” Encandela said.

The study’s next step is to compile a comprehensive guide for advisers and faculty in their efforts to help students deal with the test anxiety phenomenon.

Possible continuations of the study include administering the Westside Test Anxiety Scale to undergraduates. Green added that since Yale’s medical school is uniquely noncompetitive, it is uncertain how the findings will translate to other student populations.

Green is leading another study — already completed and currently under review at Educational Research International — that centers on a possible intervention-based course to help students deal with test anxiety, including approaches for test taking strategies and relaxation techniques.

The Step 1 test features 322 multiple-choice questions.