August 2024 - Managing assessment anxiety

Assessment, both high stakes and timed assessments are important hurdles for qualification into clinical professions. Whilst all courses should equip learners with the knowledge and skills to do well in exam situations, anxiety can impair performance. Direct observation and objective structured clinical examinations (OSCEs) can fuel additional anxiety because they are observed. Whilst a certain level of anxiety is normal and beneficial in generating adrenalin and motivating students to perform to their best, high levels of anxiety can negatively impact student performance and should therefore be managed to ensure optimal performance. 

Learning and revision techniques 

  • Teach learners to use multiple senses to create personalised learning and revision. We absorb and retain information in different ways. Some of us may be auditory learners where listening to lecture recordings is beneficial, whilst others are more visual and respond well to videos, colour coded diagrams and images. Kinesthetic learners may benefit from revising standing up, or breaking up revision with bouts of exercise. Encourage learners to try different styles of revision, using a variety of study materials and resources to find out what works best for them.
  • Encourage learners to adopt the spaced repetition approach, little and often. As Antonia Chitty advises, “arrange your revision into short blocks of time. Pay attention to when your concentration begins to flag and set a timer for 20 or 30 minute slots.” The key element to spaced practice is the space between, and planning lots of iterations with time to to reflect and digest. Practicing can also cement bad practice, so it is really important to pay attention to doing it correctly (even if slowly) to ensure poor habits are not reinforced.
  • Learners can make use of technology through phone enabled flash card apps to study in short bursts. Adding colours and images to the flash cards also helps to make mental associations. Having them on a phone means they can be kept close by and reviewed regularly.
  • Practice questions to gain familiarity with different styles and expectations of questions.
  • Encourage learners to be prepared for the unprepared. Yes, preparation is key to avoid unexpected surprises, but real life does not always go to plan so ensure that optometrist and ophthalmic dispensing learners develop strategies for when things do not go as expected. Ways to do this could be to practice a range of scenarios to give learners the breath of exposure to different situations. Encouraging learners to break scenarios into chunks can make it seem less overwhelming and allows learners to work through them in a systematic way.
  • Learners should consider attending revision and study sessions. ABDO hold an annual Student Revision Event, offering face-to-face, practical revision support to help students prepare for the Diploma in Ophthalmic Dispensing. It utilises the skills and expertise of ABDO practical examiners and includes a number of workshops specifically tailored to each of the assessment sections.
  • Remind learners to reward themselves after study sessions to aid motivation.
  • Gameify revision using online games and quizzes.

Techniques for cementing clinical skills performance 

  • Ensure all elements are undertaken under pressure and in front of lots of audiences.
  • Encourage learners to partner up or form a mentor scheme. Practicing clinical skills and knowledge with a partner or mentor will generate performance feedback and identify areas for improvement.
  • Being watched can be nerve wracking so learners should normalise the feeling of being watched and observed. Supervisors should try as much as possible to observe learners and provide regular feedback. Learners on placements should also try to arrange a swap of supervisors to gain a new perspective.

Techniques for refining skills/improving confidence

  • Define practice goals and set a progression plan. Identifying and isolating elements that are weaker will also provide focus to hone skills in specific areas.
  • Practice accurately, slowly, multiple times and then speed up and integrate multiple topics.
  • Create a Routine. Consistency is key.
  • Break down complex topics so they are less overwhelming.

Techniques for anxiety reduction 

  • Highlight the benefits of breathing and focus techniques to learners. They can help to calm the mind and ease anxiety. The NHS provide exercises to help reduce stress and anxiety.
  • Direct learners toward support from healthcare professionals, particularly the NHS and Mind if they feel this is needed. Ofqual also have some useful tips to manage assessment anxiety, as does Student Minds.
  • Re-frame the anxiety so that it can be used as a positive learning experience. Explore other ways of looking at the situation and 'reframing unhelpful thoughts.’ Create a positive narrative and try not to catastrophise situations.
  • Suggest that learners focus on their senses. This can relax you by taking your mind out of anxious thought patterns.[2]
  • Encourage learners to create a balance by taking some time out for wellbeing. This could include exploring hobbies, interests or physical activity. Spending some time on an alternative focus, helps to focus when it is time to study. Ruth Bennett, Deputy Lead Assessor on the Scheme for Registration, Dave Burke, Mental Health First Aid Instructor, and optometrists Neil Constantine-Smith, answer questions from supervisors and trainees on the Scheme for Registration on coping with anxiety on the EyePod: The optometry podcast. Practising mindfulness can also help develop strategies and coping mechanisms when assessment anxiety strikes. January's topic of the month feature has helpful tips on supporting learner wellbeing. The College of Optometrists have also developed some key resources to help manage and prioritise mental health needs. Similarly, the NHS have developed a series of tailored mental wellbeing tips.

Facing setbacks

Once a student has failed an assessment they will naturally feel more anxious in their subsequent attempts, and this anxiety can become a problem. [1]  Facing setbacks or the need to retake exams can be disheartening, but it is essential to approach these situations with resilience and a positive mindset.

  • Reflection and learning from mistakes. Setbacks should be used as a learning experience for the next opportunity. Assessors should help learners to write an action plan to help generate success at subsequent attempts. Reflect on what went wrong and how the situation or assessment question could have been handled differently.
  • December 2023's Topic of the month looks at ways to build resilience in learners. Building resilience ensures a strong foundation to tackle setbacks.
  • Learners should be reminded that if one assessment question or OSCE station does not to go plan, once finished they should draw a line under it for the time being and not let it negatively impact subsequent scenarios.

Keep updated 

If you would like to be kept up to date with the work of SPOKE, please email spokehub@college-optometrists.org to be added to our Advisory Review Group. Similarly, please email with your views of Topic of the month or any suggested themes you would like to see covered. 

References and Bibliography 

[1] Harding, Duncan, 'Reframing anxiety', Deconstructing the OSCE: Strategies for OSCE Success (Oxford, 2014; online edn, Oxford Academic, 1 May 2014), https://doi.org/10.1093/med/9780198704874.003.0004

[2] Chitty, A, 15 May 2022, Careers in Eyecare, Managing Exam and Revision Stress

Accela Marketing, Effective Strategies for Managing Final Exam Stress

Chappell, Ginny, 02 May 2022 Practice Nursing - Overcoming OSCE anxiety 

Dunbar, Dr Michaela 28 April 2022 You've Got This

Kaur Khaira M, Raja Gopal RL, Mohamed Saini S, Md Isa Z. Interventional Strategies to Reduce Test Anxiety among Nursing Students: A Systematic Review. Int J Environ Res Public Health. 2023 Jan 10;20(2):1233. doi: 10.3390/ijerph20021233. PMID: 36673999; PMCID: PMC9858718.

Martin, Randy D. and Naziruddin, Zahra, 'Systematic review of student anxiety and performance during objective structured clinical examinations (Currents in Pharmacy Teaching and Learning, Volume 12, Issue 12, December 2020, Pages 1491-1497.)

Medic Mind, Everything You Need to Know About The Optometry OSCE 

NHS - How to cope with anxiety

Past Test, 9 Mar 2023 Preparing for the OSCEs in Medical School

Student Minds