OBJECTIVE METHODS A. Survey administered at 3 time points: Time 1: Beginning of the Step 1 study period (n=85). Time 2: Directly after a test-taking course by 24 students randomly selected from 40 volunteers. Time 3: 10 weeks from baseline after most students had taken Step 1 (n=85). Past experiences with test anxiety (at Time 1). Perceptions of the test-taking course (at Time 2). Experiences with test anxiety and strategies for addressing it (at Time 3). C. Analysis: Electronically generated narrative answers were organized into Word transcripts. 2 investigators independently coded transcripts; organized codes by general categories; then, developed provisional coding frame, which they used to again independently code transcripts. Identified like and different coding (.68 kappa); reconciled differences; developed final coding scheme; then, derived major themes and findings. ACKNOWLEDGEMENTS Thank you to all the students in the Class of 2015 who participated in this study. A private training firm, the Institute of Medical Boards, presented the test-taking strategies course. Poster template from erdesign. J. Encandela, PhD, C. Gibson, MPH, M. Green, MD, G. Leydon, MA, N. Angoff, MD MORE INFORMATION About the study, contact John Encandela (see business cards) About the course, contact Nancy Angoff, Associate Dean for Student Affairs LIMITATIONS Study was local and not necessarily generalizable to other medical students. Though students narratively listed strategies that they have used to address test anxiety, we did not attempt to study the effectiveness of these strategies; we only tested the test- taking strategies course in its effect on anxiety and exam performance. CONCLUSIONS In spite of YSM students capabilities, many still do worry about high-stakes exams like Step 1. Causes and effects of anxiety differ for different students. It may be beneficial to assist students in identifying causes and effects particular to them, and to match strategies appropriate for addressing causes/effects. A test-taking strategies course may help reduce anxiety in students. The course may be improved by reducing the number of days it is offered and concentrating more on the components addressing anxiety- reduction and effective studying strategies. This concentration may, in fact, create a more robust intervention that not only reduces anxiety but positively affects performance. Yale SCHOOL OF MEDICINE T EACHING AND L EARNING C ENTER RESULTS I. Three major categories of findings about test-anxiety 1.Causes of anxiety (all having to do with students’ self-talk): Focus on “high-stakes” of the exam Focus on past academic performance Focus on time constraints and amount of material to cover Comparison of self with peers 2.Effects of anxiety: On emotional or mental well-being On cognition (memory and concentration) On physical well-being, including sleep and appetite disturbance 3.Strategies for addressing anxiety: Socializing with friends and family Cognitive strategies:  Mindfulness, re-orientation of thinking  Placing the importance of Step 1 in context with the rest of life  Prayer, yoga, spirituality Physical strategies:  Managing sleep and eating patterns  Planning study breaks  Balancing study with fun and activity  Exercise II.Perceptions of the test-taking strategies course Respondents thought the course was somewhat to extremely useful. A number thought the course was too long (6 days, 6 hours per day; could have been reduced to 2 to 3 days, with emphasis on anxiety- reduction and increasing effectiveness of study time, less emphasis on practice questions). Usefulness of the course “My main worry is how much this exam is supposed to mean and how much I’m doing compared with those around me. I realize I should not be comparing myself or listening to the worries of my peers, but it’s hard to shut that out—especially when people very close to me (and who I believe to be much smarter than me) have been studying head over heals for the exam for a long time. I’m definitely afraid I won’t have studied enough, and have not done enough these past two years to prepare me for this test.“ “It’s hard to concentrate on material due to racing worry thoughts going through my mind.” “Sometimes I think that I worry too much about how I will do and could instead direct that energy and time spent worrying to just buckling down and studying more. As someone who has generally done very well on tests (in school and standardized), but also as a worrier, I have come to accept more as I've gotten older that I will do well as long as I study (and that I can only do the best that I can).” “The preparation course helped alleviate most of the anxiety I felt about the exam.” “I cannot recommend this course enough. However, I do recognize that it is designed for a particular type of person. If someone prefers learning on their own with books, they shouldn’t do the course. If someone prefers to use reasoning and not brute force knowledge for standardized exams, this is perfect.” BACKGROUND A.Many medical students experience test anxiety that may affect test performance. B. 2 nd -year YSM students studied to determine: The relationship between test anxiety & USMLE Step 1. Effect of a test-taking strategies course on anxiety and Step 1 scores. C. Brief synopsis of our quantitative results (presented in detail elsewhere): According to a validated test-anxiety scale,* study participants (n=85) had “moderately to high-normal” test anxiety at the beginning of Step 1study period. A weak to modest inverse relationship existed between test anxiety after Step 1 and exam scores. A test-taking strategy course modestly reduced test anxiety but did not noticeably affect Step 1 scores.