Systematic review finds test anxiety affects about half of medical students

A systematic review and meta-analysis found that test anxiety affected an estimated 49.8% of medical students worldwide, indicating that the condition is widespread among learners in a high-stakes academic environment. The estimate was based on 35 studies involving 13,489 students and was published in BMC Medical Education as part of the journal’s early-access program. Although the pooled result suggests that nearly one in two medical students experience test anxiety, the researchers reported extremely high statistical heterogeneity, meaning that prevalence estimates differed substantially among the underlying studies.

The investigators searched PubMed, Scopus, Embase and Web of Science in March 2026 and supplemented those searches with backward and forward citation tracking. They included studies that quantitatively assessed test anxiety among medical students and supplied a discrete prevalence estimate. The meta-analysis used a random-effects model with a generalized linear mixed model and logit transformation to estimate the pooled prevalence. Risk of bias was evaluated with a Newcastle-Ottawa Scale adapted for descriptive cross-sectional studies. The search methods and inclusion criteria support the synthesis of an international body of evidence, but the high heterogeneity limits how precisely a single global figure can describe every medical-school population.

Measurement method was the only factor that significantly affected prevalence in the subgroup analyses. The pooled estimate fell from 49.8% to 44.9% when three studies using the Visual Analogue Scale were excluded. Other subgroup estimates varied numerically without reaching statistical significance. Prevalence was higher among female students, at 52.6%, than among male students, at 46.3%, and was higher among first-year students, at 58.6%, than among fifth-year students, at 47.9%. The highest regional estimate came from South-East Asia, at 59.3%, followed by the Middle East at 54.1%. These are differences across groups and locations, however, rather than evidence that prevalence declined over time within any one group or region.

The timing of assessment also produced different numerical estimates. Test anxiety was most prevalent in studies conducted during examinations, at 55.4%, compared with 51.7% in studies conducted before examinations and 41.5% in those conducted afterward. Estimates were also higher in studies using convenience sampling, at 52.9%, than in studies using random sampling, at 44.7%. A meta-regression found no significant association between publication year and prevalence, with a coefficient of 0.003 and a p-value greater than 0.9. The result does not identify a temporal trend, and the authors emphasized the need for standardized measurement and precise reporting of when assessments were administered.

Test anxiety is a situation-specific response that can impair cognitive functioning and academic performance in evaluative settings, according to the study’s background. The review indicates that anxiety associated with assessment is a major feature of medical education for a large share of students, but it does not establish how much the condition affected academic outcomes. The evidence supports a high pooled prevalence and substantial variation between studies; it does not demonstrate that anxiety causes poorer examination results, that any subgroup is biologically predisposed, or that a particular intervention would reduce prevalence. The authors’ call for consistent tools and clearer assessment timing could make future estimates more comparable and allow researchers to distinguish the experience of anxiety during exams from anticipatory or post-examination anxiety.

Subject of Research: Global prevalence of test anxiety among medical students

Article Title: Prevalence of test anxiety among medical students: a systematic review and meta-analysis

Article References: Omar, Y. M., Darwish, N. E., Elsaadany, M. A., Darwish, Y., & Eladawy, Y. (2026). Prevalence of test anxiety among medical students: a systematic review and meta-analysis. BMC Medical Education, 26(1), Article 1448. https://doi.org/10.1186/s12909-026-10270-2

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10270-2

Keywords: medical students, test anxiety, systematic review, meta-analysis, prevalence, medical education, assessment, student mental health, test, anxiety, medical, students