The effect of assessor visibility on student stress and anxiety in emergency care simulation assessments.
BMC Medical Education · 2024-09-27 · Quasi-experimental
Abstract
BACKGROUND: Simulation assessment can result in anxiety for students. These assessments involve being observed by assessors, so there is a significant socio-evaluative stress component which may cause greater anxiety if assessors are visible to students during assessments. The aim of this study was to determine the effect of assessor visibility on biological and physiological markers of stress and levels of anxiety experienced by pre-hospital emergency care students in a simulation assessment environment. METHODS: A paired comparison, pre-post test research design was used with two conditions; an assessor visible condition with simulation assessors visible to students in the room and an assessor not visible condition with assessors not in the room but connected via video link. With a sample of 29 emergency care students anxiety was measured with the State-Trait Anxiety Inventory and stress was measured with salivary cortisol and heart rate variability (HRV). RESULTS: Differences in state anxiety scores, HRV variables and salivary cortisol suggested lower stress and anxiety in the assessor visible group. Only heart rate was significantly different between the groups (p = 0.016), with a higher heart rate in the assessor not visible group. CONCLUSIONS: Greater stress and anxiety may be experienced by students during emergency care simulation assessments when assessors are not visible to students.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Clinician perspective · Students
Related articles
- Mental Workload and Handover in Paramedics and Paramedicine Students Following Simulated Emergency Responses: Pilot Study. (Simul Healthc, 2026)
- Student paramedic experiences of group-based simulation activities used in assessment: a qualitative UK study. (BMJ Open, 2025)
- Relationships between cognitive appraisals of threat and challenge, psychophysiological responses, and clinical performance during high-stress simulated osces. (BMC Med Educ, 2025)
- Simulation as a foundation for experiential learning among ambulance nursing students: A qualitative observation study. (Nurse Educ Today, 2025)
- Threshold-anxiety in medical students performing a prehospital high-fidelity clinical simulation: Randomized clinical trial. (Am J Emerg Med, 2025)
- Anxiety and Performance in Prehospital Emergency Care Simulation Assessments. (Simul Healthc, 2022)