Prevalence and Correlates of Test Anxiety Among Medical Students: Systematic Review

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Background: Test anxiety is common among medical students, impacting their performance, well-being, and growth. While interest is rising, evidence on its prevalence and factors remains scattered. Objective: This systematic review aimed to synthesize recent evidence on the prevalence of test anxiety and identify psychological, academic, and demographic correlates among undergraduate medical students. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Electronic databases, including PubMed, MEDLINE, Scopus, ERIC, EBSCOhost, and PsycINFO, were searched for studies published between January 2019 and July 2025. Eligible studies included cross-sectional research involving undergraduate medical students and using validated instruments to measure test anxiety. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was performed due to methodological heterogeneity across studies. Results: Thirteen cross-sectional studies from diverse geographic regions, including India, Ethiopia, Pakistan, Saudi Arabia, Iran, Germany, Bangladesh, and China, were included. Sample sizes ranged from 82 to 735 participants. The prevalence of moderate to high test anxiety ranged from 13.5% to 72%. Higher anxiety levels were consistently associated with female gender, early academic years, academic workload, poor coping strategies, and limited social support. Psychological correlates included emotional distress, low self-efficacy, maladaptive coping, and burnout, while academic factors included examination format, heavy curriculum demands, and poor academic performance. Considerable heterogeneity in measurement tools and study settings limited quantitative synthesis. Conclusion: Test anxiety is common among medical students worldwide, influenced by psychological, academic, and demographic factors. Early detection and targeted support, Effective study strategies, and stress management can enhance well-being and academic success.

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