Stress, coping profiles and anxiety among French final-year medical students in a high-stakes national ranking examination: a cross-sectional study
Abstract
Objectives To describe stress, coping behaviours, anxiety, psychological support and benzodiazepine use among French final-year medical students sitting a high-stakes national ranking examination and to explore how these patterns relate to exam ranking when interpreted through transactional stress and coping and ‘coping reservoir’ models. Design Cross-sectional questionnaire survey. Setting Single university medical faculty in France; final-year students sitting the national Épreuves Dématérialisées Nationales (EDN) and ‘national Objective Structured Clinical Examination (nOSCE)’ clinical examination. Participants All 387 sixth-year students present for the 2025 nOSCE were invited; 192 (50%) completed the questionnaire (69% women; median age 25 years). Inclusion: registered for the national exam and attending nOSCE; exclusion: non-attendance or incomplete questionnaire. Interventions None. Primary and secondary outcome measures Primary outcomes were self-rated stress for EDN and nOSCE and State-Trait Anxiety Inventory-Y (STAI-Y) state and trait anxiety scores. Secondary outcomes included stress management behaviours, psychological/psychiatric follow-up, benzodiazepine and other psychotropic use and final national ranking. Results 92% of respondents reported that stress impacted their daily life, particularly attention (83%), sleep (79%) and learning capacity (64%). Overall, 32% had consulted a psychologist/psychiatrist and 15% used benzodiazepines. Most reported regular sport (86%; ≥2 sports 69%) and breathing exercises (61%). Median nOSCE stress was 8/10; median STAI-Y state and trait scores were 45 and 46. Comparing very low versus high/very high trait-anxiety subgroups, ranking did not differ significantly, but low-anxiety students reported more sport (p=0.04), less benzodiazepine use (1/24 vs 10/37; p=0.003) and far less psychological follow-up (1/24 vs 19/46; p<0.0001). Self-reported coping strategies were not associated with better ranking. Conclusions Final-year medical students preparing for a high-stakes national ranking examination report pervasive stress, substantial functional impairment and frequent professional and pharmacological coping, with only limited linkage between anxiety and performance. Within transactional and coping reservoir frameworks, these results highlight the need for reflection on structural assessment practices and for longitudinal institutional strategies to protect learner well-being.
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BibTeX
@article{mathe2026stress,
title = {{Stress, coping profiles and anxiety among French final-year medical students in a high-stakes national ranking examination: a cross-sectional study}},
author = {Amandine Mathé and François Tison and François Sztark and Emmanuel Mellet and Alexandre Ouattara and Didier Gruson and Claire Roubaud-Baudron and Igor Sibon and Damien Roux and Patrick Dehail and Pierre Merville and Etienne Riviere},
journal = {BMJ Open},
year = {2026},
month = sep,
doi = {10.1136/bmjopen-2026-125171},
url = {https://u-bordeaux.hal.science/hal-05746336v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stress, coping profiles and anxiety among French final-year medical students in a high-stakes national ranking examination: a cross-sectional study
AU - Amandine Mathé
AU - François Tison
AU - François Sztark
AU - Emmanuel Mellet
AU - Alexandre Ouattara
AU - Didier Gruson
AU - Claire Roubaud-Baudron
AU - Igor Sibon
AU - Damien Roux
AU - Patrick Dehail
AU - Pierre Merville
AU - Etienne Riviere
PY - 2026
DA - 2026/09/08
JO - BMJ Open
DO - 10.1136/bmjopen-2026-125171
UR - https://u-bordeaux.hal.science/hal-05746336v1
AB - Objectives To describe stress, coping behaviours, anxiety, psychological support and benzodiazepine use among French final-year medical students sitting a high-stakes national ranking examination and to explore how these patterns relate to exam ranking when interpreted through transactional stress and coping and ‘coping reservoir’ models. Design Cross-sectional questionnaire survey. Setting Single university medical faculty in France; final-year students sitting the national Épreuves Dématérialisées Nationales (EDN) and ‘national Objective Structured Clinical Examination (nOSCE)’ clinical examination. Participants All 387 sixth-year students present for the 2025 nOSCE were invited; 192 (50%) completed the questionnaire (69% women; median age 25 years). Inclusion: registered for the national exam and attending nOSCE; exclusion: non-attendance or incomplete questionnaire. Interventions None. Primary and secondary outcome measures Primary outcomes were self-rated stress for EDN and nOSCE and State-Trait Anxiety Inventory-Y (STAI-Y) state and trait anxiety scores. Secondary outcomes included stress management behaviours, psychological/psychiatric follow-up, benzodiazepine and other psychotropic use and final national ranking. Results 92% of respondents reported that stress impacted their daily life, particularly attention (83%), sleep (79%) and learning capacity (64%). Overall, 32% had consulted a psychologist/psychiatrist and 15% used benzodiazepines. Most reported regular sport (86%; ≥2 sports 69%) and breathing exercises (61%). Median nOSCE stress was 8/10; median STAI-Y state and trait scores were 45 and 46. Comparing very low versus high/very high trait-anxiety subgroups, ranking did not differ significantly, but low-anxiety students reported more sport (p=0.04), less benzodiazepine use (1/24 vs 10/37; p=0.003) and far less psychological follow-up (1/24 vs 19/46; p<0.0001). Self-reported coping strategies were not associated with better ranking. Conclusions Final-year medical students preparing for a high-stakes national ranking examination report pervasive stress, substantial functional impairment and frequent professional and pharmacological coping, with only limited linkage between anxiety and performance. Within transactional and coping reservoir frameworks, these results highlight the need for reflection on structural assessment practices and for longitudinal institutional strategies to protect learner well-being.
SN - 2044-6055
ER -