Stress, coping profiles and anxiety among French final-year medical students in a high-stakes national ranking examination: a cross-sectional study.

Authors

Amandine Mathé, François Tison, François Sztark, Emmanuel Mellet, Alexandre Ouattara, Didier Gruson, Claire Roubaud-Baudron, Igor Sibon, Damien Roux, Patrick Dehail, Pierre Merville, Etienne Riviere

Published in

BMJ open. Volume 16. Issue 9. Pages e125171. Sep 08, 2026. Epub Sep 08, 2026.

Abstract

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.
Cross-sectional questionnaire survey.
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.
All 387 sixth-year students present for the 2025 nOSCE were invited; 192 (50%) completed the questionnaire (69% women; median age 25 years).
registered for the national exam and attending nOSCE; exclusion: non-attendance or incomplete questionnaire.
None.
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.
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.
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.

PMID:
42711088
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.

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