In the preclerkship period of medical school, exam-related anxiety is almost expected. But according to published research, when stress exceeds the usual pretest nerves, it can significantly undermine medical students’ exam scores and their classroom performance.
For a study published in BMC Medical Education, researchers examined gender differences in learning and study strategies among preclerkship medical students. They found elevated anxiety levels, particularly among female students, were linked to lower performance in preclerkship courses and Step 1 of the United States Medical Licensing Examination (USMLE) series.
A deeper dive into the study sheds light on differences in test-prep strategies and academic resource use by gender, among other factors. What do these findings mean for students hoping to excel?
Anxiety levels higher among women
For the study, researchers evaluated 612 medical students from 2019–2024 at a medical school in South Carolina, using the Learning and Study Strategies Inventory (LASSI). That inventory measures how students approach learning, motivation, and self-management across 10 domains: anxiety, attitude, concentration, information processing, motivation, selecting main ideas, self-testing, test strategies, time management, and use of academic resources.
Researchers found that female medical students scored significantly higher for anxiety than their male counterparts. This increased anxiety was linked to lower grades in preclerkship courses and reduced scores on USMLE Step 1—much of the study’s sample was measured while the exam still yielded a numerical score rather than a pass-fail designation.
Among women medical students, anxiety was a much stronger predictor of academic performance than it was for men, For female students, anxiety explained nearly 9.1% of the variation in USMLE Step 1 scores, far more than it did for males (2.5%).
Beyond anxiety, the study found several other areas where men and women differed in how they approach learning. Male students tended to score higher in information processing, selecting the main idea, self-testing, and test-taking strategies—skills closely tied to how they absorb and organize new material and prepare for exams. However, female students excelled in attitude and use of academic resources.
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What affects performance most
The research also reveals that male and female medical students performed similarly on scales measuring concentration, motivation, and time management, all of which proved to be significant predictors of preclerkship and USMLE Step 1 performance, especially for female students.
How medical students prepared for and approached exams had more impact on their results than any other skill or characteristic; of the 10 domains measured test strategies explained the largest portion of variance in preclerkship grades and USMLE Step 1 scores regardless of gender.
AMA member Wayne Bond Lau, MD, is dean for student affairs at Thomas Jefferson University's Sidney Kimmel Medical College in Philadelphia. In his years working with medical students firsthand he has found that the most productive learners are those who take a structured approach, meticulously planning their weekly schedule.
“Everybody knows that you get 168 hours a week. And with that time frame, you have to make sure that you plan,” Dr. Lau said.
“The most successful students that I have seen manage the pressures of medical school are the ones that have intentionally set out a schedule where they deliberately plan free time and the time that they're going to work hard also.”
Jefferson Health, which is the home of Sidney Kimmel Medical College, is part of the AMA Health System Member Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Addressing anxiety
In citing prior data that roughly one in three medical students experience anxiety and their own findings about its effects on women in medical school, the study’s authors pointed out that the root causes of medical school anxiety are systemic. In terms of how institutions can proactively support students on this front, the study’s authors advocated for “properly addressing sources of anxiety and providing techniques to manage stress could improve outcomes” for women in medical school.
As far as what individual medical students can do to manage their anxiety, Dr. Lau offered that it starts with habits.
“You must enforce good habits for yourself, putting good food in your body, making sure you engage in activities that are wholesome, and not relying on things like alcohol as a relief mechanism.”
He also touted the value of relationships outside of medical school—naming friends and family as a medical student’s “supporting cast”—for managing anxiety and stress.
“Those relationships are the ones that carry you through the toughest times,” he said. “When you are refilling your cup of strength, you must invest your time in those people.”
