Volume 43 Issue 1, Spring 2016, pp. 47-57

Veterinary students are confronted with a high workload and an extensive number of examinations. However, the skills students gained in high school cannot serve as satisfactory coping strategies during veterinary training. This disparity can lead to test anxiety, as frequently reported by international surveys. In response, a pilot study was carried out to evaluate the effects of a newly developed training seminar to prevent and/or reduce test anxiety. The seminar was offered on a voluntary basis as a low-threshold intervention to first- and second-year veterinary students at three different veterinary schools in Germany. The intervention was offered in two different designs: in either a block or in a semester course containing cognitive and behavioral approaches as well as skill-deficit methods. By conducting a survey and interviews among the participants it was determined whether the contents of the seminar were perceived as helpful for counteracting test anxiety. The potential of the intervention was evaluated using a German test anxiety questionnaire (PAF). The contents of the training seminar were all assessed as beneficial but evaluated slightly differently by first- and second-year students. The results indicate that the seminar prevents and reduces test anxiety significantly compared to the control group students. The greatest effects were achieved by offering the intervention to first-year students and as a block course. As the participants benefit from the intervention independent of the extent of test anxiety, these results suggest that it may be profitable to integrate a workshop on coping strategies in the veterinary curriculum.

Veterinary students are often confronted with a heavy workload at a high pace, a substantial amount of learning, and numerous examinations that dominate the pre-clinical stage of their studies.1,2 For many students, successful test performance is a factor causing stress and anxiety.3 Kent-Arce found that the three strongest academic stressors for veterinary students are related to three curricular factors: (1) tests and testing methods,(2) inability to absorb all the information, and (3) final exams.4 Williams et al. also showed that academic stressors such as workload, assessments, and grades are reported most frequently.5 An additional stressor seems to characterize especially achievement-oriented students, in that successful test performance is a precondition for social recognition.6 Some studies point to the conclusion that these stressors are most dominant in the pre-clinical stage of veterinary studies.7,8

To cope with these stressors, students require adequate competencies and skills. However, action and management strategies acquired in high school do not cover the new context of veterinary studies. Didactic strategies, particularly in the pre-clinical stage, focus almost solely on the transfer of scientific medical knowledge.9 However, the development of soft skills like methodological, social, and personal competencies is essential to efficient and effective planning of both the learning and examination processes.3,10

A German survey titled “Contribution to Community Medicine of the University of Leipzig: On Mental and Emotional Health” compared different areas of study (human medicine, psychology, theology, legal sciences, and veterinary medicine) and identified test anxiety as a bothersome factor often found among veterinary students.11 Their scores were found to be similar to those of the students of psychology and human medicine. Concurrently, veterinary students are the least likely to make use of professional counseling services provided by the university (human medicine, 12.8%; psychology, 15.4%; theology, 10.2%; legal sciences, 15.4%; veterinary medicine, 0%).11 Gelberg and Gelberg1 reported similar findings, suggesting that the marginal use of counseling services by veterinary students might be due to the lack of information about these services, the students' full daytime schedules, and the common stigmas with which people seeking help are often confronted. Moreover, most external counseling services are not commonly adjusted to the specific needs of veterinary students.9,12,13

Therefore, a pilot project was designed to close the existing gap between transferred and required competencies. A training seminar was designed as an intervention and prevention strategy against test anxiety and stress based on the findings of Ergene,14 Knigge-Illner,15 and Wisniewski.16 These authors point out that best effects are achieved by carrying out compound treatments merging different approaches, such as behavioral (e.g., relaxation, meditation, and imagination) and cognitive exercises (e.g., stopping anxious thoughts), as well as skill-deficit methods (e.g., study and test-taking skills).

The aim of this study was to analyze the potential of this training seminar to prevent and/or reduce test anxiety for veterinary students. As a low-threshold intervention, it was implemented in the curriculum and customized for the needs and interests of veterinary students.

The pilot project focused on the following four questions:

  1. What contents of the training seminar are especially helpful for veterinary students?

  2. When is the best time to embed the intervention within the pre-clinical stage?

  3. Which seminar design (block or semester course) is more likely to achieve the objective?

  4. Can the intervention reduce and/or prevent test anxiety in veterinary students?

First- and second-year veterinary students were recruited at three veterinary schools in Germany (Department of Veterinary Medicine, Freie Universität Berlin; University of Veterinary Medicine Hannover, Foundation; Faculty of Veterinary Medicine, University of Leipzig) during the academic summer session of 2014.

Despite minor differences in the curricula of each veterinary school, the data were treated as being comparable because of the examination regulations in Germany (the Verordnung zur Approbation von Tierärztinnen und Tierärzten). Therefore, the data summary only differentiates between first- and second-year students, leading to a larger sample size in the groups analyzed (Table 1).

Table

Table 1: Number of participants in the intervention and control group

Table 1: Number of participants in the intervention and control group

Intervention group
Participants Semester
course
Block
course
Control
group
First year 10 14 34
Second year 11 8 12
Total 21 22 46

The students subscribed voluntarily to participate both in the study and the training seminar, for which they received course credit, as the seminar was offered as an elective course. The participants were divided randomly into an intervention and a control group. Students who did not complete both the pre- and post-test questionnaires were excluded from the study (89 remained out of 125, a dropout rate of 29%).

The collection of data took place anonymously, including a code to match pre-test and post-test data. Socio-demographic data were not collected, apart from information about the veterinary school and the affiliation to the first or second year of study.

The study was based on a pre-test/post-test design. A German test anxiety questionnaire (PAF)17 was used as a standardized test anxiety scale. The PAF consists of 20 items and is based on four fundamental dimensions of test anxiety: worry, lack of confidence, interference, and excitement. Within these dimensions, cognitive, physiologic-affective, and behavioral symptoms are measured. The PAF is consistent with different theories of test anxiety. As suggested by the PAF, the raw data were transformed into t-values (M=50; SD=10) for interpretation using the following classification:

  • t<30: strongly decreased values;

  • t 30–39: decreased values;

  • t 40–60: average values;

  • t 61–70: increased values; and

  • t>70: strongly increased values.

Completion of the written PAF questionnaire took the participants about 15 minutes. The pre-test was carried out in the summer session of 2014. Shortly after the pre-test, the training seminar took place for the randomly selected participants in the intervention group. The post-test took place in the winter session of 2014/15, so that a midterm effect after approximately 3 months could be determined. The training seminar was offered to the participants of the control group within the winter session of 2014–2015, following the post-test.

The training seminar was designed as a 14-unit workshop (45 minutes per unit), offered separately for the students of the first and second years at each veterinary school participating and given by an interdisciplinary team of an educationalist (Nadine Hahm) and a veterinarian (Mahtab Bahramsoltani). It contained five major sections (detailed below): (1) dimensions of test anxiety and the cognitive shift to utilize it as a resource; (2) learning strategies (skill-deficit methods); (3) time management (skill-deficit methods); (4) stress management (behavioral and cognitive approaches); and (5) different approaches for exam simulation, including change of perspective and role (skill-deficit methods).

1. Dimensions of Test Anxiety and the Cognitive Shift to Utilize It as a Resource

After a brief introduction giving information on the dimensions, symptoms, and causes of test anxiety, the students compiled a list of typical personal test anxiety symptoms, which were then assigned to the different dimensions of test anxiety. Based on this, the group performed a cognitive shift to think of how these symptoms could function as a resource to allow them to reach their personal and study-related goals.

2. Learning Strategies (Skill-Deficit Methods)

The second section started with a unit explaining the neural and structural basics of learning. Subsequently, different learning strategies were introduced, focusing on association techniques, emotional learning strategies, and several ways of learning through repetition (e.g., structure-formation technique or expert puzzle). The techniques included both individual and group-learning strategies as well as playful techniques, like mind games, with content tailored to veterinary students. The participants were invited to practice on site and make use of the different approaches during the seminar to focus on upcoming examinations.

3. Time Management (Skill-Deficit Methods)

The students were introduced to different pre-selected methods for dealing with the enormous amount of learning materials given to them in a very short time. For this purpose, they learned how to define “SMART” goals18 and how to structure their determined learning objectives using ABC analysis.19 They also learned how to take their individual biorhythm into account, and how and when to take breaks. The final exercise consisted of the determination of an individual daily or weekly schedule in view of their next upcoming examination.

4. Stress Management (Behavioral and Cognitive Approaches)

This section of the seminar introduced several techniques that could be carried out either during the process of learning or while being examined. All techniques were applied within the seminar in circuit training so the participants could individually feel the effects and find out whether they preferred cognitive or behavioral approaches. These included breathing and calculation exercises to meet the test anxiety dimensions of excitement and interference. One example was the method of counting backward in intervals of six, which was introduced as a strategy to deal with blackout situations. In addition, they learned the power of pleasant imagination or cognitive reorganization strategies to counteract worry and excitement.

5. Different Approaches for Exam Simulation, Including Change of Perspective and Role (Skill-Deficit Methods)

Within this section, the students reflected on the circumstances of an oral examination. They started with drawing a picture of a perfect examiner and then shifted perspective by slipping into the role of the examiner, trying to fulfill their own demands to get an insight into the challenges examiners face themselves. Second, they tried different examinee roles. The objective of these exercises was to get students to realize their own power to influence the process and the outcome of examinations. Finally, the students were given the opportunity both to reflect on their individual video performances and to receive differentiated group feedback.

Subsequent to each training seminar, the participants anonymously evaluated the impact of the section's learning strategies, time management, stress management, and exam simulation material for passing examinations.

During the post-test, the participants of the intervention group were asked for a midterm evaluation of the training seminar sections. Within this survey, the section “dimension of test anxiety” was added. Due to the fact that the participants of the training seminar noted that they had perceived the different types of exam simulations differently, the section “exam simulation” was divided into three sections: “exam simulation focusing on the examiner,” “exam simulation focusing on the examinee,” and “exam simulation using video analysis.”

In addition, 15 randomly selected students of the intervention group participated in pre-test and post-test interviews to aid in the interpretation of the midterm evaluation of the training seminar. These interviews lasted about half an hour.

The statistical analyses were carried out for 89 participants completing both the pre-test and the post-test. The statistical analyses included descriptive statistics, calculation of means, standard deviations, and t-values as well as application of the t-test, ANOVA, and Chi-square test (SPSS Statistics Version 22, IBM, USA).

The analyses of interviews were carried out by giving codes to single interview passages, following the method of Meuser/Nagel (MAXQDA 11, VERBI, Germany).20 In brief, supra-individual commonalities like representative statements, common knowledge, or interpretative patterns were identified following five steps: (1) paraphrasing, (2) finding headlines (codes) for paraphrased passages, (3) thematic comparison of text units, (4) theoretical conceptualization, and (5) theoretical generalization. The interview extracts (IE) presented below were assigned to the major codes “proposed amendments” (IE01 and IE08) or “learning effects of the training seminar” (IE02–IE07) and translated corresponding to the original German template.

1. What Contents of the Training Seminar Are Especially Helpful for Veterinary Students?

The students' short-term evaluation of the sections subsequent to the training seminar revealed that first-year students seemed to benefit particularly from skill-deficit methods such as learning strategies (66%) and stress management (66%) (Figure 1a). Second-year students, by comparison, stated more often that the different examination simulations (65%) were helpful strategies for facing upcoming preliminary examinations (Figure 1a). Comparing the answers given by first- and second-year students, a significant shift can be found in the sections from which they benefitted (c2year[3, n=49]=10.13, p=.018). However, no significant difference in the answer pattern can be found within the students of the same year (c2first year[1, n=29]=1.19, pfirst year=.276; csecond year[1, n=20]=1.75, psecond year=.186).

Figure 1a: Participants' evaluation of the training seminar contents as a function of year of veterinary study (subsequent to the training seminar)

Three months after taking the training seminar, the participants of the intervention group were asked to assess the different sections again within the post-test. The results of this midterm evaluation varied from the first evaluation (Figure 1b). During the interval, the participants found more aspects of the training seminar were useful and helpful than they had first considered, resulting in an increase in the percentage of all sections. Therefore, the individual learning gains are distributed positively within a range over all content issues from 61.1% to 94.5%, while the section “dimensions of test anxiety” was least stated in both the first (73.9%) and the second (61.1%) year. The survey of the first-year students showed that all sections were considered to be helpful for passing examinations, as the percentage ranged between 73.9% for the section “dimensions of test anxiety” and 86.9% for the sections “time management” and “exam simulation focusing on the examinee.” The survey of the second-year students showed that they predominantly considered the sections “learning strategies” (94.5%) and “exam simulation focusing on the examiner” (94.5%) to be helpful for passing examinations.

Figure 1b: Participants' evaluation of the training seminar contents as a function of year of veterinary study (approximately 3 months after the training seminar)

The following interview statements of first-year students refer to the sections “learning strategies” (IE01), “time management” (IE02 and IE03), and “exam simulation” (IE04):

IE01:

I think taking the seminar within the first year of studies is more intense, since you have the time to find out which learning strategies work best for you, and you have the chance to use the strategies from the beginning. Starting with new learning strategies in the second year makes little sense, since you have already prepared most of the learning materials the old way and there is hardly any time to use alternative learning concepts.

IE02:

I am working more continuously now and formulate more realistic goals. For example, I am not trying to cram for 5 hours anymore.

IE03:

There are things I changed after the training, like really setting up learning goals. I handle the learning process more consciously now and follow my goals more determinedly.

IE04:

I am more secure now, since I am more aware of how to direct the examination by my own appearance and the way I express myself. I feel less powerless in the exam situation.

The following interview statements of second-year students refer to the sections “learning strategies” (IE05 and IE06) and “exam simulation” (IE07):

IE05:

I learned how important repetition can be for better memorization.

IE06:

What I do a lot now is to combine the stuff I am learning directly with diseases. If there were interesting cases at work I check on it directly when I get home and then get deeper into it by asking questions like “How does the kidney work?” and “How does a certain malfunction affect the entire body?” This hint was very helpful.

IE07:

Above all I learned that I am not completely at the examiner's mercy, but that I can influence the examiner by my performance. […] It was very important for me to understand that no matter what is being asked, I am a co-decision-maker in the examination. […] I don't have to let myself be hassled and I, by being attentive and reporting calmly, can bring a more relaxed atmosphere to the examination. I am simply more relaxed now since I know I am actively participating in the situation.

2. When Is the Best Time to Embed the Intervention within the Pre-Clinical Stage?

Among first-year students, there was no significant difference in test anxiety between the intervention group and the control group within the pre-test (Mint=50.12, SDint=11.08; Mcon=48.00, SDcon=10.25; tdiff[73]=0.86, pdiff=.395). ANOVA results for the first-year students showed that there was a statistically significant interaction between the intervention group and the control group from the pre-test to the post-test (F[1, 56]=9.57, p=.003). The comparison of the means of t-values for test anxiety in the pre-test and post-test revealed that among the first-year students, there was a significant increase in test anxiety (tcon[33]=3.96, pcon=.012) in the control group, while the results showed a slight decrease in the intervention group (tint[23]=−3.21, pint=.085). The results for the second-year students show a significant difference in test anxiety between the intervention group and the control group within the pre-test (Mint=54.37, SDint=7.45; Mcon=49.22, SDcon=9.38; tdiff[44]=2.06, pdiff=.045). ANOVA results for the second-year students showed that there was a similar statistically significant interaction between the intervention group and the control group from the pre-test to the post-test as found in the first-year students (F[1, 29]=5.38, p=.028). The comparison of the means of t-values for test anxiety in the pre-test and post-test demonstrates an increase for the control group and a decrease in the intervention group which were not statistically significant (tcon[11]=4.42, pcon=.072; tint[18]=−2.68, pint=.194) (Figure 2a).

Figure 2a: Means of t-values (bars represent SD) of test anxiety among first- and second-year students comparing the results of the pre-test and the post-test as a function of the intervention and the control group

ANOVA and t-test results for first-year students: ncon=34, nint=24; F(1, 56)=9.57, p=.003; tcon(33)=3.96, pcon=.012; tint(23)=−3.21, pint=.085

ANOVA and t-test results for second-year students: ncon=12, nint=19; F(1, 29)=5.38, p=.028; tcon(11)=4.42, pcon=.072; tint(18)=−2.68, pint=.194

Considering the participants with test anxiety only (increased PAF scores of ≥61), it becomes apparent that within the first-year students, there was an increase of 13.3% in the control group, while a decrease of 11.2% was notable in the intervention group. Among the second-year students, a decrease in both the control (by 3.1%) and the intervention group (by 0.6%) could be found (Figure 2b). However, no statistically significant interaction could be found in either group (c2firstyear[1, n=9]=2.25, pfirstyear=.134; c2second year[1, n=5]=0.14, psecond year=.709).

Figure 2b: Increased levels (PAF scores of ≥61) of test anxiety (%) among first- and second-year students, comparing the results of the pre-test and the post-test as a function of the intervention and the control group

First year: c2con(1, n=34)=3.04, pcon=.081; c2int(1, n=24)=0.32, pint=.571

Second year: c2con(1, n=12)=0.48, pcon=.490; c2int(1, n=19)=0.15, pint=.703

3. Which Seminar Design (Block or Semester Course) Is More Likely to Achieve the Objective?

Comparing test anxiety levels of students participating in the block course and in the semester course, there was no significant difference in the pre-test (Mblock = 52.86, SDblock = 9.91; Msemester = 50.65, SDsemester = 9.91; tblock semester[53]=0.822, pblock semester=.415). In all participants, the means of the t-values for test anxiety decreased from the pre-test to the post-test in both the block and the semester course. However, the decrease was only significant in the group of participants attending the block course (tblock[21]=−4.63, pblock=.010; tsemester[20]=−1.24, psemester=.552) (Figure 3a). The percentage of participants with test anxiety (increased PAF scores of ≥61) decreased from the pre-test to the post-test by 12.3% (c2block[1, n=22]=1.45, pblock=.229) in the group attending the block course, while the rate increased by 1.2% (c2semester[1, n=21] = 0.36, psemester = .549) in the semester course (Figure 3b).

Figure 3a: Means of t-values (bars represent SD) of test anxiety, comparing the results of the pre-test and post-test as a function of the block and the semester course

* p<0.01

nblock=22, nsemester=21; tblock(21)=−4.63, pblock=.010; tsemester(20)=−1.24, psemester=.552

Figure 3b: Increased levels (PAF scores of ≥61) of test anxiety (%), comparing the results of the pre-test and post-test as a function of the block and the semester course

c2block(1, n=22)=1.45, pblock=.229;

c2semester(1, n=21)=0.36, psemester=.549

A reflection on the difference between block and semester course is given by a first-year student:

IE08:

You are dealing with the daily stress of having to memorize several study matters and then all of a sudden you think “Gosh! Right! I also have this training seminar today!” and you go and sit there and are peppered more or less with input and ideas, not taking it too seriously since it is not essential to finish your studies. I just sat there and more or less waited for something of interest to come along. In comparison, by taking a block course I certainly could have dived more deeply into the subject and opened up to the topic better.

4. Can the Intervention Reduce and/or Prevent Test Anxiety in Veterinary Students?

To address this question, all participants' data were pooled into two groups: the intervention group and the control group, while combining data from both first- and second-year students. Regarding the results for test anxiety of the pre-test, there was no significant difference between the intervention group and the control group, whereas there was a tendency for higher levels of test anxiety among the intervention group (Mint = 51.90, SDint=9.88; Mcon = 48.43, SDcon = 9.90; tint con[119] = 1.92, pint con = .057). ANOVA results showed that there was a statistically significant interaction between the intervention group and the control group from the pre-test to the post-test (F[1, 87]=15.44, p<.001). The comparison of the means of the t-values in these groups from the pre-test to the post-test showed a significant decrease of test anxiety within the intervention group (tint[42]=−2.97, pint=.029) and a significant increase of test anxiety within the control group (tcon[45]=4.08, pcon=.002) (Figure 4a). These results were mirrored in the frequency of participants suffering from test anxiety (increased PAF scores of ≥61) in both groups, comparing the pre-test and the post-test. While the percentage decreased by 6.7% (c2int[1, n=43]=0.46, pint=.499) in the intervention group, it increased by 7.9% (c2con[1, n=46]=1.06, pcon=.303) in the control group (Figure 4b).

Figure 4a: Means of t-values (bars represent SD) of test anxiety among all students comparing the results of the pre-test and the post-test as a function of the intervention and the control group

* p<0.05

p<0.01

ncon=46, nint=43; F(1, 87)=15.44, p<.001; tcon(45)=4.08, pcon=.002; tint(42)=−2.97, pint=.029

Figure 4b: Increased levels (PAF scores of ≥61) of test anxiety (%) among all students comparing the results of the pre-test and post-test as a function of the intervention and the control group

c2con(1, n=46)=1.06, pcon=.303; c2int(1, n=43)=0.46, pint=.499

1. What Contents of the Training Seminar Are Especially Helpful for Veterinary Students?

The contents of the training seminar were evaluated twice by the participants. The short-term evaluation occurred after the training seminar and a second evaluation was done 3 months later, to incorporate the midterm outcome of the contents.

Within the short-term evaluation, the first-year students regarded particular learning strategies and stress management to be useful for successfully passing examinations. First-year students are often confronted with a lot of new learning material and an enormous workload for the first time.1,2 As meeting new challenges increases the intrinsic motivation to acquire new strategies to face this situation,21 the first-year students might be rather open to new learning strategies and stress management in particular. The situation appears to differ for the second-year students. They have already had to manage the learning demands and the workload for more than a year and therefore have likely developed individual, more or less successful, strategies to meet their goals. As reported in IE01, they were more resistant to new strategies on learning and stress management because behavioral readjustment was associated with more effort.22 Indeed, they more often had to deal with the frequently unsuccessful results of their learning strategies and stress management within the examinations. Therefore, their motivation was more focused on overcoming existing problems.23 This fact might have led to the effect that second-year students assessed the sections on exam simulation as more important.

During the approximately 3-month interval between the pre-test and the post-test, almost all participants had to take several examinations. Thus, they had the chance to apply the methods introduced in the different sections of the training seminar. Even though the fields of interest differ between first- and second-year students, both groups assessed all sections of the training seminar as more supportive in the midterm than in the short-term evaluation. First-year students in particular were more concerned about time management and second-year students were more attracted by learning strategies, while both first- and second-year students mentioned the exam simulations. Within the ACT policy report of 2004, it is stated that introducing time management and learning strategies, as well as test taking and stress management in the context of a first-year program, strengthens the potential for study success.24 A study carried out at a medical school evaluating the effects of a wellness elective revealed that within the first-year medical curriculum emphasis was particularly given to the introduction of time management skills, as these enable students to balance social demands with academic needs.25 While these studies suggest early implementation of learning strategies, time management, and stress management, they do not propose a specific time in particular for their implementation.

As claimed in the interviews (e.g., IE02 and IE03), the first-year students realized by application of the delivered methods of time management that they particularly profited from defining specific goals and following a more balanced time schedule that includes breaks. That might be based on the fact that defining “SMART” goals and considering breaks increases capacity and leads to a higher output.26,27 In contrast to the short-term evaluation, the learning strategies had a higher impact on the second-year students in the midterm. This suggests that the learning strategies were transferred successfully and used in their daily study routines despite some initial resistance.28

In the midterm evaluation, the section exam simulation was split up into three subsections. The results showed that the main difference between first- and second-year students concerning the exam simulations was that second-year students saw a higher value in the exam simulation focusing on the examiner. As pointed out in the interview extracts IE04 and IE07, besides the focus on their own performance, the engagement with the examiner was more relevant to second-year students, as the examiner's role was, to some extent, demystified. Exam simulations have the potential to change the view of the relationship between examinee and examiner, as simulations help students to perceive the situation from a meta-level and promote the development of coping strategies and self-consciousness.29

The section on dimensions of test anxiety was mentioned least in both first- and second-year students. A possible explanation could be that, in fact, not all students taking the course necessarily suffered from test anxiety. Thus this part of the course certainly did not match with the needs and interests of some of the participants.

The conclusion that can be reasonably drawn is to keep a broad variety of training content to reduce test anxiety. This notion is supported by the prevailing opinion that test anxiety is best reduced by compound treatments merging cognitive, behavioral, and skill-deficit methods.1416

2. When Is the Best Time to Embed the Intervention within the Pre-Clinical Stage?

The potential of the training seminar to reduce test anxiety was determined using the PAF by comparing the pre-test and the post-test results. These findings showed a decrease of test anxiety in the intervention group both in the means as well as in the increased levels for the first- and the second-year students. In contrast, an increase of the means of test anxiety was measured in both control groups, which was significant for first-year students (p<.05). The increase of test anxiety among first-year students in particular could be due to the fact that the transition from high school to university is associated with an increase in stress levels.2,30 A study among freshmen in different study fields (e.g., human medicine, biology, physics, chemistry, mathematics, theology, political sciences, economics, engineering, agriculture, and veterinary medicine) suggested that facing new social and intellectual challenges may cause emotional pressure, which may lead to an increased risk of depression, anxiety, and stress.31 These observations were also reported by several further studies showing an elevated risk of depression, anxiety, and stress among first-year undergraduates in particular.30,3234

Considering all participants suffering from measured test anxiety, a proportional decrease was only detectable among the first-year students. Based on these findings it can be deduced that the intervention has the potential to reduce test anxiety in both first- and second-year students, whereas the potential to prevent test anxiety from becoming more prevalent is higher among the first-year students. This finding is supported by the significant increase of test anxiety levels, particularly in the first-year students of the control group. As stated before, these observations were consistent with studies of students in other fields.3236 Therefore, it can be concluded that an early intervention might have the potential not only to reduce but also to prevent test anxiety and stress levels in these fields of study.

3. Which Seminar Design (Block or Semester Course) Is More Likely to Achieve the Objective?

Comparing the efficiency of the block versus semester course, it was shown that the means of t-values for test anxiety were reduced in both seminar designs, which was significant (p<.01) in the block course. The number of participants showing increased levels of test anxiety only decreased within the block course.

It was anticipated that the effect of the semester course would be greater than the block course, since participants could deal with the issues discussed in the training over a longer period and have the chance to integrate several aspects into their routines, on a weekly basis, testing whether and how these aspects could be applied best. However, the results revealed that the block course produced better effects for decreasing test anxiety. This could be explained by the presumption that during the block course, the participants are more open to a sensitive topic like test anxiety and develop a greater general willingness to change their behavior patterns.35 This hypothesis was also supported in an interview with a first-year student. The participant stated that the course might have been more intense for those people who spent two entire days as a group, as they were free from daily stressors interfering with introspection (IE08).

4. To What Extent Can the Intervention Reduce Test Anxiety in Veterinary Students?

Merging all participant data into an intervention and a control group produced a greater number of participants to determine the potential benefit of the training seminar to reduce and/or prevent test anxiety. As a result of this combination, test anxiety was shown to be significantly reduced in the intervention group (p<.05), whereas it was increased significantly in the control group (p<.01). Therefore, it can be tentatively concluded that the intervention contributes both to reducing the extent of measured test anxiety for students affected and to helping prevent test anxiety.

The limiting factor in measuring the potential of the low-threshold intervention was the small sample size. Participation in each training seminar was restricted to a maximum of 12 students to ensure efficiency, and therefore the number of participants could not exceed the total maximum of 144 students. The number was additionally reduced, in part, by the fact that fewer second-year students could be recruited and by the dropout rate (29%). The major reasons for the dropout can be found in non-attendance in the training seminar and particularly in non-completion of the post-test.

Although recruitment of the students was done by indicating that test anxiety was not a prerequisite for participation in the study, it may be that students who expect to suffer from test anxiety were more attracted by the training seminar. Therefore, the increased levels of test anxiety might be higher in this study than among all students of the veterinary schools involved. Still, the number of participants suffering from high anxiety-levels in the pre-test or post-test was too small to find statistically significant effects particularly for this group (n=22, 25%). As socio-demographic data (e.g., age, gender, or social background) were not collected within the study to maintain anonymity, it cannot be excluded that these factors may also have had an impact on the outcomes.

Furthermore, the results of the evaluation of the seminar contents might be influenced by the order of contents presented. Learning strategies that were introduced in the early sessions could have had a lower evaluation score than content that was covered later in the seminar (e.g., exam simulations). This would apply to the semester course, in particular, which lasted seven weeks, as opposed to the block course, which was evaluated within 2 days of completion.

Veterinary medical schools play an important role in supporting students during their studies, not only by providing a knowledge base but also by conferring certain professional skills, such as social or personal competencies.2 Considering international studies and the results presented here, an obvious solution could be to offer a service such as a professional practice program specifically designed for the needs of veterinary students.1,2,7,8,36 In Germany, such a service is not provided within an undergraduate degree program. It is advisable to offer such a program within the curriculum for incoming freshman students. To strengthen study success, different stress-inducing challenges could be addressed by implementing workshops on study skills or time and stress management.

The evaluative findings of the training seminar indicate that first- and second-year students' interests differ slightly. It is important to tailor such seminars to the students' needs. Therefore, to improve the relevance of the offerings, the training contents could be split between the first and the second year. The sections “learning strategies,” “time management,” and “stress management” could be integrated into the first-year curriculum, whereas a workshop specifically focusing on the performance in oral examinations could be integrated into the second-year curriculum. Similarly, further topics like budgeting or specific clinical communication skills could be offered in the following years.

Problems with location, timing, and scheduling of counseling services have been identified as interfering problems that veterinary students face.1 We recommend close cooperation between veterinary medical schools and local career and counseling services. Likewise, a steady disciplinary and interdisciplinary exchange of experiences and adaptions made through similar training programs would be valuable.

ACKNOWLEDGMENTS

The authors would like to thank the students participating in the study and the training seminar; Marc Dilly and Stephan Birk for supporting the recruitment of participants and data acquisition; the Competence Centre for E-Learning, Didactics and Educational Research in Veterinary Medicine (KELDAT) for financial support; and Colleen Nichols for language revision.

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