Exam-Related Anxiety among Medical Undergraduates at the Faculty of Medicine, University of Zawia, Libya: A Cross-Sectional Study

Abstract

Background: Medical degree programs are internationally recognized as among the most academically rigorous forms of professional training. In this demanding environment, exam-related anxiety constitutes a substantial psychological burden, yet its magnitude among medical undergraduates in Libya has received limited empirical attention. This investigation sought to quantify examination anxiety levels among students enrolled at the Faculty of Medicine, University of Zawia, and to evaluate associations between anxiety severity and selected demographic and academic characteristics. Methods: This cross-sectional survey-based study was employed, utilising a 38-item, psychometrically validated questionnaire administered to students spanning all academic stages (first year through internship). Item responses were captured on a four-point Likert scale (0 = strongly disagree to 3 = strongly agree). Anxiety severity was categorised as mild, moderate, severe, or very severe based on mean per-item scores. Inferential analyses comprised the Mann-Whitney U test, the Kruskal-Wallis H test, the chi-square test, and Pearson correlation coefficients. Result: Two hundred and thirty-four students participated (female: 83.3%; male: 16.7%; mean age: 22.2 ± 2.3 years). The instrument exhibited excellent internal consistency (Cronbach’s α = 0.931). The cohort mean total anxiety score was 63.7 ± 22.1 out of a maximum of 114 (55.9% of the attainable maximum), corresponding to a mean per-item score of 1.68 ± 0.58. The majority of participants (58.1%) met criteria for severe or very severe anxiety. Female students returned significantly elevated scores relative to their male counterparts (65.1 ± 21.7 versus 56.5 ± 23.0; p = 0.023). No statistically significant variation was detected across academic year (p = 0.147), academic standing (p = 0.354), or age (r = −0.066, p = 0.319). Items attracting the highest endorsement rates included sleep impairment arising from pre-examination rumination (90.2%), pervasive tension during final examination preparation (87.6%), and the desire to be relieved of examination-related distress (89.7%). Conclusion: This study has found that examination anxiety is highly prevalent within this cohort, with the majority of students reporting severe or very severe symptomatology. Female students are disproportionately affected. These findings underscore an urgent requirement for systematically delivered psychological support, tailored stress-management programs, and structural reforms within the curriculum.