Abstract:

Introduction:
Exam anxiety is a growing concern in post-secondary education and can lead to negative outcomes. Students unfamiliar with the test-taking environment are more likely to have test anxiety. One strategy to condition against anxiety-inducing situations is in vivo exposure, which involves exposing individuals to situations resembling real-world environments. This study used virtual reality (VR) as a tool for in vivo exposure to help occupational therapy (OT) students familiarize themselves with the test environment and reduce exam anxiety.

Objectives:
To determine if VR simulation of a practical hands-on exam would reduce OT student test anxiety for an upcoming examination. Student perspectives were collected to gain insights into how to enhance the VR learning system and identify effective strategies for reducing student anxiety.

Methods:
In 2022, first-year OT students were invited to participate in a VR session three-days before their Objective Structured Clinical Exam (OSCE). Participants were divided into two groups: those who experienced the VR simulation (YesVR) and those who did not (NoVR). The state anxiety levels of both groups were measured using the State-Trait Anxiety Inventory (STAI). The VR simulation consisted of history-taking and cognitive assessment modules, allowing students to communicate with virtual patients in natural language within a virtual clinic that replicated the OSCE environment. Virtual patient responses were generated by artificial intelligence (GPT), fine-tuned with transfer learning techniques based on real-world student and standardized patient video recordings. A mixed method approach was used where students were invited to participate in semi-structured interviews and focus groups within one week after completing the OSCE. A t-test at α=0.05 compared YesVR and NoVR groups' state anxiety scores, while an interpretative thematic analysis was used to analyze the qualitative data.

Results:
85 first-year OT students participated in this study, 28 in the YesVR group, and 32 in the control group (NoVR), and 25 participated in interviews and focus groups. Our findings showed a significant difference in mean state anxiety between the two groups, with NoVR students displaying higher anxiety levels (mean = 55.00 ± 10.18) compared to YesVR students (mean = 43.04 ± 13.19), p < .001. Our analysis identified several major themes that significantly impacted student anxiety and course performance, including the student's experience, exam feedback, fear of the unknown, self-consciousness, knowledge of the physical environment, practice, mindset regarding grades, time constraints, and peer influence. VR was deemed helpful in familiarizing students with the exam environment and process which directly helped reduce their anxiety.

Conclusion:
VR provides a novel and resource-efficient approach to practice for clinical exams; this can help increase student familiarity with testing environments and potentially reduce test anxiety by decreasing ambiguity in testing situations. This is particularly relevant for students who have an intolerance to uncertainty, which can negatively impact their performance. This study underscores the importance of addressing student anxiety in clinical exam preparation and highlights the potential of VR in reducing such anxiety.

Keywords:

Virtual reality, artificial intelligence, student anxiety, examination preparation, learning tools.