Effect of anxiety on performance in multiple choice examination

Negative scoring of incorrectly answered multiple choice questions has logistic advantages, but may disadvantage anxious students. We therefore attempted to observe the effects of positive and negative marking of true/false questions on the examination performance of medical students with different levels of anxiety. Third‐year medical students (141 men, 71 women) completed a Spielberger State‐Trait Anxiety Inventory before an examination in pathology in 1994. Students knew there would be penalties for wrong answers in the first half of the examination and no penalties in the second half. Performance on the two halves was compared and effects of levels of anxiety assessed. Students reported slightly higher trait anxiety than American norms. Women students reported higher levels of state anxiety than men, and levels for both genders were indicative of a moderately stressful situation. Trait anxiety was not associated with performance in either the negatively or positively marked halves of the examination. For women students, but not men, lower state anxiety was positively associated with higher performance on the negatively marked half of the examination (r = 0.29), but accounted for only 8% of the variance in scores. In our study, anxiety was correlated only slightly with results of a negatively marked examination. We conclude that anxious medical students are not unduly disadvantaged by this method of marking.