Medical students find assessments stressful. Of course….but what do we do about it?

In this issue, Lyndon et al. [1] present the results of a systematic review on the relationship between academic assessment and psychological distress among medical students. One of their main findings is that different types of assessments are associated with subjective and physiological stress in medical students. As someone who has studied emotions, particularly stress, for 10 years, it would be easy for my response to be ‘of course!’ Medical training and practice are awash with emotional situations, from undergoing high stakes assessments, to the fear of making costly mistakes, to witnessing heartbreaking loss and death. However, this aspect of medical education has, for the most part, been ignored or merely superficially addressed in our study of how medical students learn and perform [2]. The Lyndon et al. paper [1] shines a light on an important and often neglected aspect of learning and performance. Research on how medical trainees learn, reason through clinical situations, or interact with patients has tended to focus on the knowledge and skills they require and how to develop them. However, there is overwhelming evidence from the psychological and neuroscience domains showing that emotions cannot be separated from cognitive functions [3]. We, as humans, are always in an emotional state of some kind. These emotions are instrumental in shaping how we attend to the world, what we remember from our experiences and how we make decisions. While there is growing interest in this topic in medical education, Lyndon et al. [1] highlight the nascent nature and disparity of the research to date on this topic. They are left, as is often the case for meta-analyses in medical education, with one sure conclusion: more research is needed.