Anxiety and study methods in preclinical students: causal relation to examination performance.

Stress and anxiety are substantially raised in many preclinical students in their first year at medical school. Although correlated with poor end-of-year examination performance, anxiety levels did not cause poor performance, but were themselves caused by previous poor performance in sessional examinations. Study habits showed declining deep and strategic approaches, and increasing surface ('rote-learning') approaches. Surface learning correlated with poor end-of-year examination performance, and was a result of previous poor sessional examination performance. Deep learning did not correlate with performance, whereas strategic learning correlated positively with examination success, even when measured 2 years previously during application to medical school.