The incidence of anxiety among paramedic students



How to Cite

Wills HL, Asbury EA. The incidence of anxiety among paramedic students. Australasian Journal of Paramedicine [Internet]. 2019Feb.4 [cited 2022Aug.19];160. Available from:



Summative assessments are an established form of assessing student performance, knowledge and ability against learning outcomes. The impact of anxiety on paramedic student success is not well understood but may adversely affect student outcomes. The aim of this study was to explore the origins and incidence of anxiety among paramedic students.


Distance and campus-based students from all three years of the Bachelor of Health Science (Paramedicine) program at Whitireia New Zealand were approached to participate in this study. A mixed method data collection was used. Participants completed an online survey including the Westside Test Anxiety Scale (WTAS), program-specific questions and free response section to garner qualitative data. Quantitative data was analysed using descriptive statistics and t-tests, qualitative data was the subject of thematic analysis.


One hundred and seventeen paramedic students participated in the study. Participants with previous tertiary education to diploma level had significantly higher WTAS scores than those with prior degree qualification (36.72 ± 5.92 vs. 31.42 ± 7.58, p=0.02). Students undertaking full-time work with part-time study had significantly higher WTAS scores than those enrolled in full-time study with part-time work (36.71 ± 7.0 vs. 32.09 ± 7.25, p=0.027). Qualitative analysis identified three themes: stressors, obstacles to learning and negative experiences.


High levels of anxiety were identified across the student body. There were significant differences in anxiety based on previous educational achievement and between full-time and part-time students. This demonstrates that different course delivery methods and student backgrounds may impact on paramedic student anxiety.


Eberly Center for Teaching Excellence & Educational Innovation. Whys and hows of assessment. Carnegie Mellon University. 2015. Available at:

Sloan TA, Lundin M, Wilson D, Robinette R. The use of test anxiety assessment and anxiety reduction training to predict and improve performance of collegiate pilot trainees. Central Washington University 2009;60-9.

Hancock DR. Effects of test anxiety and evaluative threat on students ’ achievement and motivation. J Educ Res 2001;94:284.

Weiten W. Psychology: themes and variations. 9th edn. Pacific Grove CA: Brooks Cole; 2010.

Clapper TC. Beyond knowles: what those conducting simulation need to know about adult learning theory. Clin Simul Nurs 2010;6:e7-14.

Nielsen B, Harder N. Causes of student anxiety during simulation: what the literature says. ibid. 2013;9:e507-12.

Carey E, Hill F, Devine A, Szücs D. The chicken or the egg? The direction of the relationship between mathematics anxiety and mathematics performance. Front Psychol 2016;6:1-6.

Leblanc VR, Regehr C, Tavares W, Scott AK, Macdonald R, King K. The impact of stress on paramedic performance during simulated critical events. Prehosp Disaster Med 2012;27:369-74.

Mills BW, Carter OBJ, Ross NP, Quick JK, Rudd CJ, Reid DN. The contribution of instructor presence to social evaluation anxiety, immersion and performance within simulation-based learning environments: a within-subject randomised cross-over trial with paramedic students. Australasian Journal of Paramedicine 2016;13(2).

Barr N, Readman K, Dunn P. Simulation-based clinical assessment: redesigning a signature assessment into a teaching strategy. ibid. 2014;11(6).

Proctor N, Ferguson M. Mental health emergencies. In: Curtis, Kate; Ramsden C, editor. Emergency and trauma care for nurses and paramedics. 2nd edn. 2016. p. 953-74.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing, 2013.

Wild J, Smith KV, Thompson E, Béar F, Lommen MJJ, Ehlers A. A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychol Med 2016;46:2571-82.

Fjeldheim CB, Nothling J, Pretorius K, et al. Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees. BMC Emerg Med 2014;14:11.

Shepherd L, Wild J. Cognitive appraisals, objectivity and coping in ambulance workers: a pilot study. Emerg Med J 2014;31:41-4.

Mounsey R, Vandehey M, Diekhoff G. Working and non-working university students: anxiety, depression, and grade point average. Coll Stud J 2013;47:379-89.

Sansgiry SS, Bhosle M, Sail K. Factors that affect academic performance among pharmacy students. Am J Pharm Educ 2006;70(5).

Israel G. Determining sample size. University of Florida Cooperative Extension Service, Institute of Food and Agriculture Sciences 1992;85:108-13. Available at:

Driscoll R. Westside Test Anxiety Scale. 2004. Available at:

Driscoll R. Westside Test Anxiety Scale validation. Online submission. 2007. Available at:

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101. Available at:

Kasmaee RB, Nadi MA, Shahtalebi B. Investigating effective components of higher education marketing and providing a marketing model for Iranian private higher education institutions. Int Educ Stud 2016;9:104-13.

Sarason IG, Pierce GR, Sarason BR. Cognitive interference theories: methods and findings. Mahwah, NJ: Erlbaum; 1996. p. 456.

Nieuwenhuys A, Oudejans RR. Anxiety and performance: perceptual-motor behavior in high-pressure contexts. Curr Opin Psychol 2017;16:28-33.

Muirhead V, Locker D. Canadian dental students’ perceptions of stress. J Can Dent Assoc (Toronto) 2007;73(4).

Dawson S, Bakharia A, Heathcote E. SNAPP: realising the affordances of real-time SNA within networked learning environments. In: Networked Learning; 2010.

Wijekumar K, Ferguson L, Wagoner D. Problems with assessment validity and reliability in web-based distance learning environments and solutions. J Educ Multimed Hypermedia 2006;15:199-215.

Ali M, Asim H, Edhi AI, et al. Does academic assessment system type affect levels of academic stress in medical students? A cross-sectional study from Pakistan. Med Educ Online 2015;20:27706.

Mehta RK, Nussbaum MA, Agnew MJ. Muscle- and task-dependent responses to concurrent physical and mental workload during intermittent static work. Ergonomics 2012;55:1166-79.

Williams B, Abel C, Khasawneh E, Ross L, Levett-Jones T. Simulation experiences of paramedic students: a cross-cultural examination. Adv Med Educ Pract 2016;181.

Alinier G. Skills benefits of advanced simulation training. J Paramed Pract 2009;1:369-76.

Boyle MJ, Williams B, Cooper J, Adams B, Alford K. Ambulance clinical placements – a pilot study of students’ experience. BMC Med Educ 2008;8:19.

Timm A. “It would not be tolerated in any other profession except medicine”: survey reporting on undergraduates’ exposure to bullying and harassment in their first placement year. BMJ Open 2014;4:e005140.

Levett-Jones T, Pitt V, Courtney-Pratt H, Harbrow G, Rossiter R. What are the primary concerns of nursing students as they prepare for and contemplate their first clinical placement experience? Nurse Educ Pract 2015;15:304-9.