PROPOSAL

TEST ANXIETY LEVEL BASED ON GENDER

AMONG SEMESTER V MEDICAL STUDENTS OF

UDAYANA UNIVERSITY BALI INDONESIA.

YOGESWARY PHNNIR SALVAM

1202005227

MEDICAL EDUCATION STUDY PROGRAM

FACULTY OF MEDICINE

UNIVERSITY UDAYANA

DENPASAR

2015

ACKNOWLEDGEMENT

I take this opportunity to express my profound gratitude and deep regard to my

guide dr. I Wayan Westa, Sp.KJ (K) for his exemplary guidance, monitoring and

constant encouragement throughout the course of this research. The blessing, help

and guidance given by him time to time shall carry me a long way in the journey

of life on which I am about to embark. Then I also would like to thank my friends

for motivating me and appreciating my work. I would also like to thank my

parents for helping me and encouraging me to go my own way. I wish to

acknowledge the contribution and the support of the Udayana University and to

the medical students for their participation in this elective study. Last, but not the

least, I would like to thank God, who made all the things possible and made it

successfully.

CONTENT

ACKNOWLEDGEMENT…………………………………………..….…………i

CONTENT……………………………………………………………….…..........ii CHAPTER I: INTRODUCTION

1.1 Research Background………………………………….…...................1

1.2. Problem Identifications………………………………...…....……….3

1.3. Aim of Research……………………………………….…...………...3

1.4. Research Benefits…………………………………………...…..…....3

CHAPTER II: LITERATURE REVIEW

2.1.Definition…………………………...………………………..……….4

2.2. Factors………………………………………..………………………………5

2.2.1 Gender……….......…………………………………………..……...5

2.2.2 Life style issues....…………………………………………......……6

2.2.3 Lack of information.…………………………..………....……..…..6

2.2.4 Psychological factor…...……………..……………….……….........6

2.2.5 Biological Factor……………………..……......................…..……..6

2.3. Diagnosis.......................................................................................…...7

2.3.1. GAD-7…………………..……………………………....…………7

2.3.2. HAM-A/HARS……………………………………..……...………7

2.3.3. TAQ.……….……………….………………………...…...……….7

2.4. Treatment.....................................................................................…....8

2.4.1. Medication……………………………………..………......……....8

2.4.2. Cognitive Behavioral Therapy…………….……..………...………8

2.4.3. Meditation…………………………………..…….……....……..…9

2.4.4. Parental Anxiety Management…………………………….…..…...9

2.4.5. Combined Treatments ….…………………….…………...…….....9

2.4.6. Elimination of Caffeine ………..………………..………..…….…9

2.4.7. Other Treatments…………………………….………………...…..10

CHAPTER III: CONCEPT, OPERATIONAL DEFINITION, HYPOTHESIS

3.1 Concept………………………………………………………………11

3.2 Operational Definition

3.2.1. Anxiety ……………………………………….…….......................12

3.3 Hypothesis..............................................................................…..........12

CHAPTER IV: METHOD OF RESEARCH

4.1. Design of Research………………………………………………….13

4.2 Population and Sample of Research

4.2.1. Population of Research…………………….……….……………..13

4.2.2. Criteria of Sample…………………….…………….……………..13

4.2.3. Sample Size………………………….……….……………………14

4.2.4. Method of Sampling for Research…………..…………………….14

4.3 Research Variable……………………….…………...………………14

4.4. Data Collecting Method and Analysis………………...…………….14

4.5 Place and Time of Research…………………………………....…….15

4.6 Instrument of Research………………………………………..……..15

4.7 Limitation of Research……………………………………….…........15

REFERENCE.............................................................................................………16

i

CHAPTER I

INTRODUCTION

1.1 Research Background

Medical conditions such as depression, insomnia, stress, bipolar disorders and

post-traumatic disorders and moreover anxiety has increased in number of cases

rapidly over the past years especially among students due to pressure they gone

through in their daily life and also to perform well.

As we know today, anxiety is became a common phenomenon of everyday’s

life. It plays an important role in human life because all of us are the victims of

anxiety in different ways and in different situation of our daily life activities.

Generally speaking, anxiety can either be a trait anxiety or a state of anxiety. Trait

anxiety which means, a stable characteristic or else trait of the person who undergoes

anxiety. State anxiety is the one which is aroused by some temporary situation of the

environment such as examination, accident, punishments and others (Mohammad

Nadeem et al, 2012). We all sure would have experienced at least a minor anxiety at

some point in our lives. Actually, it is the feeling of thousand butterflies flying in

your stomach before like a big date with someone, the tense feeling you get when

yourself know that you're in danger (eg: dog chasing you). Globally, approximately

273 million (4.5% of the general population) who had an anxiety disorder. It is more

common in females (5.2%) than males (2.8%).In Asian countries, the lifetime rates of

anxiety disorders are probably between 9% and 16%, and while the yearly rates are

between 4% and 7% (Prof Theo Vos et al, 2010).

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Nowadays, test anxiety is a common or maybe main cause of poor academic

performance among students in every part of this world. The work of assessing

student’s learning is complex. In order to assess to their work objectively, teachers

and instructors use various methods and instruments, one of which is examination.

We are aware that nowadays examination has become an inherent part of the society

we live in. Consequently, most of the important decisions are made mainly based on

exam results. So, it is not surprising if test anxiety during examination period has

become a most prominent problem in school and also universities.

Therefore, test anxiety can also interfaces with learning’s in that more anxious

students will be more easily distracted by irrelevant aspects of the task at hand and

also having trouble in focusing on significant details or information. In addition, it is

also more common in females than in males. Having an anxiety disorder means

coping with everyday life while feeling anxious and worried, with sweaty palms and

a pounding heart, with a paranoid sense that something bad is going to happen, or

even with the threat of a looming panic attack. This is what millions of females deal

with daily, but why they are more likely than males to experience anxiety is still a

mystery. It clearly shows that gender as associated factors that lead to different test

anxiety level among students.

Therefore, it is concluded that test anxiety level based on gender too (Shireen

et al, 2008). This problem should be overcome immediately as it can cause a variety

of effects such as it can cause the affected student to be unable to concentrate on their

education, it can also cause them to constantly lose focus and not actually perform

well during their examination which then leads them to fall into depression state.

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Based on this research background, the topic Of Test Anxiety Level Based on Gender

as Associated Factor among Semester V Medical Students of Udayana University

Bali, Indonesia was chosen.

1.2 Problem Identifications

a. How many of the semester V female and male medical students of Udayana

University are affected with mild test anxiety level?

b. How many of the semester V female and male medical students of Udayana

University are affected with moderate test anxiety level?

c. How many of the semester V female and male medical students of Udayana

University are affected with severe test anxiety level?

d. Does gender as associated factor contribute to test anxiety level among

semester V medical students of Udayana University?

1.3 Aim of Research

Mainly this research is to investigate the test anxiety level based on gender

among semester V English class medical students of Udayana University.

1.4 Research Benefits

a. The result of this study may also provide information and latest updates to

teachers and students about the test anxiety level based on gender among

semester V medical students of Udayana University.

b. It may help teachers to guide and motivate students according to their

requirements and background.

c. Knowing the test anxiety level of semester V medical students of Udayana

University according to their gender who are suffering from test anxiety.

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CHAPTER II

LITERATURE REVIEW

2.1 Definition

Anxiety has been defined as a diffuse, unpleasant, vague sense of

apprehension, which is often assisting by autonomic symptoms, likewise headache,

perspiration, palpitations, stiffness in the chest, and mild stomach discomfort feeling

(Kaplan, H. and Sadock, 1996). Benjamin (1987) noted that test anxiety can interface

with attention, learning and testing. The idea that test anxiety may interface with a

student's ability to demonstrate completely what they have learned is not new. In

1998 test anxiety also defined by Zeidner, that it’s a set of phenomenological,

physiological, and behavioral responses that accompany concern about possible

consequences or else failure on an exam or similar evaluative situation or condition

(Dr.Sadhan Das Gupta et al,2012). In contrast to fear, anxiety involves a more general

or diffused emotional reaction to beyond simple fear which that is out of proportion

to threats from the environment. Freud called anxiety as emotional pain. Anxiety

interferes with school functioning only when an abnormal level is reached, where as

within normal range, being anxious does not automatically imply worst school

functioning and indeed may to a certain extent be motivating and enhancing to

academic performance and this known as test anxiety. Test anxiety defined as

perceived arousal, reported worry, self-denigrating thoughts, tension, and reports of

somatic symptoms in exams or similar evaluative situations. For individuals with test

anxiety, both preparing for and taking a test cause high level of worry and discomfort.

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As a result, affected students do not perform to their potential and their test scores

misrepresent their level of knowledge and understanding. In addition, it was found

that boys regard a examining situation as a challenge for them in their academic life

and therefore as low test anxious has determined while in contrast with girls that tend

to see the testing or evaluative situation as a threat or danger that they have to

undergoes, and therefore they are tend to be more test anxious compared to males. So

that as the consequences of this problem some studies was conducted to investigate

effect of gender on test anxiety level (Zaheri et al, 2012).

2.2 Factors

The main contributing factors of test anxiety are such gender, age, life style

issues, lack of required information and studying style, psychological factors and

biological factors (Shireen Hashmat et al, 2008).

2.2.1 Gender

According to Zeinder (1977), the main interpretation of these revealed gender

difference is that males and females socialized to experience evaluation situations

differently and also respond to test anxiety in different ways. It has been suggested

that males may be more likely to perceive examination situations as a personal

challenge rather than as a threat and exhibit behavior characteristic of highly anxious

individuals like fear, feeling worry, anger, lower self-esteem (Zaheri et al, 2012).

Males and females show a clear difference in the levels of anxiety they experience.

Females’ greater anxiety appears to place them at a disadvantage (Ellen Rydell

Altermatt et al, 2004).

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2.2.2 Life style issues

Life styles related issues include inadequate rest, insufficient physical activity,

poor nutrition and lack of time management are found to be the contributing factors

leading to exam anxiety as reported by many authors (J.A. Afolayan et al, 2013).

2.2.3 Lack of information

Sujit et al have reported that lack of strategic studying likewise ineffective

studying style through inconsistent content coverage and also most of the students

will studying all night before exams which causes them to be inadequate rest,

inefficient studying style too which includes lack of revising and review of course

material studied are major factors leading to differ in test anxiety level (J. A.Afolayan

et al, 2013).

2.2.4 Psychological factors

Psychological factors which contribute significantly to exam anxiety are

negative and irrational thinking about exams, outcomes of exams and feelings of no

control over exam situation (e.g. going blank during exam) are reported by many

authors (shireen Hasmat et al, 2008).

2.2.5 Biological factors

It is basically a series of biochemical changes in human brain and body, such

as increase in adrenaline (causing heart to beat faster) and a decrease in dopamine (a

brain chemical that helps to block pain). These changes result in a state of heightened

attention to the source of the anxiety. A high level of anxiety causes human body to

prepare to fight or run away from the perceived threat which commonly called as

“flight-or-fight” response (shireen Hasmat et al, 2008).

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2.3 Diagnosis

There are several steps that need to be done to confirm the diagnosis.

Diagnosis of anxiety disorder can be made by taking complete anamnesis and by the

usage of screening tools that is valid to be use among that particular country

population. The anamnesis can be done by using basic four and sacred seven concept.

From the anamnesis, actually we can have a rough idea on what the supposed

diagnosis will be for that case and also by asking specific question and information

that required which will further support our suspected diagnosis to be confirmed.

Screening tool that can be use is as follows:

2.3.1 GAD-7 (Generalized Anxiety Disorder- Seven Item Scale)

The GAD-7 is a 7 item scale, which is useful for screening Generalized

Anxiety Disorder’s severity level in clinical practice and also in research study. This

GAD-7 can also be used to assess the therapeutic interventions, so which help us to

know the progress of that patient (Spitzer RL et al, 2006).

2.3.2 HAM-A/HARS (Hamilton Rating Scale for Anxiety)

Hamilton Anxiety Rating Scale is a 14 item scale, which designed to identify

the level of anxiety symptoms and also to assess the response to therapeutic

interventions that have already done to the patient (Hamilton M. et al, 1959).

2.3.3 TAQ (Test Anxiety Questionnaire)

Nist and Diehl (1990) developed a short questionnaire for determining if a

student experiences a mild or severe case of test anxiety. It indicates how often each

statement describes who fill-up the questionnaire by choosing a number from one to

five as outlined 1- never, 2 - rarely, 3 - sometimes, 4 - often and 5 - always.

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2.4 Treatment

Treatment for anxiety is not specified yet and it depends on the severity level.

Medication will not cure anxiety disorders but will keep them under control. Taking

prescription of drugs does not really cure the underlying causes of the anxiety

problems that faced by the person. Drug treatments for anxiety disorders work by

downplaying threat detecting mechanisms in the body (Terry Dixon, 2011).

2.4.1 Medication

The first famous known medication is benzodiazepines such as Alprazolam,

Diazepam, and Lorazepam commonly used to treat test anxiety with low dosage

while at higher dosage it can lead to sedative effect. Antidepressant commonly used

for general depression, which can accompany test anxiety. Side effects include, but

are not limited to, the potential to cause agitation and suicidal thoughts. These need to

be taken on a regular basis not when needed before an exam (Terry Dixon, 2011).

2.4.2 Cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT) is very useful in treating anxiety

disorders. CBT helps to change the pattern of thinking that support the fear and help

the sufferer overcome the negative beliefs. CBT often lasts about two weeks and

takes place in small groups. Medication combined with psychotherapy has shown to

be the most effective treatment approach for people suffering from anxiety disorders.

Cognitive interventions have only had limited results when it comes to improving test

performance (Olatunji et al, 2010).

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2.4.3 Meditation

Meditation, is one kind of treatment that use to treat test anxiety (Jon Kabat-

Zinn et al, 1992). Meditation reduces anxiety level mentally. Most commonly other

simple activities likewise jogging, lying down for a moment, walking around or just

listening to the simple, soothing and also mind relaxing music which will help to

decrease the test anxiety level in particular individual.

2.4.4 Parental Anxiety Management

Recent years have seen increasing interest in the role the family plays in the

development and treatment of childhood disorders. (Paula M. Barrett et al, 2001).

Although it is always advisable to seek professional help, especially in more severe

cases, help is not always readily available. Even if parents do decide to seek help in

managing their child's anxiety, they can still play a key role in helping their child.

2.4.5 Combined treatments

Some research also shows that a combination of CBT and Parental Anxiety

Management has been proven to be more effective than administering these

treatments separately (Paula M. Barrett et al, 2001).

2.4.6 Elimination of Caffeine

Stimulants are some type of chemicals that excite your central or peripheral

nervous system in your body system. The term "excite" in this matter, means which

release more chemicals or send more and faster messages through your nervous and

body system to the brain. While each of these excites our mind and body, and also

can create extra energy that is transformed into anxiety or else create nervous or tense

feeling toward the situations. Caffeine known to be the most common stimulant that

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often found in coffee (P.Narrow et al, 2003). Especially, one cup of coffee in the

morning is most unlikely to cause extreme anxiety although different people can react

differently towards the stimulant, so it may contribute to more anxiety symptoms (A.

Smith, 2002).

2.4.7 Other treatments

Other treatment methods that could use in treating severe anxiety cases also

include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS),

psychosurgery, and also breathing training teaches correct breathing habits to people

with anxiety disorders (Nicola Reavley et al, 2010).

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CHAPTER III

CONCEPT, OPERATIONAL DEFINITION AND HYPOTHESIS

3.1 Concept

Based on the description mentioned above, hence the main concept of this

study is to know the test anxiety level based on gender as associated factor.

Semester V English class medical students

of both gender of Udayana University

Test

Test

Anxiety

Moderate

Anxiety

Severe

Anxiety

No

Anxiety

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3.2 Operational Definition

3.2.1 Anxiety

To evaluate test anxiety level, Test Anxiety Questionnaire (TAQ) is used.

Nist and Diehl (1990) developed a short questionnaire for determining if a student

experiences a mild or severe case of test anxiety level. Score ranged from 10 to 50.

a. 10-19: no test anxiety

b. 20-35: moderate test anxiety

c. 35-50: severe anxiety

3.3 Hypothesis

Since it is a descriptive study, this study does not have a hypothesis. However

a predictable hypothesis would be those female students will have more test anxiety

level than male students.

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CHAPTER IV

METHOD OF RESEARCH

4.1 Design of Research

This research which investigates the problem of test anxiety level is known as

descriptive study. Descriptive study is the study that uses the collection of data

without any manipulation of the surrounding environment with true data. This study

is a one-time interaction study which is with the groups of people or else clearly

known as the cross sectional study. As this study was descriptive at first, we shall use

survey technique, questionnaire and checklist by given it to the participants by the

researcher or investigator. Therefore, descriptive studies such as a cross-sectional

study, really helps in generating the hypothesis on which further research may be

carry out.

4.2 Population and Sample of Research

4.2.1 Population of Research

Target population of this study is the English class students of Udayana

University in Denpasar, Bali. These students will particularly be chosen from English

class students who are currently pursuing their studies in semester V.

4.2.2 Criteria of Sample

Research will take place on campus students and these students selection

randomly done based on the name list of semester V students from the faculty of

medicine of Udayana University. Moreover, in this descriptive study about 100

students in total will be selected which includes 50 males and 50 females. All the

xiv

participants will be assured that confidentiality of information provided and moreover

they will be approached and each of them will be provided an informed consent

particularly before each of them participating in this research study. The inclusion

criteria’s for this study are the participants selected must be aged between 19 to 22

years old, from both genders, stable mental status, and joins the study research

willingly.

4.2.3 Sample Size

The sample size of this research is that, 100 medical students of semester V of

English class from medical faculty of Udayana University which is composed of 50

males and 50 females.

4.2.4 Method of Sampling for Research

Sampling technique that will be used for this research study is simple random

sampling. The investigator selects 100 medical students of Udayana University from

a name list of semester V English class students. Each name will be put on a separate

small piece of a sheet and then the names will be drawn randomly until all the 100

names have been picked up and it will be recorded accordingly.

4.3 Research Variable

In this descriptive study, to investigate the above stated problem, medical

university students of Udayana University will be approached. They will be given

papers of questionnaires to access their test anxiety level.

4.4 Data Collecting Method and Analysis

The data will be collected from students who are studying in the faculty of

medicine Udayana University specifically those who are in their fifth semester of

xv

English class students. Ethical approval was obtained from the respective relevant

ethics committee within the Udayana University.

4.5 Place and Time of Research

This research will be conducted at University of Udayana Denpasar, Bali. The

time and duration of data collection is from 10 am in the morning until 4pm in the

evening. The questionnaire paper will fill-up own by the English class students

exactly one week before their exam. The questionnaire used for the study was

designed by the researchers and self administered to the students and collected at the

spot after been fully completed by the students.

4.6 Instrument of Research

The instrument that used in this investigation is questionnaire to access test

anxiety level. The questionnaire consisted of two sections. Section A was designed to

collect data on personal variables of gender, age and religion. While the other one

Section B will be focus on the study objective or aim of this research. The

questionnaire had particular items on indicators of variables to require the opinion of

respondents or participants. The questionnaire used in this research Test Anxiety

Questionnaire (TAQ).

4.7 Limitations of Research

This descriptive cross sectional study uses questionnaire to analyze, hence it

may not be entirely true since it depends on the person or participants who willingly

join the study on what they would like to fill up in their forms. Sometimes they also

may refuse to provide the accurate answers in the questionnaire given due to some

personal thoughts.

xvi

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