Prevalence of test anxiety among medical students: a systematic review and meta-analysis

Abstract Background Test anxiety is a situation-specific construct that can markedly impair cognitive functioning and academic performance in high-stakes educational environments. Medical students are frequently exposed to evaluative situations, and test anxiety is common in this population; however, reported prevalence estimates vary widely due to methodological inconsistencies across studies. Therefore, we aimed to estimate the pooled prevalence of test anxiety among medical students. Methods We searched PubMed, Scopus, Embase, and Web of Science in March 2026, supplemented by backward and forward citation searching. Studies were eligible if they quantitatively assessed test anxiety among medical students and reported a discrete prevalence estimate. The pooled prevalence was calculated using a random-effects model with a generalized linear mixed model and logit transformation. Subgroup analyses were conducted by gender, academic year, geographic region, assessment tool, administration timing, and sampling technique. A meta-regression examined the association between publication year and prevalence. Risk of bias was assessed using the Newcastle-Ottawa Scale adapted for descriptive cross-sectional studies (NOS-xs2). Results Thirty-five studies comprising 13,489 medical students were included. The overall pooled prevalence of test anxiety was 49.8% (95% CI: 39.9%–59.6%, I² = 98.2%, Tau² = 1.33), which decreased to 44.9% upon exclusion of studies utilizing the Visual Analogue Scale ( n = 3). Among subgroup analyses, only the assessment tool showed a significant effect. Nevertheless, prevalence was numerically higher in females (52.6%) than males (46.3%), among first-year students (58.6%) compared with fifth-year students (47.9%); and highest in South-East Asia (59.3%), followed by the Middle East (54.1%). Prevalence was also highest in studies conducted during examinations (55.4%), compared with pre-examination (51.7%) and post-examination (41.5%) periods, and in studies using convenience sampling (52.9%) compared to random sampling (44.7%). Meta-regression showed no significant association between publication year and prevalence (β = 0.003, p > 0.9). Conclusions Test anxiety affects nearly half of all medical students globally. The substantial heterogeneity underscores the need for standardised measurement and precise reporting of administration timing in future research.