{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:14:45Z","timestamp":1788869685849,"version":"build-2803163510"},"reference-count":52,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,28]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe stress, coping behaviours, anxiety, psychological support and benzodiazepine use among French final-year medical students sitting a high-stakes national ranking examination and to explore how these patterns relate to exam ranking when interpreted through transactional stress and coping and \u2018coping reservoir\u2019 models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional questionnaire survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>\n                      Single university medical faculty in France; final-year students sitting the national\n                      <jats:italic>\u00c9preuves D\u00e9mat\u00e9rialis\u00e9es Nationales<\/jats:italic>\n                      (EDN) and \u2018national Objective Structured Clinical Examination (nOSCE)\u2019 clinical examination.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All 387 sixth-year students present for the 2025 nOSCE were invited; 192 (50%) completed the questionnaire (69%\u2009women; median age 25 years). Inclusion: registered for the national exam and attending nOSCE; exclusion: non-attendance or incomplete questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>\n                      Primary outcomes were self-rated stress for EDN and nOSCE and\n                      <jats:italic>State-Trait Anxiety Inventory-Y<\/jats:italic>\n                      (STAI-Y) state and trait anxiety scores. Secondary outcomes included stress management behaviours, psychological\/psychiatric follow-up, benzodiazepine and other psychotropic use and final national ranking.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>92% of respondents reported that stress impacted their daily life, particularly attention (83%), sleep (79%) and learning capacity (64%). Overall, 32% had consulted a psychologist\/psychiatrist and 15% used benzodiazepines. Most reported regular sport (86%; \u22652 sports 69%) and breathing exercises (61%). Median nOSCE stress was 8\/10; median STAI-Y state and trait scores were 45 and 46. Comparing very low versus high\/very high trait-anxiety subgroups, ranking did not differ significantly, but low-anxiety students reported more sport (p=0.04), less benzodiazepine use (1\/24 vs 10\/37; p=0.003) and far less psychological follow-up (1\/24 vs 19\/46; p&lt;0.0001). Self-reported coping strategies were not associated with better ranking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Final-year medical students preparing for a high-stakes national ranking examination report pervasive stress, substantial functional impairment and frequent professional and pharmacological coping, with only limited linkage between anxiety and performance. Within transactional and coping reservoir frameworks, these results highlight the need for reflection on structural assessment practices and for longitudinal institutional strategies to protect learner well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-125171","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:00:36Z","timestamp":1788868836000},"page":"e125171","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Stress, coping profiles and anxiety among French final-year medical students in a high-stakes national ranking examination: a cross-sectional study"],"prefix":"10.1136","volume":"16","author":[{"given":"Amandine","family":"Math\u00e9","sequence":"first","affiliation":[{"name":"Palliative Care, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Tison","sequence":"additional","affiliation":[{"name":"Service de Neurologie des Maladies Neurod\u00e9g\u00e9n\u00e9ratives, IMNc, CHU Bordeaux, Bordeaux, France"},{"name":"CNRS, IMN, UMR 5293, University of Bordeaux, Bordeaux, France"},{"name":"Institut de M\u00e9decine Int\u00e9grative et Compl\u00e9mentaire (IMIC), H\u00f4pital Xavier Arnozan, CHU de Bordeaux & Universit\u00e9 de Bordeaux, Pessac, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Sztark","sequence":"additional","affiliation":[{"name":"Institut de M\u00e9decine Int\u00e9grative et Compl\u00e9mentaire (IMIC), H\u00f4pital Xavier Arnozan, CHU de Bordeaux & Universit\u00e9 de Bordeaux, Pessac, France"},{"name":"Service d'Anesth\u00e9sie-R\u00e9animation I, CHU de Bordeaux, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Mellet","sequence":"additional","affiliation":[{"name":"Palliative Care, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Ouattara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Anesthesia and Critical Care, CHU de Bordeaux, Bordeaux, France"},{"name":"Biologie des Maladies Cardiovasculaires, U1034, Universit\u00e9 de Bordeaux & INSERM, Pessac, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Gruson","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, CHU de Bordeaux, Bordeaux, France"},{"name":"Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Universit\u00e9 de Bordeaux, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Roubaud-Baudron","sequence":"additional","affiliation":[{"name":"P\u00f4le de G\u00e9rontologie Clinique, CHU de Bordeaux, Bordeaux, France"},{"name":"Univ. 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