Relationships between cognitive appraisals of threat and challenge, psychophysiological responses, and clinical performance during high-stress simulated OSCEs

Sep 29, 2026

Uploaded by Aran

Healthcare education uses Objective Structured Clinical Examinations (OSCEs) to assess competency, yet they often elevate students’ psychophysiological stress. Cognitive Appraisal Theory proposes that learners evaluate whether coping resources match situational demands. This study investigated how threat and challenge appraisals relate to physiological stress responses and clinical performance in final-year paramedicine students during simulated high-stress OSCEs, comparing threat-associated arousal and poorer outcomes with more regulated responses under challenge appraisals.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

Cognitive appraisal and stress in OSCEs

Paramedic training context in higher education

Methods

Results

Conclusion

Betson etal. BMC Medical Education (2026) 26:2 BMC Medical Education [https://doi.org/10.1186/s12909-025-08365-3](https://doi.org/10.1186/s12909-025-08365-3) RESEARCH Open Access Relationships between cognitive appraisals of threat and challenge, psychophysiological responses, and clinical performance during high-stress simulated osces Jason Betson 1,3*, Erich C. Fein2, David Long3 and Peter Horrocks4 Abstract Introduction In healthcare education, Objective Structured Clinical Examinations (OSCEs) are often utilised as a practical assessment tool and can cause marked elevations in psychophysiological stress levels for students. Cognitive Appraisal Theory asserts that individuals engage in evaluative processes to determine whether their available coping resources are sufficient to meet the demands of a given situation. This study examined the relationship between cognitive appraisal s and psychophysiological responses, as well as clinical performance, in final-year paramedicine students during simulated high-stress OSCEs. Specifically, it investigated whether threat appraisals are associated with distinct physiological stress markers and poorer clinical outcomes compared to challenge appraisals. Methods A total of twenty-six undergraduate paramedicine students participated in the study, evaluated through cardiovascular indicators, functional near-infrared spectroscopy (fNIRS) neuroimaging, clinical performance evaluations, and stress and decision-making assessments. Results The results revealed that students who approached the simulated OSCE with a challenge-oriented mindset demonstrated more regulated cardiovascular and cerebral stress responses and achieved significantly higher scoreson clinical performance measures. In contrast, those exhibiting threat appraisals showed heightened physiological arousal, demonstrated by significant increases in cortisol levels, whilst achieving lower clinical competence. Conclusion These findings suggest that the way students cognitively appraise high-pressure clinical scenarios can meaningfully influence both their biological stress responses and their ability to perform effectively. This study highlights the importance of fostering challenge appraisals which may enhance students’ resilience under pressure and ultimately improve patient care outcomes in real-world emergency settings. Keywords Paramedic, Scenario, Simulation, Education, Stress *Correspondence: Jason Betson [jason.betson@acu.edu.au](jason.betson@acu.edu.au) 1Faculty of Health, Australian Catholic University, Melbourne, Australia 2School of Psychology and Wellbeing and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia 3School of Health and Medical Sciences and Centre for Health Research, University of Southern Queensland, Ipswich, Australia 4School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l

FAQs

What does the study examine during simulated high-stress OSCEs?

It examines the relationship between cognitive appraisals (threat vs challenge), psychophysiological stress responses, and clinical performance in final-year paramedicine students.

How were students assessed in the study?

Participants were evaluated using cardiovascular indicators, functional near-infrared spectroscopy (fNIRS), clinical performance evaluations, and stress and decision-making assessments.

What were the key differences between threat and challenge appraisals?

Challenge appraisals were associated with more regulated cardiovascular and cerebral stress responses and higher clinical performance, while threat appraisals showed heightened physiological arousal (including increased cortisol) and lower clinical competence.

Sep 29, 2026

Uploaded by Aran