Autonomic Stress Responses in Oral Examination Simulations: Neuroscientific Insights from Comparing Peer-Led and Lecturer-Led Approaches

This mixed-methods study investigated the impact of simulated oral examinations on inducing neurocardiac stress in medical students, integrating physiological measurements, quantitative assessments, and qualitative feedback. Ninety-five students participated, with heart rate variability (HRV) markers such as RMSSD, pNN50, SDNN, and LF/HF ratios used to evaluate stress responses. Both lecturer-led and peer-led simulations significantly reduced HRV markers, indicating heightened sympathetic activation and reduced parasympathetic activity. In lecturer-led simulations, RMSSD showed significant reductions (t = 8.27, p < .001; t = 9.38, p < .001), paralleled in peer-led sessions (t = 4.47, p < .001; t = 4.97, p < .001). The LF/HF ratio significantly increased in lecturer-led exams (z=-2.69, p = 0.007), while peer-led simulations exhibited a more moderate response. Students' perceived competence and confidence significantly improved post-simulation (lecturer-led: t=-8.41, p < .001; student-led: t=-5.82, p < .001), and test anxiety significantly decreased. In the follow-up assessment conducted after the actual exams at the semester's end, 94.85% of students reported that the simulations were helpful in preparing for their final exams, aiding in reducing stress and enhancing performance. These findings highlight the potential of peer-led simulations as a resource-efficient alternative for fostering student resilience and coping under exam stress, though further exploration is needed to fully understand the nuanced autonomic responses in different settings.