Abstract
Clinical simulation assessments are widely used in health professions education but are often
associated with heightened anxiety and cognitive interference, which may affect student
performance. Although psychological skills interventions have demonstrated benefits in
performance contexts, their impact within clinical simulation assessment, particularly in
relation to personality traits, remains underexplored. This mixed methods, pre- post quasiexperimental
study examined relationships between anxiety, cognitive interference, cognitive
test anxiety, working memory capacity, personality traits and simulation performance and
evaluated the effect of a Performance-enhancing Psychological Skills (PEPS) Intervention
among emergency medical care students (n = 61). Quantitative data were collected before
and after the intervention, with regression analyses used to explore predictive relationships.
Qualitative data were gathered through focus group interviews using a Qualitative Descriptive
(QD) approach to examine student perceptions of simulation-related anxiety and perceptions
of the intervention. Prior to the intervention, higher neuroticism and cognitive test anxiety were
associated with increased state anxiety and cognitive interference, while conscientiousness
was positively associated with performance. Following the intervention, reductions in preassessment
state anxiety and cognitive interference were observed and previously significant
predictive relationships between personality traits and cognitive outcomes were reduced;
however, no significant improvement in simulation performance was found. Qualitative
findings highlighted fear of failure, social-evaluative threat and assessment unpredictability as
contributors to anxiety. Participants reported reduced levels of anxiety following the
intervention. Overall, the findings indicate that anxiety and cognitive interference are features
of simulation assessment and are influenced by stable personality traits. Psychological skills
interventions may mitigate maladaptive psychological responses, although such
improvements do not necessarily translate into immediate performance gains, highlighting the
possible value of integrating psychological preparedness alongside technical teaching and
learning in simulation-based education.