Oral Examination Anxiety in Physicians, Narcissism, and Object Relations

By applying object relations theory, both examiners and candidates can increase understanding of examination anxiety in oral certification in order to enhance the fairness and validity of the examinations. Unconscious images of self and others which examiners and candidates may project onto each other can affect the examination. The examiner must observe himself, the candidate, and the other examiner, lest a transference affecting the examination's progress occur, and to avoid an enactment, which may interfere with the examination. This observing should appropriately support the candidate in functioning at an optimal level of competence. Unconscious processes may prejudice the examiner's attitude towards a candidate, thus jeopardizing the examination's fairness and validity. The candidate's anxiety, based on projections onto the examiners, may interfere with his/her optimal functioning and affect the outcome. If a candidate's anticipatory anxiety is excessive, he/she needs to decide if it needs to be managed on a symptomatic or psychotherapeutic basis. Candidate and examiner both need to monitor their feelings during the examination in order to optimise the examination's fairness and validity. All these issues may also be considered in the relationship between psychiatric educators and trainees.