How to react to a student’s panic attack in an oral exam?

Question

Suppose, I am an examiner in an oral exam. I have done my best to design and conduct the exam to reduce students’ anxiety, but it just didn’t work: The student has a panic attack that makes it impossible to continue the exam in a regular way. How can I rescue the situation, if at all?

Some clarifications:

• The student is not just nervous, but is in some anxiety spiral, freezes, cries, etc. They obviously cannot think straight anymore or answer questions in a manner that would allow a reasonable assessment. Any attempt to just continue the exam would only exacerbate the situation.

• Of course, every panic attack is different. I am aware that I need to weigh the alternatives depending on the specifics of the situation. This question is asking for the toolbox; I still need to select the right tool myself.

• Assume that, before the panic attack, the student has not yet demonstrated sufficient skill, knowledge etc. to pass the exam. (Usually, because the exam only took a few minutes so far.)

• This question is not about prevention. While that is certainly the preferable way, it doesn’t always work and we already have a question on that: How to help reduce students' anxiety in an oral exam? That question is about what can be done in preparation or while staying “examination mode” such as asking very basic questions or switching the topic. This question is about when that has failed.

• The baseline option (i.e., doing nothing) would be to let the student fail the exam and re-take it as far as permitted by the pertaining examination and accommodation rules. I acknowledge that this may be the best option in many cases, but it is still dissatisfying as it is a lot of work and effort for everybody involved and the situation may just repeat.

Answer 1

First of all: if your university has a support unit for disabilities and/or mental health issues, contact them and ask the same question. They are the professionals here; we are just keyboard warriors on the internet.

In any case, here are some possible ideas:

1. Wait 30 minutes for the panic attack to pass (and then asking a different question); this may already solve the problem.

2. When you resume, have the student write their answers, even if it is an oral exam. This may reduce the stress.

3. Do you have the option to adjourn the exam without it appearing as failed? If so, I would prefer that. Treat it as a medical emergency.

I have experienced the effectiveness of (1) and (2) in the past (as a third person, I was neither the student nor the professor).

Answer 2

I think this should be seen as a medical reason to postpone the exam.

Like a student stumbling and breaking their leg after the first question, or becoming unconscious.

I know that after the start of the exam, you have to be careful about medical reasons because of possible cheating, but I think you can trust your judgement here.

Answer 3

During my final exams at my school we had a case like this. One girl was completely incapable of taking any verbal exam. But it seems there was no fixed rule who had to take the exam and where.

So while this student was waiting outside the exam room sitting on a bench, another teacher sat down besides her, talked to her, asked about her preparations, then various questions about the subject, and so on. Last question was reportedly “Are you afraid of that test?” “Yes.” “No need, you passed.”

Not quite the same situation, but you could check if a subterfuge like that is possible and legal.

Answer 4

First, you might want to check if there are rules about this topic in your university (e. g. about medical emergencies in exams). There might be rules or a "teaching help center" which can answer this question to some extend.

If there is not and you are free to do whatever you want, I would count this exam as if it never happened and reschedule it (I'd do the same if some other medical emergency happened or if there would be a fire alarm). As you describe it, a normal exam is not possible in your circumstances. Failing would not be an accurate measure of the student's knowledge.

If your structures allow this, I would talk to the student afterwards (maybe in the next days) if this happens often and if the student wants some adjustments (e.g. a friend present at the exam, drinking water at the exam, more writing instead of speaking etc.).

Since, in my experience, this does very rarely happen, I'd say it's okay to reschedule and meet their adjustments (as long as they are reasonable and fair). If this happens often at your university (or you believe some students fake it to cheat somehow), do talk about this topic in a faculty meetings and try to invite experts on panic attacks to give input.

However, if this happens only once and you are not sure if the student might fake this - I'd say it's much better to let the "guilty student" alone as to punish a "non-guilty" student.

Answer 5

If I were in charge of the situation, I'd just declare the situation "adjourned", no matter what the ambient administrative rules... Next, try to take all steps for the welfare of the student.

Later, think about rescheduling, ... and have a calm talk with the student about the business of oral exams. And/or possibly have a university office recommend some sort of "accommodation", for anxiety...

In contrast to some other remarks: no, in my observation (mostly about grad-level oral exams of various sorts), panic-attacks are not about incompetence, but are manifestations of sometimes-chronic, sometimes-acute mental health issues.

No, I do not pretend to have any way to "solve this problem". My approach for many years, with my own research students (in math...), was to do endless rehearsals, with them at the blackboard, me sitting in "the audience", playing various roles as "heckler", or, with "time-out", to give advice on how to deal with the heckler... At that level of things, "endless rehearsals" seemed effective in de-sensitizing people.

Answer 6

Consider multiple redeemable assessments for this item (or some rehearsals), to give additional "exposure"

Another answer here recommends that you should assess without any special consideration unless there is a prior accommodation agreed. That seems reasonable to me, partly from a procedural standpoint, but also because a major part of the reason for assessment is diagnostic. For situations like this, one approach that can be useful is to give students multiple "bites of the cherry" by having multiple redeemable pieces of assessment. This allows the student to perform the assessment and get back a mark, but it also means that bad performance on an individual assessment item is not fatal to the overall course mark. In cases where there is difficulty with a particular type of assessment (e.g., involving presentation or public speaking) the approach of using multiple redeemable assessments can also give the student greater exposure and practice of that type of assessment; hopefully greater exposure lessens anxiety and panic over time. A variation on this is to have sessions planned specifically for rehearsal, where students will practice speaking to their course lecturer or the class as a whole, to get used to speaking to an audience in a formal setting. (In this case the rehearsals would typically be non-assessable but they would still give some opportunity for practice.) Obviously this is something that should be planned in advance and described in the course outline, so this is more a solution for future cases rather than a way of dealing with the present case.

I notice that there are a lot of answers here that recommend various ways of alleviating the student's poor performance by allowing substitute assessments or other accommodations in the assessment, or by treating this as a medical intervention akin to a heart attack or loss of consciousness. However, one thing to note in relation to this your assessment is that oral presentation and public speaking are highly useful professional skills; these are skills that a university should teach its students and give them assessed opportunities to practice. Because of the importance of oral presentation in professional work, there is pedagogical value in a student being placed in a pressure situation where they practice speaking and conversing on an academic topic to a small or large group, and they are judged on the quality of their exposition. There is also pedagogical value in ensuring that the result of the assessment effectively performs its diagnostic purpose --- i.e., failing a student who is not yet competent at giving an oral presentation.

It is perfectly natural to feel bad for someone who is panicked by this situation (see the classic Seinfeld joke on public speaking), and to want to alleviate the situation, but by removing or nullifying the thing that causes them panic (but which they will encounter later in life after university) it is likely that the student will not gain exposure and practice for that skill with realistic feedback on their lack of competence. It is a generally accepted psychological principle that exposure lessens anxiety (which is the basis for exposure therapy) so this may be a situation where a failed assessment, augmented by later attempts at the same type of assessment, will be a valuable learning experience for the student.

Answer 7

Something like this happened to me in a music exam.

I knew that my sight-reading was deficient. As the exam progressed and the sight-reading got near I had the weirdest symptom. My eyes began to shake! When the score was put in front of me I simply said to the examiners "Are my eyes shaking? I can't read anything". They looked puzzled and passed over that part of the test. Luckily my score was high enough in other sections and I passed.

Had they insisted, I would have probably run out of the room or my symptoms would have got worse.

The point was that, in my case, my physiology came to my rescue to cover for my lack of mental ability.

Conclusion

Real (not faked) physical symptoms can occur if a student isn't sufficiently prepared or believes they are not. In my case, as soon as the pressure was removed, I was embarrassed but physically back to normal.

What to do?

Skip over the difficult patch. I suggest learning some simple grounding exercises and suggesting the student go through them. When they are calmer, ask them for some feedback on what the problem is. Point out that nobody is expected to be perfect at everything.

If you get to the stage where they need the skipped part in order to pass, then be upfront and tell them. Ask if they now feel capable of at least trying and that they will likely get some credit even if not as much as they hoped for.

Answer 8

You don't mention the exact context of the exam, but I recommend doing everything you can to avoid calling it a failure, or officially recording it as such in any official capacity. Just treat it as an unavoidable testing irregularity, similar to how you would have likely handled a fire in the building.

I recommend working with the student, the department, and any relevant powers that be to create a testing situation that would satisfy the requirements and not trigger a panic attack. Maybe a situation where the examination committee reads the documents involved, generates a list of questions, gives the student enough time to formulate written answers, and then the committee can have an oral component for follow-ups to the answers, if an oral component can't be avoided.

Another possibility would be holding the exam over zoom, with the student in familiar environments.

Maybe even just having the committee hold "practice" sessions with the student, to get them used to the idea of an oral exam, would be enough to alleviate the situation.

All of the options are more work, but we do that for our students.

Answer 9

If you have no warning that the student is prone to this, then mark them as if they did not attend (or failed)

It may sound harsh, but this is a standard principle in all academic settings I'm aware of. If a person has a recognised condition or disability, then provision is made for this ahead of time. This provision may be anything reasonable such as environment, assessors, extra time, breaks, or anything like that. The student contacts the school/department, and reasonable provision is negotiated so that their condition does not disadvantage them.

If a person has not contacted the school/department and negotiated provision for some condition or disability, any assessor must not give them any extra benefits, regardless of what happens. The school cannot risk an overly-lenient assessor giving out bonuses to students just because they feel sorry for the student, regardless of how justified it may seem. Also remember that you'll likely have a couple of dozen other students to assess, all waiting for their turn, and you can't disadvantage them.

All schools do have provision for dealing with unforeseen emergencies though, for instance if a student has a heart attack mid-exam. Perhaps the student has never had a panic attack before, so this was genuinely unexpected. In that case the student would follow the appropriate procedures for this, and the school can figure out what is best to handle the situation. This may be a second exam, assessment based on existing work, assessment based on teacher feedback over the year, or something similar.

If you have been made aware of this, then follow the rules

If the student has told the school/department that this is a possibility, then you should have a well-defined rule book to follow for them. That's the point of the student making people aware ahead of time - precisely so that someone such as yourself isn't left winging it, with a severely distressed person on their hands, and quite likely getting severely distressed yourself.

One of the most common provisions, by the way, is that they should have a carer present (or nearby) who can be called in if/when this occurs. So the typical response if this does happen will be to get the person who knows how to deal with it, and you shouldn't have to.

Answer 10

First and foremost you need to know the rules of your institution. If the flexibility was there - I would say pause the exam and see if the student is able to return to assessment in a reasonable period of time (say no more than 30 minutes). If they can continue - I would continue in the same way (without modifying the assessment, including without avoiding the questions that preceded the panic attack)

If the option existed to return to the exam another time without academic penalty (and option A wasn't suitable) - then I would take this. I would encourage the student to seek medical attention and submit necessary paperwork for any accommodation required, which would be managed by the relevant office at the institution, who can ensure that accommodations are reasonable and fair.

If I have to complete the assessment, and make a determination - I would use the appropriate code for an incomplete assessment and note the medical episode. I would iterate my willingness to be rescheduled for the assessment.

At the end of the day - if the student is unable to complete the assessment then they cannot pass the assessment. Hopefully, the institution does not have a one-shot assessment process. I would not modify the form of the assessment without it going through a formal, documented, process for accommodations.

Answer 11

I was a teacher for 8 years, so I'm going to offer my two cents which may prove to be an unpopular opinion, but that's nothing new. I always managed better than average success on my exams and had plenty of students go on to be very successful using my methods, to take from that what you will.

My experience with "test anxiety" is that 99.99% of people who claim to have it, are anxious because they aren't skilled and knowledgable enough to perform well on the test, and they know it inside.

The first question to be honest with yourself with is: "Is this oral exam environment even remotely reflective of the environment the student will be expected to perform in for the future, if they were to pass?". If the answer is yes, you need to fail them and they need to sort out this issue. You can't pass a student who A) didn't demonstrate the required knowledge and skills, and B) get's so overwhelmed by a situation where they are required to demonstrate their knowledge that they have a meltdown. You aren't doing a student any favours by passing them along before they are capable of meeting the outcomes of the course, it will catch up to them eventually, better now than later.

Secondly, accommodations are well and good, but you can NOT accommodate to the point that the fundamental outcomes are no longer being properly assessed. I assume that you're using an oral exam because that's reflective of the required skills in your course, and you've stated that you've already done your best to design the scenario to reduce anxiety, so that's the YOU part of the scenario taken care of. The THEM part of the scenario is seeking the help to deal with their anxiety/panic in whatever ways might be necessary. That's not something you can do for the student.

At the end of the day, you may have to accept the reality that some people simply don't have the knowledge and skills to be successful in a particular field. You can't alter your standards to make them appear successful. You get to set the bar, and provide students with the resources to clear it, but you can't lower it when they fail.

Answer 12

Fail them unless they have a disability plan.

If they have a disability plan with the university's disability services team for their panic attacks, then follow whatever accommodations they are given as a part of that.

Otherwise, fail them. The point of exams is to assess skills, and for oral exams, one of those skills is public speaking. They've clearly demonstrated that they're lacking those skills, so they deserve to fail. Just go down the marking rubric and mark them appropriately for their performance (or lack thereof).

If you're feeling compassionate, maybe make them aware of your university's disability services in private afterwards.