Factors Associated with Public Speaking Anxiety among medical students of a tertiary care hospital in Karachi, Pakistan

Abstract Background Public speaking anxiety can adversely affect medical students’ communication, academic performance, and future professional competence. However, limited evidence is available on the factors associated with public speaking anxiety among undergraduate medical students in tertiary care settings. This study aimed to identify factors associated with public speaking anxiety among medical students of a tertiary care hospital in Karachi, Pakistan, and to estimate its prevalence. Methods We conducted an analytical cross-sectional study among medical students aged 18 to 30 years enrolled in years 1 through 5 at a tertiary care hospital in Karachi, Pakistan. A sample of 199 students was calculated using the World Health Organization sample size calculator and recruited through nonprobability convenience sampling. Public speaking anxiety was assessed using the Personal Report of Public Speaking Anxiety scale. Descriptive statistics were used to summarise participants' characteristics and anxiety levels. Public speaking anxiety scores were categorised as low, moderate, and high. Ordinal logistic regression was performed to examine factors associated with higher levels of anxiety, with results reported as adjusted odds ratios and 95% confidence intervals. The proportional odds assumption was tested and met. Results Of the 199 participants, 40.2% had low, 50.3% had moderate, and 9.5% had high anxiety. For descriptive purposes, students with moderate to high scores were classified as having public speaking anxiety, yielding a prevalence of 59.8% (95% confidence interval 52.9 to 66.4). In multivariable ordinal logistic regression, students with the oldest birth order had higher odds of greater public speaking anxiety than those with the youngest birth order (adjusted OR = 2.70, 95% CI = 1.13 to 6.48). Fourth-year students were also more likely than final-year students to report higher anxiety levels (adjusted OR = 6.69, 95% Cl = 1.73-25.85). Conclusions Public speaking anxiety was common in this sample, affecting more than half of the students at moderate to high levels. Higher anxiety was independently associated with the oldest birth order and fourth-year status. These findings suggest the need for targeted educational and mental health support strategies to strengthen students’ communication confidence during undergraduate medical education.