Abstract: The aim of the present work was to determine the correlation between the State-Trait Anxiety Inventory (STAI) score and pupillary diameter and whether this correlation exists to develop a predictive model of anxiety with the pupillary diameter of students exposed to high-fidelity clinical simulation. This was a randomized, blinded, simulation-based clinical trial. The study was conducted at the Advanced Clinical Simulation Center, Faculty of Medicine, Valladolid University (Spain), from February 1 to April 15, 2023, and involved volunteer sixth-year undergraduate medical students. The STAI score, vital signs (oxygen saturation, perfusion index, blood pressure, heart rate, and temperature), and pupillary response were assessed. The primary outcomes were the delta (pre/postsimulation) of the state STAI and the delta of the pupillary diameter. Sixty-one sixth-year students fulfilled the inclusion criteria. There was no difference regarding the clinical scenario. There was a statistically significant correlation between the state STAI score and pupillary diameter. The predictive model had an AUC of 0.876, with the delta diameter of the pupillary being the only statistically significant variable for anxiety prediction. Our results showed that both the pupillary response and the STAI score allowed the identification of students with disabling anxiety. These results could pave the way for appropriate protocol development that allows for personalized tutoring of students with elevated anxiety levels.
