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The aim of this pilot study was to measure and compare dental hygiene students' level of text anxiety and performance when being tested on an objective structured clinical examination (OSCE) using camera supervision versus direct examiner observation. This randomized, controlled trial, conducted in October 2016, assessed students' anxiety levels and performance using the Zung Self-Rating Anxiety Scale and performance on an OSCE. All 32 first-year students in one U.S. dental hygiene program were invited to participate, and all 32 participated for a 100% response rate. Participants were randomly assigned to the direct observation (N=16) and camera-supervised (N=16) groups. The comparison of pre-OSCE anxiety levels and performance scores evaluated with direct observation (36.4 and 20.4) versus camera-supervised (37.5 and 20.9) found no statistically significant difference between the two groups (p=0.496, p=0.403). The difference in post-OSCE anxiety levels between the direct observation and camera-supervised groups (33.8 and 37.8) approached significance (p=0.051). This study found that student anxiety levels were similar between the two groups except for the post-OSCE direct observation anxiety levels, which were lower. No significant difference was found between the two groups' performance scores. Due to similar performance scores and anxiety levels for the direct examiner and camera-supervised methods, the camera-supervised OSCE warrants further exploration as an alternative approach to direct observation for evaluation of students' performance. [ABSTRACT FROM AUTHOR]