Objectives: The study investigates the impact of anxiety on medical students performance in Objective Structured Clinical Examinations (OSCEs), focusing on the relationship between self-perceived and actual performance. Methods: Conducted among 5th-year medical students at Taif University, the study used an online questionnaire with the PHQ-4 scale to measure anxiety and depression. The aim was to correlate these levels with students self-assessment and actual performance in OSCEs. Results: The study analyzed responses from 62 students. The average self-reported anxiety level was 8.95 ± 1.348 on a 10-point scale, with 64.5% of students reporting severe anxiety and depression. No significant gender differences in anxiety and depression severity were noted (p=0.308). Higher levels of anxiety and depression were reported by students who perceived their grades as lower, although this was not statistically significant (p=0.431). There was no statistically significant correlation between anxiety/depression severity and actual grades (p=0.280). Conclusions: The study underscores the prevalent issue of anxiety among medical students and its potential influence on their self-perceived performance in critical evaluations like OSCEs. It suggests the necessity for targeted interventions to manage student anxiety, which could enhance self-assessment accuracy and overall performance.