Background <p>Research on test anxiety has decreased in recent years, but the phenomenon of test anxiety has always been a major hazard that continuously plagues students’ academic performance. In recent years, with educational reforms, there have been more variables in examinations, and examinations have also become increasingly important in individual careers. Therefore, this study will continue to research test anxiety in the new era and continue to deepen the understanding of this issue. Moreover, existing studies mostly focus on the impact of general self-efficacy on anxiety, while there are fewer studies on the impact of academic self-efficacy on test anxiety, and currently, there are fewer studies that quantitatively research the relationship between individual personality and brief fear of negative evaluation. Therefore, this study aims to explore the indirect associations of academic self-efficacy and brief fear of negative evaluation between neurotic personality and test anxiety in medical sciences students.</p> Methods <p>By using the convenient sampling method, 420 medical sciences students studying in a medical college in Jinzhou City from October 2024 to March 2025 were selected as the research subjects. A questionnaire survey was conducted using the general information questionnaire, Eysenck Personality Questionnaire Short Scale, Academic Self-Efficacy Questionnaire, Brief Fear of Negative Evaluation Scale, and Test Anxiety Scale. The relationships between related variables were inspected through Spearman correlation analysis; The indirect association degree test was conducted using Model 6 of the SPSS macro program Process. Meanwhile, to verify the significance of the degree of indirect association, the Bootstrap method was used for repeated sampling 5,000 times to calculate the 95% confidence interval.</p> Results <p>The relevant analysis results show that neurotic personality is negatively correlated with academic self-efficacy (<i>r</i> = -0.313), positively correlated with fear of short-term negative evaluation (<i>r</i> = 0.382), and positively correlated with test anxiety (<i>r</i> = 0.348), with all P values less than 0.05. Academic self-efficacy and transient fear of negative evaluation play an indirect association role between neurotic personality and test anxiety of medical students, with an indirect association degree of 0.412, accounting for 66.58% of the total association degree.</p> Conclusions <p>Neurotic personality is not only directly associated with the test anxiety level of medical sciences students, but also indirectly related to the test anxiety level of medical sciences students through academic self-efficacy and the brief fear of negative evaluation.</p>