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Identification of stressors and Perceptional difference of stress in first and final year Doctor of Physical Therapy students; a comparative study.

Byline: Ayesha Afridi and Muhammad Faisal Fahim

Keywords: stress, academic stressor, doctor of physical therapy and students.

Introduction

Doctor of physical therapy is a new immerging health related field with more and more complicated practices and technologies. To excel in the field of physical therapy there is a huge amount of stress and pressure on the students to cope with upcoming new techniques of efficiently treating patients. 1 Previous researches have determined that stress and anxiety is increasing in university students which adversely affects their academic performance. 2 Medical and allied health students are considered to be the most stressed due to their long term and expenses. Many studies reported different causes of stress in first and final year medical and allied health students. First year stress is due to totally changed life style and environment of medical school while final year stress in students is considered due to shift of routine from preclinical to clinical section. 3

within a limited time duration, memorizing and cramming of many small details in a single topic, strict examination procedures with many assignments, presentations etc. 4 Social life stress is caused by dealing with patients in pain, morbidity and mortality and personal problems. Financial crisis related stress can effect the medical students private and social life at the university. 3 Even in developed countries offering many facilities for good education on fifty percent of medical students experience stress and physical exhaustion. This stress and physical exhaustion has long term drastic effects on health professionals as well as on patient's satisfaction level, treated by those health care professionals. 5 A limited number of studies on stress in medical students are reported in developing countries, while Malaysian studies show that thirty percent of medical students are facing different types of stress with various causative factors.

A few Asian studies have found almost the same results. 6 Researches to identify the stressors and prevalence of stress in medical students have shown that prevalence ranges from 21.6% to 56%. 7 It is normal to take stress in life up to some extent as it enhances the performance in academic work load, but if threshold for stress exceeds the limits, it considerably effects the academics, social and personal life of medical students especially in first year. These events can effect first year medical students from their first day at university followed to final year. 8 One of the most important stimulus, triggering stress is considered to be the year of study in five years course during this time stress is incessant and growing with time. 9 This study was not conducted in a university, so ethical approval letter was not taken in consideration and questionnaire was sent to first and final year students using email and social media.

The research was conducted according to the principles of the Declaration of Helsinki. Comparative cross sectional survey was conducted to identify the main stressors and perceptional differences among first and final year students. An online questionnaire was sent to the students who were asked to send it back to researcher through mail and social media account. It took almost 6 months to get the responses (March to September 2015). A convenient sampling method was used. There were 109 responses were from first year students while 68 were from final year. From total 177 students, 60 were males and 117 were females, age ranging from 17 to 24 years. There was no specific sample size calculation method applied, all the students of 1st and final year were included. Only completely filled questionnaire were included. All the participants were asked to provide a written consent.

This questionnaire included six categories of different stressors bothering the medical and rehabilitation students. These six domains were covered in 40 questions which were scored on 0-4 Likert scale.

Annexure (Questionnaire)

Consent form: The study has no potential harm to participants. All data

###collected from you will be coded in order to protect your identity,

###and should not be disclosed to anyone.

Name###Age:###Gender: M/F

Occupation:###Address:

###no stress causing###Causing###causing###causing

###at all###mild###moderate high###severe

###stress###stress###stress###stress

stressTests/Examinations

Talking to patients about

personal problems

Conflicts with other students

Quota system in examinations

Verbal or physical abuse by

other students(s)

Parental wish for you to study medicine

Need to do well (self-expectation)

Not enough study material

Conflict with personnel(s)

Heavy workload

Participation in class discussion

Falling behind in reading schedule

Participation in class presentation

Lack of guidance from teacher(s)

Feeling of incompetence

Uncertainty of what is expected of me

Not enough medical skill practice

Lack of time for family and friends

Learning context- full of competition

Teacher- lack of teaching skills

Unable to answer questions

from patients

Inappropriate assignments

Having difficulty understanding

the content

Facing illness or death of the patients

Getting poor marks

Poor motivation to learn

Lack of time to review what have

been learnt

Verbal or physical abuse by teachers

Frequent interruption of my work

by others

Unable to answer the questions

from the teacher(s)

Conflict with teacher(s)

Unwillingness to study medicine

Large amount of content to be learnt

Need to be imposed by others

Not enough feedback from teacher(s)

Unjustified grading process

Lack of recognition for work done

Working with computers

Verbal or physical abuse by personnel(s)

Family responsibilities

1: Academic related stressors (ARS)

Examinations, assignments, quizzes, expended course work, short time span for preparation of exams, difficult course content, and high competition in academics, high expectations of teachers, parents and self are related to ARS.

2: Inter/Intrapersonal Related Stressor (IRS)

Students relationship with colleagues, teachers, administration, patients and with students own self, least motivation to study, low self-confidence, any physical verbal or emotional abuse by someone are related to IRS.

3: Teaching and Learning Related Stressor (TLRS)

Teacher's capabilities to clear the concepts of students well, least appreciation and encouragement from teachers are related to TLRS.

4: Social Related Stressor (SRS)

Spending time on extra-curricular activities, with friends and family and listening to the problems of patients are related to SRS. 10

5: Drive and Desire Related Stressor (DRS)

Behaviours, emotions, thinking power disturbances due to self and others bad attitudes, mentally not satisfied and ready to study in college, choosing wrong career, demotivation after knowing about field scope are related to DRS. 10

6: Group Activities Related Stressor (GARS)

Presentations, problem based learning and group discussions are all included in GARS. 10 Data was entered and analyzed using statistical packages for social sciences (SPSS) version 23. Distribution and frequency was examined on demographics and chi square test was applied on 2 groups for perception comparison.

Table-1: Showing ARS, IRS and TLRS causing stress in first and final year students.

###Academic Related Stressor###Chi-Square###Total

###moderate###Value###students###p-value

###mild stress###stress###high stress###severe stress

Year of###1st

Study###Year###13(11.9%)###61(56.0%)###35(32.1%)###0(0.0%)###37.590###109###0.000

###final

###year###0(0.0%)###17(25.0%)###45(66.2%)###6(8.8%)###68

Total###13(7.3%)###78(44.1%)###80(45.2%)###6(3.4%)###177

###Interpersonal and Intrapersonal Related Stressor

###moderate

###mild stress###stress###high stress###severe stress

Year of###1st

Study###Year###7(6.4%)###42(38.5%)###48(44.0%)###12(11.0%)###9.465###109###0.024

###final

###year###4(5.9%)###24(35.3%)###40(58.8%)###0(0.0%)###68

Total###11(6.2%)###66(37.3%)###88(49.7%)###12(6.8%)###177

###Teaching and Learning Related Stressor

###moderate

###mild stress###stress###high stress###severe stress

Year of###1st

Study###Year###20(18.3%)###58(53.2%)###31(28.4%)###0(0.0%)###21.111###109###0.000

###final

###year###7(10.3%)###22(32.4%)###32(47.1%)###7(10.3%)###68

Total###27(15.3%)###80(45.2%)###63(35.6%)###7(4.0%)###177

Table-2: Showing SRS, DRS and GARS causing stress in first and final year students.

###Social Related Stressor###Chi-Square###Total

###moderate###Value###students###p-value

###mild stress###stress###high stress###severe stress

Year of###1st

Study###Year###32(29.4%)###63(57.8%)###14(12.8%)###0(0.0%)###20.244###109###0.000

###final

###year###12(17.6%)###28(41.2%)###25(36.8%)###3(4.4%)###68

Total###44(24.9%)###91(51.4%)###39(22.0%)###3(1.7%)###177

###Drive and Desire Related Stressor

###moderate

###mild stress###stress###high stress###severe stress

Year of###1st

Study###Year###31(28.4%)###53(48.6%)###20(18.3%)###5(4.6%)###4.065###109###0.255

###final

###year###19(27.9%)###39(57.4%)###10(14.7%)###0(0.0%)###68

Total###50(28.2%)###92(52.0%)###30(16.9%)###5(2.8%)###177

###Group Activities Related Stressor

###moderate

###mild stress###stress###high stress###severe stress

Year of###1st

Study###Year###14(12.8%)###37(33.9%)###52(47.7%)###6(5.5%)###9.595###109###0.022

###final

###year###11(16.2%)###35(51.5%)###22(32.4%)###0(0.0%)###68

Total###25(14.1%)###72(40.7%)###74(41.8%)###6(3.4%)###177

Results

Table 1 shows that first year 61 (56.0%) students reported moderate stress while final year 45 (66.2%) students reported high stress, in response to academic related stressors. This perceptional difference among first and final year students was highly significant (p-value 0.000).Among all students (first and final year) majority of students scored high stress in response to academic related stressors. Inter/Intrapersonal Related Stressor response was high stress in both first and final year students (44.0% and 58.8% respectively) and perceptional difference among first and final year was significant (p-value 0.024). Teaching and learning related stressor was scored with moderate stress in 53.2% first year students while final year students47.1% perceived this stressor differently as high stress. (P-value 0.000).

Table 2 shows that first and final year students scored moderate stress (57.8% and 41.2% respectively) but perceptional difference was significant (p-value 0.000). 48.6% first year and 57.4% final year students were moderately stressed over drive and desire related stressor. There was not significant perceptional difference related to drive and desire related stressor among them (p-value greater than 0.05). Group activity related stressor was causing high stress in first year 47.7% students while moderate stress in 51.5% final year students. Perceptional difference existed with p-value less than 0.05. All stressors were perceived differently in first and final year students except drive and desire related stress which was equally moderately affecting the first and final year students. This stressor was also noted as the main cause of stress among students 52.0%.

Second leading cause of stress was social related stressor 51.4% while academic and teaching and learning related stressors were equally affecting the students of DPT 45.2% and least affecting stressor was group activity related with 41.8%.

Conclusions and Recommendations

Academic burden, choice of studying medical related course, choosing wrong career and worrying about scope, is prominently affecting the DPT students with moderate stress. To suppress these stress causing factors, rehabilitation colleges should properly arrange the seminars and workshops on career counseling throughout the DPT course for students.

Disclaimer: None.

Conflict of Interest: None.

Funding: None

References

1. Association APT. Guide to Physical Therapist Practice. Alexandria, VA: American Physical Therapy Association; 2014.

2. Regehr C, Glancy D, Pitts A. Interventions to reduce stress in university students: A review and meta-analysis. J Affect Disord 2013; 148: 1-11.

3. Omigbodun OO, Odukogbe AT, Omigbodun AO, Yusuf OB, Bella TT, Olayemi O. Stressors and psychological symptoms in students of medicine and allied health professions in Nigeria. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 415-21.

4. Lyndon MP, Strom JM, Alyami HM, Yu TC, Wilson NC, Singh PP, et al. The relationship between academic assessment and psychological distress among medical students: a systematic review. Perspectives Med Educ 2014; 3: 405-18.

5. Youssef FF. Medical student stress, burnout and depression in Trinidad and Tobago. Acad Psychiatry 2016;. 40: 69-75.

6. Shamsuddin K, Fadzil F, Ismail WS, Shah SA, Omar K, Muhammad NA, et al. Correlates of depression, anxiety and stress among Malaysian university students. Asian J Psychiatr 2013; 6: 318-23.

7. Yusoff MSB, Rahim AFA. Stress, stressors and coping strategies: first year medical students in Malaysian public universities. VDM Publishing, 2011.

8. Rahman NI, Ismail S, Ali RM, Alattraqchi AG, Dali WPEW, Umar BU,et al., Stress among first batch of MBBS students of Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Malaysia: when final professional examination is knocking the door. Int Med J 2015; 22: 1-6.

9. Ali HM, Attar DM, Al-Abdulwalid F, Juma FA, Al-Mezail HI, Al-Jalahma JA, et al., Comparison between the first and sixth year medical students in the arabian gulf university of bahrain regarding anxiety and depression. Int Neuropsych Dis J 2014; 2: 85-93.

10. Yusoff MSB, Fuad A. The Medical Student Stressor Questionnaire (MSSQ) Manual. Universiti Sains Malaysia; 2010.
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Publication:Journal of Pakistan Medical Association
Article Type:Report
Date:Apr 30, 2019
Words:2500
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