Levels and Sources of Stress in Physical Therapy Students during Clinical Experiences
Purpose: Research suggests that students in health care professions experience higher levels of stress than other students. Stress has been linked to burnout, depression, anxiety disorders, substance abuse and suicide in healthcare students. Studies of perceived levels and sources of stress in physical therapy (PT) students are limited and primarily focused on undergraduate and master’s level PT education during the didactic phase of the curriculum. The purpose of this study was to explore the levels and sources of stress experienced by Doctor of Physical Therapy (DPT) students during the clinical education portion of their curriculum. Methods/Description: This was a cross-sectional, descriptive, survey-based research study. Eligible participants included 925 first, second, and third year DPT students from eight Midwestern colleges and universities. Surveys included demographic questions, the Perceived Stress Scale (PSS-10) and the Undergraduate Sources of Stress (USOS) scale. The Perceived Stress Scale is comprised of 10 questions with responses rated on a 5-point Likert scale ranging from never (0) to very often (4). This scale measures two underlying factors – perceived helplessness and perceived self-efficacy. The USOS questionnaire includes 18 items that are rated as to the amount of stress they cause from “not at all” (0) to “a great deal” (4). These items comprise three subscales: academic demands, personal issues and financial issues. Surveys were sent electronically to students between January and September 2018. Data were analyzed with descriptive statistics, one-way ANOVA, and correlation analysis. A qualitative analysis of responses to open-ended questions was also completed. Results/Outcomes: 259 surveys (28%) were returned for analysis. Most respondents identified as female (73%), third-year students (60%), and were between the ages of 20 and 24 (49.8%). 45.3% indicated that they did not work; 35.5% reported student debt equal to or greater than $90,000; 74.1% were married or in a relationship; and 53.3% relocated for their current clinical. The average PSS score was 20.36 (SD=3.17). Average USOS subscale scores were: academic 1.52 (SD=.84), financial 1.45 (SD=.79), personal 1.15 (SD=.74). Significant differences in PSS scores were found between program year of study [X=21.05 (third year); X=19.21 (second year)] and between levels of clinical [X=21.58 (terminal); X=19.62 (intermediate); X=19.66 (beginning)]. No significant differences in sources or levels of stress were identified based on clinical setting type. There were significant differences in USOS financial between DPT programs [X=1.04 (University C); X=1.64 (University E); X=1.65 (University F)]. Significant correlations were identified between financial sources of stress and both amount of student debt (r=.26, p=.000) and percentage responsibility for graduate education (r=.24, p=.000). Other sources of stress identified in qualitative responses included preparation for the board examination, living away from home, and job searching. Conclusions/Relevance to the conference theme: Mean PSS scores were higher in this sample of DPT students during clinical education than a similar sample of DPT students during the didactic portion of the curriculum. A previous phase of this study assessed PSS scores among first and second year DPT students during the didactic portion of the curriculum. In that study, the average PSS score was 15.69 (SD=5.85). Two studies conducted among undergraduate physiotherapy students in Israel found a similar difference in average PSS score between the didactic portion of the curriculum (13.5) and the clinical portion of the curriculum (15.9). Mean PSS scores were higher than age-matched norms and those reported for undergraduate physical therapy outside of the United States, but similar to those reported for DPT students in the United States during the didactic portion of the curriculum. Students in terminal clinicals reported significantly higher levels of stress as compared to students in beginning or intermediate clinicals. Likewise, third year students reported higher stress levels than first or second year students. There was no significant difference in PSS based on gender, which differs from findings in previous research that female students report significantly higher perceived stress. Academic sources were the highest source of stress, which is consistent with previous research. High levels of stress can have serious negative impacts on the physical and mental health of individual students. In addition, stress has been associated with burnout which has been linked to decreased levels of empathy, unprofessional conduct, and less altruistic professional values. Identifying perceived stress levels, sources of stress, and mitigating factors has the potential to improve the health of students and positively impact patient care.