Analysis of stress, coping strategies, and academic success in physical and occupational therapy students: preliminary results
Danielle Fuselier, SPT, Alyssa Petterson, SPT, and Samson Ptacek, SPT
Danielle Fuselier, SPT, Alyssa Petterson, SPT, and Samson Ptacek, SPT
USD PT Research 
Do you believe your results are skewed by gender due to a majority of participant responses coming from females?
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Macey,
I think this is a great discussion point! I think our results only show a very homogenous population primarily being female, 20-24 year old, PT students at our university. The results are very reflective of a small group of people. It would be interesting to see what the results would be if more males participated, more OT students, older students, etc. I would also love to see this survey be given to other disciplines besides PT/OT within our own SHS and to other schools/programs outside the Midwest.
I have been able to meet many other students in SLP, OT, and PT from various schools across the country at my inpatient rehab clinical experience and discussing their coursework/workloads/etc. with them makes me wonder how different our results would be. I definitely think that would be the next step for this survey project!!
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What are some ideas you guys have on being able to increase participation and compliance with the survey if you did it over again?
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Thanks for the question Lance! As with any survey it is difficult to get participants in the first place, and the surveys we used could be considered quite lengthy. Additionally, our survey was administered to a rather small population. We intend(ed) for our participants to take it multiple times throughout their academics in PT school, requiring time and commitment from each participant. We discussed briefly before beginning our research the use of small gift cards awarded randomly for participation in the study, but we were informed that we would not be able to do so due to the IRB protocol. It may be beneficial to have a small block of time set aside at each semester that participants would be able to fill out the survey during class time to allow for greater participation, essentially building it into orientation and then specific dates in the Fall and Spring semesters. I believe the greatest barrier to the survey is that students already feel a great deal of stress with their classes, then to add additional task to complete a survey about stress could potentially lead to increased stress. Any ideas regarding how to maintain compliant participation would be greatly appreciated!
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It would be quite interesting to see future research on this topic and throughout many schools as the structures of therapy programs can vary greatly. Do you guys have any thoughts on how the structure and course load of the USD therapy programs may be leading to increased amounts of stress (other than therapy school is hard by itself), such as concurrent classes, inadequate break periods, student selection, etc. that other programs may be doing better that may yield similar success rates as denoted by GPA? It would also be interesting to see how these results carry over from student to practitioner.
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Thanks for the question James! It is quite interesting to ponder how various variable effect the students and how different programs may allow for less stress, where other may have increased stress. Without having a formal knowledge of various PT programs (as I can only speak for our program) what works for some students does not work for others. As you mentioned some students thrive in the academic coursework enjoying concurrent classes and needing few breaks, where others need more time to process information, may have different learning styles, or a difficult home life. Essentially, throughout the research we found that students that were able to find positive stress relieving outlets (exercise, making time for family/friends, productive hobbies) tended to be more successful compared to those who embarked upon negative stress relieving outlets (drinking, denial, etc). As the profession is at a doctorate level, one can expect a certain amount of stress, regardless of the program and structure, but it is ultimately up to the student to find effective coping methods to succeed within the specific environment (school program).
I agree it would be interesting to further research other program structure and student stress. Additionally, how this caries into the student as a clinician.
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Do you believe the course load at various universities affects the stress levels? If so do you think that different universities with a lighter course load in the beginning, allowing students to get more accustomed to graduate school and therefore report higher GPAs and less stress?
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Hi Holly, thanks for the question! I think there are a multitude of factors that can effect a students stress level, but lighter course loads may aid in students abilities to transition from undergraduate programs to graduate level courses. It would be interesting to incorporate other universities into the study with different structures to see how this may effect student stress. I think we can all agree that graduate level programs cause some amount of stress, but it is ultimately up to the student to seek effective coping methods to handle stress appropriately leading to higher GPAs. Unfortunately we do not have the data to make assumptions, but I think it would be interesting to add various programs with different structures into the study!
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Holly, I think this is an interesting question! I know of some programs that take just anatomy and physiology initially with no other coursework as this is the basis of many other courses, but I do not know if I would consider this a lighter caseload initially as it is still quite time intensive. Is there a particular set-up you are considering when discussing lighter caseloads?
I agree with Dani’s response that there are more factors than just course load, but it would be awesome to be able to gather data about student stress and the framework of the curriculum in order to see if this is a factor. Thanks for the question!
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In your introduction you included professional stress as one of your three types of stresses, is there any information or other studies out there that have looked at one population of students and followed them through to a professional career to see if their stress levels, coping strategies, and self esteem have changed or remained the same? Do you guys feel that it would be the same students who did well in a classroom environment also do well with stress outside in a professional environment, vice-versa, or a totally new mix of who does well and who has increased stress? Thank you!
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Hi Ike!
This is an excellent question! During our research, we found many articles looked at stress in medical and nursing students. One particular article we utilized looked at sources of stress in undergraduate medical school students, in recent medical school grads, and in practicing doctors entitled “Sources of distress during medical training and clinical practice: Suggestions for reducing their impact” by Benbassat et al. The authors identified exogenous and endogenous stressors in these groups and found the stressors did change throughout their career! However, they did not address stress levels, self-reported coping, or self-esteem. The stressors commonly reported in students were adjustment to school, student abuse, unethical behavior, and exposure to death and suffering. Recent grads reported the lowest life satisfaction and highest reported mental problems. This group reported feelings of guilt and inadequacy, discrepancies between what they learned in school and what they saw in practice, and other training gaps. The group of practicing doctors reported different levels of job satisfaction with different specialties, constraints on their decision-making, medical error, and others. All groups reported fears of personal inadequacy.
I can only guess, but I would think students who learned to cope well with stress and achieve academic success would do well in the professional environment. However, some students who have coped well with academic stress may not cope well with professional stressors, new settings, or patient interactions. I think there are many factors that would indicate how a person transitions from academic to professional settings.
Thanks for the great question, Ike! Let us know if you have any other questions or if I didn’t quite answer your question 🙂
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Wonderful and informative poster you guys! I really look forward to future research on this. Do you feel like the amount of outcome measures may have limited participation? Is there an outcome measure you feel could be taken out to optimize participation?
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Hi Emily!
I do believe the length of our survey was a bit of a barrier in participation. I also think the design of the study asking people to take the survey up to 7 times is another barrier on top of the length of the outcome measures. We did want to address all of the aspects these outcome measures utilize in our study, but perhaps future research limiting the study to only looking at stress OR coping and self-efficacy in relation to academic success would allow for shorter surveys. Ideally, this would increase initial and long-term participation, but you never know if this was the only barrier to participation. I think with the purpose of our study it would be difficult to remove an outcome measure and still analyze our intended variables. This is a great question though and is something to look at moving forward with the study!
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I found it really interesting that the participants with middle GPA scores had increased stress and decreased coping strategies, but increase self esteem. I did not assume that would be the outcome! Do you have any ideas why the self esteem was higher for the middle GPA participants vs. the low and high GPA participants?
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Hi Nicole thanks for the question. We can only speculate as to why participants in the highest and lowest GPA categories had the lowest perceived stress and student in the highest and lowest GPA categories had the lowest self esteem leaving the middle GPA to have higher perceived stress and self esteem. It could be due to those with the middle GPA struggle slightly with assignments/workload (comparative to others) but still believe they can accomplish the workload accordingly. Whereas those with the highest GPAs may constantly be putting pressure upon themselves to be the “best” and at times feel inadequate unless they are succeeding in school leading to lower self-esteem. It is really hard to say what ultimately influences the individual as each participant can perceive the same experience differently based on a multitude of factors (school, personal life, previous experiences, etc.)
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Guys, very interesting research.
I agree with Nicole, I am highly surprised that those with middle GPA scores had increased stress and decreased coping strategies, yet reported higher self-esteems. As a non-traditional student myself, I wonder how students who took time off from undergraduate school before PT school would answer these questionnaires compared to those who transitioned from undergrad to graduate school immediately. My question is two-fold, and mostly speculation, but I hope fun all the same:
1) How do you think those who took time off before admission into graduate school would answer on self-esteem, coping mechanisms, and stress levels? Do you think that their possible time in the work force prior to PT/OT school would give them greater coping mechanisms or do you think that changing from a 9-5 job to all day class plus nightly studies would increase their stress?
2) Do you think that including those who are non-traditional graduate students to those who transitioned immediately would skew your results?
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Jordan! These are great questions. Like you, we can only speculate as well.
I think that those who took time off prior to entering PT/OT school would demonstrate greater coping mechanisms as they have had to learn to manage their time with full-time work and other obligations. I would also speculate that their stress levels and self-esteem may be slightly lower as they are not used to having homework (on top of full day of coursework). The stress of getting used to studying habits again and possibly being behind initially as they re-adjust to coursework could cause slightly lower self-esteem. However, those who were working in related fields such as PTAs may find they are ahead of the curve and have a higher self-esteem because of their hands-on skills.
We included all students in the PT/OT coursework. Although, there are primarily traditional students there are some non-traditional students in the program or even traditional students who now have families and greater responsibilities than they may have in undergraduate school. Although I think the results would be different, I do not think they would be skewed necessarily. We asked for participants age during this study which does allow us to see the difference between non-traditional and traditional students in a sense without asking the question directly. It will be interesting to see what the results show with continued surveying!
Thanks for the thought-provoking questions!
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Noticing one of your citations is from a facility in Islamabad, how do you think this study would differ in students from various states and countries?
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Hi Anthony. Thank you for your question, it is one that we have wondered ourselves and hope to answer with future research. It is difficult to say what differences we would see, but during my time in clinical rotations I have met PT and OT students from other states and programs, and one thing is clear when discussing our schooling: the work load is extensive and the demands on students are high. I believe that stressors due to the schooling demands would be very similar, but I think that societal and cultural ideals may pose a different host of stressors to individuals in other countries. I also believe that coping strategies would potentially vary depending on region and location. As I am sure you can attest, there are limitations to the ways in which we can cope with and manage stress in a small midwestern town.
Thanks again for your question! With future research, I hope we can provide more concrete answers by studying a more diversified subject sample.
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Great research! I just have one question, how well do you think this research would translate to different graduate studies, such as MD or PA? I believe that our workload can be fairly similar, so do you think it would be much different, or are there other factors that you think could play a role which would make their stressors different from PT and OT? Thanks!
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Hi Zach. Thanks for the question. I believe that our research would translate well to graduate studies such as MD and PA, especially early on in these programs when students are primarily learning in the classroom setting. As you stated, the workload can be comparable, but I think discrepancies may arise when learning in the clinical setting. For example, some of the studies in our literature review discussed delivering terminal diagnoses/prognoses to patients and their families and communicating with dying patients as potential causes for distress in medical students. Additionally, the shear length of schooling for medical students when considering residencies could be a factor in the different stressors they experience.
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Very interesting research! I have two questions for you. Were there any additional outcome measures that you considered using for this study? Also how do you think the results would have been if you looked at the stress and coping strategies separately in the classroom setting vs. the clinical education experience? Thanks.
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Thanks for the questions, Gina!
The scales that we used for our study were those that had been used in the previous body of research, and we found them to be proven valid and reliable. Because of our findings we did not have other measures that were considered for this study. Our results indicated a significant difference in PSS, RSES, and CSES survey scores based on self-reported GPA, but there was no significant difference found in any of our survey scores based on program year (though only 6 of our 24 respondents were in their 3rd year studying in the clinical setting, leaving students receiving clinical education underrepresented in the study.) However, I do think that the top responses to open ended questions regarding stressors would be different between those studying in the classroom and those in the clinical setting as the demands of the two settings are quite different. I believe that the top coping strategies utilized by students in both groups would remain quite similar though.
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This research was very exciting being that it applied to the PT cohort at USD. It is not surprising that one of the top coping strategies was exercise for this subject group. Being that you have your results now, do you still believe that self-reported GPA has the potential to predict stress levels and self-esteem in this subject demographic?
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Will, we were not surprised by exercise being one of the most frequently utilized coping strategies either!
Based on our results, I do believe that self-reported GPA has potential to be predictive of perceived stress levels, self-esteem, and coping self-efficacy. I do recognize the limitations of the study thus far, however. Being that the majority of our participants were 20-24-year-old female PT students, I am excited to have this research continue and hopefully gain data from a larger, more diverse group.
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Good work! I’m wondering if maybe the results would change if you used different outcome measures for stress? Thanks.
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Hey Cooper!
Through our review of the literature, we found that these scales were proven to be valid and reliable. I think it is possible that if we had found other reliable and valid instruments within the body of literature that the breadth of our results may have been impacted. Did you have any specific outcome measures for stress in mind?
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What would be your potential explanation of why those with higher GPA had lower perceived stress but additionally had lower confidence?
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Hi Haley, thanks for the question. I agree with what Dani said previously, that individuals within the highest GPA range may place pressure upon themselves to maintain the highest level of achievement, which may create feelings of inadequacy if they are not succeeding to their standards and lead to lower self-esteem. Another potential explanation is that those with the highest GPAs may place much of their self-worth into their level of achievement, leading to the same pitfalls of reduced self-esteem if they are not quite matching their personal standards. There are many potential factors that could play into these results and it will be interesting to see if these findings stay consistent with further study.
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