Practical Examination Stress in Undergraduate Physiotherapy Students (PESiPs)

This is a prospective, observational study with cross-sectional and longitudinal components to report the levels of student stress during practical examinations. The study will be conducted over seven or nine consecutive university study periods. The study may be terminated after seven study periods if sufficient participants have been recruited to achieve sample size estimate. This will eliminate any unnecessary testing and study commitment for participants. Each study period runs for 13 weeks with two study periods per academic year. Study period 1 commences in February, and study period 2 commences in July. Cohorts will be followed from recruitment to termination of study period 1 of their 3rd year in the physiotherapy undergraduate degree at JCU. Thus data will be collected at four time points each sin five time periods. The outcome measures employed include perceived stress scores using the PSS10 questionnaire, salivary cortisol measured using saliva sampling (CSST) and heart rate variability extrapolated from heart rate using a PolarH10© heart rate monitor (HRM). All measures will be administered and extracted using standardised valid and reliable methods. The CSST analysis will be conducted in PC2 laboratories of the, Australian Institute of Tropical Health and Medicine, JCU. All outcome measures will be conducted at each data collection time point (T1-4) in each university study period. -The CSST, takes approximately 5-7 minutes to administer. Saliva is collected using a technique where the student places a swab attached to a plastic tube into their mouth. When sufficient saliva has been absorbed, the swab is placed into a collection tube and sealed for processing. Salivary tests have been advocated for studies which investigate stress, as unlike urine or blood sampling they appear to cause less anxiety during sample collection (1). -The PSS10, is a 10-item instrument to measure perceived stress over the previous month (1,2).The PSS10 takes approximately 5 minutes to administer. - Heart Rate variability, will be extrapolated using customised software (Kubios©) using heart rate monitoring captured on a chest mounted HRM. The HRM is attached and maintained on the participant’s chest below nipple line via an elasticated strap secured by velcro. Change in HR, and HRV data will be transferred to a computer for further analysis. Recruitment will occur at the beginning of each study period (1 and 2) for the duration of the research. Recruitment will be promoted through advertising recruitment posters, placed in the university's health sciences precinct which has a high presence and visible of physiotherapy students. .Participants will be invited to continue their participation in the study on an annual basis (January of each year) and renewed consent will be gained and signed each year. The four data collection points for each university study period are as follows: T1-Week 3 Data Collection Baseline (duration 20-25 minutes).•T2-Week 8 Data Collection Mid Study Period (duration 20-25 minutes).•T3-Week 13 Data Collection Pre-Practical Examination (duration 20-25 minutes).•T4-Week 13 Data Collection Post-Practical Examination (duration approximately 60minutes). Data collection process will be as follows: At T1, and T2 participants will complete the PSS10 while sitting quietly in the data collection room, following which one CSST will be obtained, and the HRM will be applied and remain in situ to record resting HR for 10 minutes. At T3 a CSST will be obtained from the participant, following this the HRM will be applied and HR will be recorded continuously. The participant will then sit quietly to complete the PSS10. Saliva collection, HRM application and completion of the PSS10 is expected to take no longer than 25 minutes. As the HRM self-stores HR recordings, no members of the research team will enter the practical examination room at any time. Therefore, the HRM via the chest mounted strap will not be removed between T3 and T4, to allow continuous and uninterrupted HR recording before, during,and 10 mins post-examination. T4 will begin at completion of the practical examination when the student exits the examination room. The HRM will already be in situ, the student will be guided to the quiet data collection room, so resting HR can be recorded for 10 minutes post-examination. At T4 the participant will not complete the PSS10, but will be invited to remain in the data collection room for a maximum of 60 minutes, during which they will complete CSSTs at 30-and 60-minutes post-examination. Following T4 completion, the study is complete, and the participant is free to exit the data collection room. (1).Hellhammer, D. H., Wüst, S., Kudielka, B. M.,Salivary cortisol as a biomarker in stress research.Psychoneuroendocrinology,2009.34, 163—171 (2). Cohen, S., & Williamson, G.M.,Perceived stress in a probability sample of the united states.In S. Spacapan, & Oskamp, S. (Ed.), The social psychology of health: Claremont symposium on applied social psychology,1988. Newbury Park, CA: Sage. (3). Cohen, S., Kamarck, T., & Mermelstein, R.,A global measure of perceived stress.Journal of Health & Social Behaviour,1983. 24(4), 385-396. doi:10.2307/2136404