Physical therapy students’ perceived levels and sources of stress during clinical education experiences

Main Article Content

Lisa L. Dutton
https://orcid.org/0000-0003-0459-0792
Christina Anderson
https://orcid.org/0009-0009-3755-115X

Abstract

Purpose: Stress has been linked to poor performance and mental health disorders in health professions students. Very little is known about health professions students’ stress during clinical education. 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: In this cross-sectional, descriptive study, 925 first-, second-, and third-year DPT students from eight Midwestern colleges and universities were invited to complete an electronic survey during a clinical experience. The survey included demographic information, the 10-item Perceived Stress Scale (PSS), and the Undergraduate Sources of Stress (USOS) scale.


Results: The response rate was 28% with a total of 259 returned surveys. The mean PSS score was 14.15 out of a possible 40, with a range from 0 to 30. There were significant differences in levels of stress based on program year and clinical level. No significant differences in level or sources of stress were noted based on gender or clinical setting. Academic sources were the greatest source of stress reported. Amount of student debt and percentage of responsibility for graduate education were significantly correlated with financial sources of stress.


Conclusion: Participants in this study reported mean PSS scores during clinical education experiences similar to those previously reported for physical therapy. Identifying perceived stress levels, sources of stress, and mitigating factors has the potential to improve the health of students and positively impact patient care.

References

1. Chajut E, Algom D. Selective attention improves under stress: implications for theories of social cognition. J Pers Soc Psychol (2003) 85(2): 231–48. doi: 10.1037/0022-3514.85.2.231

2. 5 things you should know about stress. National Institute of Mental Health. Available from: https://www.nimh.nih.gov/health/publications/stress/index.shtml [cited 22 January 2021].

3. Almhdawi KA, Kanaan SF, Khader Y, Al-Hourani Z, Almomani F, Nazzal M. Study-related mental health symptoms and their correlates among allied health professions students. Work (2018) 61(3): 391–401. doi: 10.3233/WOR-182815

4. Rafati F, Bagherian B, Mangolian Shahrbabaki P, Imani Goghary Z. The relationship between clinical dishonesty and perceived clinical stress among nursing students in southeast of Iran. BMC Nurs (2020) 19(39):1–8. doi:10.1186/s12912-020-00434-w

5. Thomas-Davis A, Bullock AP, Hooper H, McCluney MK. The effects of stress on first-year graduate students in health professions. J Natl Soc Allied Health (2020) 17(1): 6–62.

6. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences, and solutions. J Intern Med (2018) 283: 516–29. doi: 10.1111/joim.12752

7. Cohen S, Janicki-Deverts D. Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. J Appl Soc Psychol (2012) 42(6): 1320–34. doi: 10.1111/j.1559-1816.2012.00900.x

8. Bidwal MK, Ip EJ, Shah BM, Serino MJ. Stress, drugs, and alcohol use among health care professional students. J Pharm Pract (2015) 28(6) :535–42. doi: 10.1177/0897190014544824

9. Dutton LL, Anderson CEP. How stressed are they?: Levels and sources of stress in Doctor of Physical Therapy students. J Allied Health (2021) 50(4): 277–83.

10. Richardson MV, Miller H, Papa E, Santurri L. Perfectionism, stress, and the entry-level Doctor of Physical Therapy student: a cross-sectional, observational study. J Phys Ther Educ (2022) 36(1): 9–16. doi: 10.1097/JTE.0000000000000213

11. Bogardus JM, Blackinton M, Litwin B, Nelson TM, Mitchell K. Depression, anxiety, and stress in Doctor of Physical Therapy students: analysis of incidence and lived experiences. J Phys Ther Educ (2021) 35(3): 251–7. doi: 10.1097/JTE.0000000000000185

12. Bogardus J, Armstrong ES, VanOss T, Brown DJ. Stress, anxiety, depression, and perfectionism among graduate students in health sciences programs. J Allied Health (2022) 51(1): e15–25.

13. Ellison J, Mitchell K, Bogardus J, Hammerle K, Manara C, Gleeson P. Mental and physical health behaviors of doctor of physical therapy students. J Phys Ther Educ (2020) 34(3): 227–33. doi: 10.1097/jte.0000000000000141

14. McKerrow I, Carney PA, Caretta-Weyer H, Furnari M, Miller Juve A. Trends in medical students’ stress, physical, and emotional health throughout training. Med Educ Online (2020) 25(1): 1–8. doi: 10.1080/10872981.2019.1709278

15. Ayed A, Amoudi M. Stress sources of physical therapy students’ and behaviors of coping in clinical practice: a Palestinian perspective. Inquiry (2020) 57: 1–6. doi: 10.1177/0046958020944642

16. Janse van Vuuren EC, Bodenstein K, Nel M. Stressors and coping strategies among physiotherapy students: towards an integrated support structure. Health SA Gesondheid (2018) 23: 1–8. doi: 10.4102/hsag.v23i0.1091

17. Struessel T, Forster JE, Van Zytveld C. Doctor of Physical Therapy student experiences during clinical education: patient safety, error, and the system. J Phys Ther Educ (2019) 33(1): 3–15. doi: 10.1097/JTE.0000000000000072

18. Jacob T, Gummesson C, Nordmark E, El-Ansary D, Remedios L, Webb G. Perceived stress and sources of stress among physiotherapy students from 3 countries. J Phys Ther Educ (2012) 26(3): 57–65. doi: 10.1097/00001416-201207000-00008

19. Brooke T, Brown M, Orr R, Gough S. Stress and burnout: exploring postgraduate physiotherapy students’ experiences and coping strategies. BMC Med Educ (2020) 20(433): 1–11. doi: 10.1186/s12909-020-02360-6

20. Dickson T, Mulligan EP, DeVahl J. The toll of student debt: stress among health professions students and the promising role of financial self-efficacy on career choices. J Phys Ther Educ (2020) 34(4): 339–46. doi: 10.1097/JTE.0000000000000162

21. Delany C, Miller KJ, El-Ansary D, Remedios L, Hosseini A, McLeod S. Replacing stressful challenges with positive coping strategies: a resilience program for clinical placement learning. Adv Health Sci Educ (2015) 20(5): 1303–24. doi: 10.1007/s10459-015-9603-3

22. Gallasch D, Conlon-Leard A, Hardy M, Phillips A, Van Kessel G, Stiller K. Variable levels of stress and anxiety reported by physiotherapy students during clinical placements: a cohort study. Physiotherapy (2022) 114: 38–46. doi: 10.1016/j.physio.2021.12.002

23. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav (1983) 24(4): 385–96. doi: 10.2307/2136404

24. Blackmore A, Tucker B, Jones S. Development of the undergraduate sources of stress questionnaire. Int J Ther Rehabil (2005) 12(3): 99–105. doi: 10.12968/ijtr.2005.12.3.19553

25. Taylor JM. Psychometric analysis of the ten-item perceived stress scale. Psychol Assess (2015) 27(1): 90–101. doi: 10.1037/a0038100

26. Kim HY. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod (2013) 38(1): 52–4. doi: 10.5395/rde.2013.38.1.52

27. Pett MA. Nonparametric statistics for health care research: statistics for small samples and unusual distributions. 2nd ed. Thousand Oaks, CA: Sage; 2016.

28. DeWees TA, Mazza GL, Golafshar MA, Dueck AC. Investigation into the effects of using normal distribution theory methodology for Likert scale patient-reported outcome data from varying underlying distributions including floor/ceiling effects. Value Health (2020) 23(5): 625–31. doi: 10.1016/j.jval.2020.01.007

29. Felter CE, Cicone J, Mathis L, Smith DL. Identifying and addressing social determinants of learning during the COVID-19 pandemic. Phys Ther (2021) 101(11): 1–9. doi: 10.1093/ptj/pzab210

30. Commission on Accreditation in Physical Therapy Education. Aggregate Program Data: 2022 Physical Therapist Education Programs Fact Sheet. 2022. Available from: https://www.capteonline.org/globalassets/capte-docs/aggregate-data/2022-pt-aggregate-data.pdf [cited 02 October 2023].

Article Details

Keywords:
Physical Therapy Students, Stress Levels, Sources of Stress, Clinical Education
Section
Original Research Articles
How to Cite
Dutton, L. L., & Anderson, C. (2024). Physical therapy students’ perceived levels and sources of stress during clinical education experiences. The Journal of Clinical Education in Physical Therapy, 6. https://doi.org/10.52214/jcept.v6.11999