Test anxiety and academic performance in chiropractic students

Effect of unproctored versus proctored examinations on student performance and long-term retention of knowledge

OBJECTIVE

To compare unproctored and proctored online exams among chiropractic students.

METHODS

Pre-existing data of 234 students across 4 consecutive endocrinology classes were analyzed for this study. The course was comprised of 3 lectures (50 minutes per lecture) each week. Student performance was evaluated by midterm exam and summative exam (S1). The students from 3 classes were asked to take a voluntary second summative exam (S2) approximately 7 months after the S1. Since this study was partially conducted during the COVID pandemic, some classes took the midterm and the S1 proctored in the classroom while others took them unproctored from a remote location.

RESULTS

The mean midterm exam (p < .001) and S1 scores (p = .01) for the unproctored group (93.6 ± 7.0 and 88.8 ± 8.2) were significantly higher than the proctored group (88.1 ± 8.2 and 83.9 ± 11.2). The mean time taken by students was much greater for the unproctored exams than for the proctored exams (midterm: 40.7 ± 10.2 versus 16.7 ± 7.0, p < .001; S1: 47.0 ± 8.7 versus 21.5 ± 9.0, p < .001). By contrast, the mean unproctored S2 scores were lower than the proctored group (60.2 ± 14.7 versus 88.1 ± 8.2, p < .001). A linear regression test showed that the final exam was a statistically significant predictor of the recall exam (p < .01, R2 = 28.3%).

CONCLUSION

The findings suggest that student performance is significantly altered by test format.

Resilient responses to stressful events among chiropractic students: A cross-sectional survey

OBJECTIVE

Resilient students may better navigate the challenges of chiropractic training. This study explored the relationships between response to stressful experiences, perceived stress, and quality of life among students at 1 US chiropractic college campus.

METHODS

A cross-sectional survey was conducted with 873 students. The anonymous online questionnaire included demographics, quality of life, perceived stress, and the Response to Stressful Events Scale (RSES). Hierarchical multiple regression analyses assessed for significant relationships among variables.

RESULTS

A sample of 221 students (60% female) completed the survey (25% response rate). Male respondents reported greater psychological health. Participants reporting high quality of life exhibited higher resiliency on the RSES flat score and many RSES domains. Respondents who rated greater psychological health and social relationships exhibited greater spiritual resiliency. Respondents reporting higher psychological health and lower levels of perceived stress exhibited higher self-efficacy resilience. Psychological health was the most important predictor for RSES flat score and domains, except for spiritual resilience, for which social relationships were most important. Male gender was predictive of 3 RSES domains: meaning making, active coping, and cognitive flexibility.

CONCLUSION

More resilient responses to stressful events were reported by male chiropractic students and those who reported greater psychological health, higher quality of life, or lower perceived stress. Female students and those experiencing psychological challenges or lower quality of life might consider resilience training to increase the use of protective coping strategies. These findings may permit academic institutions to identify students at highest risk and employ interventions to prevent program withdrawal.

Effect of lavender and rosemary aromatherapy on test anxiety in chiropractic students

OBJECTIVE

Test anxiety is a debilitating disorder that can impair cognitive performance and affect academic success. Aromatherapy is commonly used for relaxation therapy. The primary aim of the study was to determine if nasal inhaler aromatherapy, utilizing a blend of rosemary and lavender essential oils, could be a useful strategy to reduce testing anxiety in students.

METHODS

This study recruited first trimester chiropractic students enrolled in both Neuroanatomy I and Biochemistry I. A randomized crossover design was utilized over 2 study days during final exams, with a 2-day wash-out period. Participants were randomly assigned into groups based on results of test anxiety analysis. On each day, students were given a nasal inhaler with either an aromatherapy blend of lavender and rosemary essential oils or distilled water as the control. Students completed pretest surveys and posttest surveys to rate their anxiety levels. Paired sample t-tests were performed to determine group differences in test anxiety. Both intention-to-treat and per-protocol analyses were conducted.

RESULTS

Forty-five students were randomly assigned into the study, whereas only 38 completed per-protocol. Between group comparisons showed no statistically significant difference between change in anxiety scores between aromatherapy and control for both intention-to-treat (p =.10) and per-protocol (p =.07).

CONCLUSION

Use of personal inhalers and aromatherapy diffusers were not shown to reduce test anxiety in a chiropractic population under high-stakes examination. Other options should be explored for future research.

Addressing Test Anxiety Using Game-Based Assessment

This paper identifies an opportunity to integrate gamification in undergraduate biomedical engineering (BME) classrooms to alleviate student test anxiety and promote student perception of their academic performance. Gamification is a popular educational strategy that does not appear to be widely explored or adopted in higher education, particularly in a BME setting. This study proposes methods for the development, implementation, and evaluation of academic games and provides concrete practices and detailed instruction in which games can be used as an alternative to a traditional exam to support student mental health. The reflection provides the feedback received from students which demonstrates a balanced view of using game-based activities for tests and evaluations, cautiously optimistic based on the initial positive attitude seen from students.

Coping strategies and chiropractic student perceived stress

OBJECTIVE

To investigate coping strategies adopted by chiropractic college students and how these strategies affect student-perceived stress levels.

METHODS

Four hundred seven (407) 1st-quarter students were recruited during 2014 and 2015. The validated Brief COPE inventory was used to assess coping strategies during the 1st week of classes. Perceived Chiropractic College Stress (PCCS) was assessed via a modification of Vitaliano Perceived Medical School Stress survey instrument. The modified coping instrument was administered during the 1st quarter (PCCS1) and 6 months later during the 3rd quarter (PCCS2).

RESULTS

Mean perceived stress levels were greater after 6 months. Although perceived stress increased more for females than for males over that period, it was not statistically significant. Male and female coping strategies differed only in the preferential use of emotional support by females. Students generally adopted active coping strategies (eg, active coping and planning) rather than avoidant strategies (eg, substance abuse). Regression analysis revealed a moderate positive relationship between avoidant-emotion coping and PCCS1 with a weaker positive correlation between problem-focused coping, sex, and PCCS1. Avoidant-emotion coping also demonstrated a moderate positive correlation with PCCS2. Neither sex nor the 3 coping strategies were predictors of PCCS change (PCCS2 - PCCS1).

CONCLUSION

This study is a starting point for exploring the relationship between perceived stress and coping behaviors in a chiropractic training institution. Students generally used healthy adaptive coping strategies with minimal sex differences. Avoidant-emotion coping appears to be a reliable predictor of PCCS, with sex being a poor predictor.

Aromatherapy for test anxiety in chiropractic students

OBJECTIVE

Up to 85% of college students experience test anxiety, which may contribute to decreased academic performance. The purpose of this study was to assess the feasibility of recruiting chiropractic students for a randomized trial involving aromatherapy for anxiety reduction.

METHODS

This study enrolled chiropractic students who were randomly assigned to separate rooms during a biochemistry test. Waterless diffusers dispersed a lemon and rosemary blend of essential oils in the experimental room and water in the control room. Students completed pretest surveys rating current and general anxiety. Posttest surveys included rating current anxiety. Analysis of covariance (ANCOVA) was preformed to determine within- and between-group differences for current anxiety. Feasibility was the primary aim, and the statistical significance of anxiety test scores between rooms was the secondary aim.

RESULTS

Sixty-four students were included in the study. The feasibility of research methods was noted for adherence to the study protocol (informed consent, randomization, and survey distribution and completion) and resource allocation. Design improvements are required in recruitment methods, follow-up surveys, and intervention blinding. ANCOVA for between-group comparisons showed no statistically significant difference between groups' pre- and posttest anxiety scores (p = .22). Two reported side effects, eye and sinus irritation, could not be attributed to treatment group. Most students were willing to use aromatherapy for test anxiety in the future.

CONCLUSION

We demonstrated feasibility in conducting a randomized study to measure the influence of aromatherapy on test anxiety in chiropractic students. A powered, randomized study is needed to determine if aromatherapy may be effective in reducing test anxiety.

Stress and burnout in chiropractic students of European chiropractic colleges

OBJECTIVE

High levels of stress and burnout are known to negatively impact academic success, quality of life, and well-being of students. The purpose of this study was to investigate the degrees of stress and burnout levels of students from several European chiropractic colleges.

METHODS

Stress and burnout were assessed using the Perceived Stress Scale (PSS-10) and the Maslach Burnout Inventory-Student Survey (MBI-SS). Surveys were delivered electronically in November 2017 to chiropractic students from 4 different chiropractic colleges. Data were analyzed using t test and 1-way ANOVA to determine differences between demographic data. Scores in perceived stress and burnout subscales were compared to the general, chiropractic, and medical student populations.

RESULTS

Both the MBI-SS and PSS had similar response rates (30%-34%) and demonstrated statistically significant differences between institutions, with C-3 demonstrating the highest levels of exhaustion (p < .001) and the highest levels of perceived stress (p = .012). MBI-SS results show that in the general chiropractic student population, 26.4% presented high emotional exhaustion, 18.2% high cynicism, and 43.8% low academic efficacy. Meanwhile, the PSS score indicated "moderate" levels of stress.

CONCLUSIONS

European chiropractic students experience higher levels of perceived stress than the general population and they may suffer levels of burnout similar to those of medical students. These results suggest that colleges should monitor stress and burnout levels in their students. This may help to establish student support systems in order to improve students' quality of life and academic performance, as well as help new graduates transition to their professional lives.

Effects of anxiety on dental students' noncognitive performance in their first objective structured clinical examination

Patient-dentist discourse is a core nonoperational competency in dental education. The skills of querying patients and responding to questions are noncognitive attributes, and their evaluation by the standardized patient objective structured clinical examination (OSCE) is particularly necessary. However, it is not clear whether students' test anxiety affects these attributes. This study aims to examine the relationship between dental students' state-trait anxiety, noncognitive performance, and examination results during their first OSCE. A single dental school cohort (n = 226) of 5 year students attending their first clinical examination from 2014 to 2017 was studied. Participants completed the Chinese Mandarin Version State-Trait Anxiety Inventory Y form before taking the OSCE. The difference between state and trait anxiety levels was compared by paired t test. Gender differences and the effect of age group in these anxiety levels were analyzed using multivariate analysis of variance. Moreover, gender, age group, state anxiety, and trait anxiety scores were compared with the OSCE items of noncognitive performance using a chi-square test. Students showed significantly higher state anxiety than trait anxiety levels; moreover, women showed significantly higher state anxiety than men. Furthermore, gender, age group, state anxiety, and trait anxiety had no association with the noncognitive performance examination results. Most participants showed moderate state and trait anxiety levels during their first OSCE. Further, the state-trait anxiety had no significant effect on their noncognitive performance. However, 26.5% of participants did not pass the examination; therefore, dental educators should increase communication skill training courses during clerkship training to improve students' noncognitive attributes.

Comparison of first-year grade point average and national board scores between alternative admission track students in a chiropractic program who took or did not take preadmission science courses

OBJECTIVE

We compared first-year cumulative grade point average and a composite score on part I of the National Board of Chiropractic Examiners (NBCE) exam for first-year alternative admission track program (AATP) students who did and did not take three specific undergraduate courses: general chemistry, organic chemistry, and anatomy and physiology.

METHODS

All AATP students in 2015 (n = 50) were evaluated for the course history of general chemistry and anatomy and physiology compared to their first-year cumulative grade point average and NBCE part 1 scores using independent t-tests.

RESULTS

Students in the AATP who took general chemistry tended to score higher overall on the NBCE exams (p = .038, r = .229). Organic chemistry and anatomy and physiology had no statistical effect on improving board scores. First-year cumulative grade point average seemed to be unaffected by any of the undergraduate courses evaluated.

CONCLUSION

There was a statistically significant difference in composite NBCE part 1 score between AATP students who had and had not taken general chemistry 1 before admission. There were no differences in first-year GPA between AATP students who had and had not taken undergraduate chemistry and A&P courses.

Predicting stress and test anxiety among 1st-year chiropractic students

OBJECTIVE

We evaluated perceived stress in 1st-year chiropractic students and the relationship between perceived stress and test anxiety. Moreover, we sought student-identified stressors that complicate chiropractic education.

METHODS

We tested 3 hypotheses in a longitudinal descriptive study: (1) student-perceived stress would increase over 6 months of chiropractic training, (2) depression level and grade-point average (GPA) at matriculation would predict student-perceived stress 6 months into the program, and (3) perceived stress would correlate with cognitive and emotional test anxiety levels. Assessments used were prematriculation GPA, perceived chiropractic college stress (PCCS), the Center for Epidemiologic Studies Depression Scale, and the Test Anxiety Inventory.

RESULTS

Four hundred and seven students participated during 2014 and 2015. PCCS increased 18% after 6 months (t₍₄₀₆₎ = 6.32, p < .001, d = .33). Prematriculation GPA was not a significant predictor of PCCS at 6 months, p = .082. By contrast, the Center for Epidemiologic Studies Depression Scale at the beginning of the chiropractic training program was a significant predictor p < .001, multiple R² = 7.1%. PCCS correlated with test anxiety worry and emotionality (r = .37, p < .001 and r = .35, p < .001, respectively). The top 4 stressors identified by students were (by priority) finances, time for a life outside school, personal competence/endurance, and curriculum/environment.

CONCLUSION

Our findings are consistent with perceived stress increases during medical school. Surprisingly, prematriculation GPA, a widely used academic performance predictor, was a poor predictor of PCCS, while depression level at matriculation was a moderate predictor. PCCS correlated with test anxiety worry and emotionality, known academic performance impediments.

Why So Stressed? A Descriptive Thematic Analysis of Physical Therapy Students' Descriptions of Causes of Anxiety during Objective Structured Clinical Exams

Purpose: The purpose of this study was to collect and conduct a descriptive content analysis of the primary triggers of practical exam anxiety in Master of Physical Therapy (MPT) students in a Canadian university programme. Method: First and second-year MPT students were invited to reflect upon their top 5 sources or triggers of OSCE exam anxiety, collected in written format during a low-stress, low-examination period of their programme. All participants had participated in at least 3 OSCEs before providing data. The emergent themes were member-checked with 10 of the original participants to improve trustworthiness of the results. Results: 56 of a possible 105 students provided 224 triggers of OSCE anxiety. Thematic content analysis revealed 6 emergent meta-themes that adequately captured all triggers. They were: social performance anxiety, fear of lacking competence, overvaluing the outcome, fear of the unknown, impaired personal health/coping resources, and operational/procedural influences. These meta-themes were endorsed by the participant sub-group. Conclusions: OSCEs are common forms of evaluation in MPT training programmes, but are also highly anxiogenic. The first step toward mitigating exam anxiety, thereby ensuring exam performance is less confounded by anxiety, is to identify the common triggers. Confidence in results will be strengthened by replication in other programmes.

Mind wandering, together with test anxiety and self-efficacy, predicts student's academic self-concept but not reading comprehension skills

BACKGROUND

Mind wandering (MW) has commonly been linked to bad scholastic performance; however, such association has rarely been investigated in the classroom. Moreover, in examining such association, motivational variables have been largely ignored.

AIM

We aimed at examining the associations between the dispositional tendency to engage in MW and a series of reading comprehension skills and measures of academic self-concept above and beyond the role of sex, age, test anxiety, self-efficacy, and self-regulation strategies.

SAMPLE

Late adolescents (N = 272, 133 females; 17.23 ± 1.10 years) recruited from 15 classes in public high schools.

METHODS

Students were examined in their classroom during regular teaching activities and first performed a reading comprehension test. Then, they underwent a battery assessing literacy skills, academic self-concept, the dispositional tendency to mind wander, and aspects related to self-regulated learning.

RESULTS

Reading comprehension and literacy skills (decoding, orthographic awareness, spelling skills, and phonological abilities) were not associated with the tendency to mind wander. Instead, MW, test anxiety, and self-efficacy - but not self-regulatory strategies - were independent predictors of academic self-concept.

CONCLUSIONS

This study highlights the importance of evaluating the effects of MW on academic self-concept, taking into account a complex pattern of motivational and emotional variables.

Test anxiety and self-esteem in senior high school students: a cross-sectional study

PURPOSE

In this study, it is aimed to determine the level of test anxiety and self-esteem in the high school students preparing for the university exam in Bitlis, Turkey, and to investigate the effect of test anxiety on self-esteem.

MATERIAL AND METHODS

Seven-hundred and twenty-four high school students who were preparing for the university entrance examination in Bitlis participated in the study. A questionnaire which includes socio-demographic data form, Rosenberg Self-Esteem Scale and Revised Test Anxiety Scale was prepared as an e-questionnaire for the students to fill easily and uploaded to the Bitlis State Hospital's website. Schools were called and informed for the students to fill out the e-questionnaire on the Internet.

RESULTS

The most important findings from our study are that gender is influential on test anxiety and self-esteem score and test anxiety level are negatively correlated. It was observed that female students had more test anxiety than male students and those who had higher self-esteem had less test anxiety.

CONCLUSION

Consequently, our study shows that university entrance examination creates anxiety on students and reduces self-esteem, especially in female students.

Requiring students to justify answer changes during collaborative testing may be necessary for improved academic performance

OBJECTIVE

Three hypotheses were tested in a chiropractic education program: (1) Collaborative topic-specific exams during a course would enhance student performance on a noncollaborative final exam administered at the end-of-term, compared to students given traditional (noncollaborative) topic-specific exams during the course. (2) Requiring reasons for answer changes during collaborative topical exams would further enhance final-exam performance. (3) There would be a differential question-type effect on the cumulative final exam, with greater improvement in comprehension question scores compared to simple recall question scores.

METHODS

A total of 223 students participated in the study. Students were assigned to 1 of 2 study cohorts: (1) control - a traditional, noncollaborative, exam format; (2) collaborative exam only (CEO) - a collaborative format, not requiring answer change justification; and (3) collaborative exam with justification (CEJ) - a collaborative exam format, but requiring justification for answer changes.

RESULTS

Contrary to expectation (hypothesis 1), there was no significant difference between control and CEO final exam scores (p = .566). However, CEJ final exam scores were statistically greater (hypothesis 2) than the control (p = .010) and CEO (p = .011) scores. There was greater collaboration benefit when answering comprehension than recall questions during topic-specific exams (p = .000), but this did not differentially influence study cohort final exam scores (p = .571, hypothesis 3).

CONCLUSION

We conclude that test collaboration with the requirement that students explain the reason for making answer changes is a more effective learning tool than simple collaboration that does not require answer change justification.

Secondary Level Achievement

Abstract. The study was developed in the context of Personality and Social Cognitive Theory with constructs that encapsulate non-intellective processes of academic achievement. The goal was to explore the role of the Five Factor Model (FFM) of personality in academic performance and to use this model as a reference point to test the incremental validity of two measures of Self-efficacy (Academic and Emotional) and an indicator of Absenteeism. Participants (N = 120) were comprised of 17-year-old male (n = 47) and female (n = 73) opportunistically sampled secondary level college students. A cross-sectional design was used to examine the relationship between the independent variables (FFM, Academic Self-efficacy, Emotional Self-efficacy, and Absenteeism) and the outcome variable, Grade Points Average (GPA). Correlation analysis found that four FFM factors and the two Self-efficacy measures were associated with GPA. In a hierarchical regression analysis, the FFM explained 22% variance on performance and the two Self-efficacy measures added 9% incremental variance followed by 3% for Absenteeism. Overall, the non-intellective constructs explain a substantial 34% variance on achievement and provide focal points for theoretical, empirical, and pedagogical evaluation. Moreover, they are suggestive of the pathways and processes that support learning, augment ability, and enhance achievement.

The relationship between levels of resilience and coping styles in chiropractic students and perceived levels of stress and well-being

OBJECTIVE

The aim of this study was to explore the relationship between chiropractic students' coping styles and levels of resilience with their physical injuries, perceived levels of stress, and well-being.

METHODS

A questionnaire was distributed to the entire student body of the chiropractic program at Murdoch University, and gathered demographic variables and responses to the Connor-Davidson Resilience Scale, Perceived Levels of Stress Scale, Everyday Feelings Questionnaire, and Coping Inventory for Stressful Situations. Linear regression analysis was used to calculate for significant relationships.

RESULTS

Of 244 students, 194 (81%) completed the surveys. Being female and not having recovered from an injury within 12 months was significantly associated with lower levels of well-being and higher levels of stress. Being female, possessing an increased use of an emotional-based coping style, and having lower levels of well-being were associated with higher levels of stress (R² = 0.65, F(6,164) = 50.47, p < .001). Lower levels of well-being were associated with being female, higher perceived levels of stress, lower levels of resilience, and an increased use emotional coping styles (R² = 0.64, F[6,164] = 49.5, p < .001).

CONCLUSION

It is possible to identify chiropractic students at the university who are at risk of experiencing low levels of well-being and high levels of stress. These students may benefit from interventions aimed at enhancing their coping style choices and increasing their resilience levels. Future studies are recommended to see if these findings are consistent across chiropractic programs nationally and internationally.

Pharmacy Student Anxiety and Success With Objective Structured Clinical Examinations

Objective. To evaluate whether a relationship exists between the degree of student state-anxiety and pass rates on moderate-to-high stakes objective structured clinical examinations (OSCE). Methods. Third-professional year (P3) students were assessed using the Speilberger State-Trait Anxiety Index (STAI) three weeks prior to their first moderate-to-high stakes OSCEs. Students' OSCE station pass rates, individual station analytical scores, and the overall pass rate for the class were compared with student responses on STAI surveys to measure their association. Results. Seventy-three students (100%) provided consent to participate in the research; 64 (87%) sufficiently completed the STAI survey. Degree of student state-anxiety or train-anxiety was not associated with any of the outcomes assessed in this study. Overall pass rate, individual station pass rates, and station analytical checklist scores were not inversely correlated with state- or trait-anxiety scores. Conclusions. Efforts to assist students in OSCE performance should focus on means other than reducing associated anxiety. Future research in this area should focus on what interventions beyond instruction could be put in place to help students be more successful during OSCEs.

Test Anxiety in the Nursing Skills Laboratory: A Concept Analysis

BACKGROUND

The concept of test anxiety has been well documented within the health education literature, with much of the literature addressing the clinical environment and simulation laboratories. Minimal exploration of test anxiety has been conducted within the context of a nursing skills laboratory.

AIM

This concept analysis of test anxiety will provide clarity to the meaning and use of this concept within the nursing educational setting of a controlled skills laboratory.

METHOD

Walker and Avant's (2005) framework was used to identify the defining attributes, antecedents, and consequences of test anxiety and applied in model, borderline, and contrary cases, and empirical referents.

CONCLUSIONS

Understanding the concept of test anxiety will enable nurse educators to develop strategies to reduce student anxiety during testing in the skill laboratory. These insights can lead to positive changes within the nursing curricula and may benefit those students who experience testing anxiety.

Is Cognitive Test-Taking Anxiety Associated With Academic Performance Among Nursing Students?

The cognitive component of test anxiety was correlated with academic performance among nursing students. Modest but statistically significant lower examination grade T scores were observed for students with high compared with low levels of cognitive test anxiety (CTA). High levels of CTA were associated with reduced academic performance.

Ansiedade em Provas: um Estudo na Obtenção da Licença para Dirigir

Resumo Situações de avaliação geram ansiedade e dentre elas está a prova prática de direção para a obtenção da licença para dirigir, essa ansiedade pode perturbar o desempenho e impedir a obtenção da habilitação. O presente estudo visou analisar: (a) a fundamentação teórica que embasa a intervenção terapêutica em casos de ansiedade em avaliações e provas; e (b) o processo terapêutico de uma cliente que procurou terapia comportamental após tentativas fracassadas na obtenção da licença para dirigir. A relevância da análise funcional da ansiedade e dos repertórios de enfrentamento da ansiedade foi considerada. Em seguida, um estudo de caso foi relatado: uma paciente com um histórico de seis reprovações no teste prático para a obtenção da licença para dirigir e níveis altos de ansiedade. Esse estudo demonstrou que um preparo apropriado e a intervenção terapêutica contribuíram para reduzir a ansiedade e promover a condição necessária para a obtenção da licença para dirigir. Estudos adicionais deverão ser realizados de modo a se obter uma melhor compreensão da relação entre a ansiedade e o desempenho, especialmente no que diz respeito ao processo de obtenção de uma licença para dirigir.

Effects of test stress during an objective structured clinical examination

OBJECTIVE

The existence of test stress has been widely reported among professional students. To our knowledge, no studies exist that explore student stress response to objective structured clinical examinations. The aim of this study was to evaluate possible correlations between stress and objective structured clinical examination performance in a sample of chiropractic students.

METHODS

A total of 116 students completed a 2-part questionnaire to assess test stress and the physiological symptoms and signs of stress. Heart rate, systolic blood pressure, and diastolic were measured during the physical examination laboratory class within the first 3 weeks and then again just prior to their objective structured clinical examination in week 5. Statistical tests were then performed for questionnaire data, heart rate and blood pressure differences, and correlation between the objective structured clinical examination grade and symptoms and signs.

RESULTS

Questionnaire results showed that 5.1%-22.4% of students sometimes or often felt a certain degree of stress. More than 50% had 1 or more physiological symptoms and signs of stress. The objective structured clinical examination heart rate (75.23 ± 11.20 vs 68.16 ± 8.82, p < .001), systolic blood pressure (120.43 ± 9.59 vs 114.97 ± 11.83, p < .001), and diastolic blood pressure (73.00 ± 7.93 vs 69.32 ± 7.76, p < .001) were significantly higher than baseline. There were also negative linear correlations between objective structured clinical examination grades and physiological symptoms and signs and between objective structured clinical examination grades and feeling statement score.

CONCLUSION

The results support our hypothesis that chiropractic students experience stress when performing the objective structured clinical examination and that high levels of stress had a negative impact on performance.

Saliva pH as a biomarker of exam stress and a predictor of exam performance

BACKGROUND

Salivary pH is regulated by the sympathetic and parasympathetic nervous system; therefore, it may serve as a biomarker of stress.

AIMS

To assess the associations between the cognitive and emotional dimensions of exam stress and pH levels, and the predictability of salivary pH in relation to test performance.

METHODS

A prospective study. Eighty-three nursing students answered a questionnaire on stress appraisals, experienced stress, test anxiety (including worry and emotionality subscales) and health behaviors, and gave a saliva sample for measuring pH on the morning of their first term exam and three months later. Their performance on the test (grades) was also recorded.

RESULTS

Levels of pH in saliva were higher (levels of acidity were lower) in the post exam compared to the exam period, in parallel to lower threat appraisal, experienced stress, and test anxiety levels post exam. Controlling for smoking, physical activity and working hours per week, pH levels at both time points were predicted by appraised threat regarding the exam situation, experienced stress, and the emotionality dimension of test anxiety. pH at Time 1 predicted performance on the exams and mediated the associations of experienced stress and emotionality subscale with test performance.

CONCLUSIONS

the present study indicates that pH levels may serve as a reliable, accessible and inexpensive means by which to assess the degree of physiological reactions to exams and other naturalistic stressors.