• Herrin S
• Spegman AM

• Association of Chiropractic Colleges / congresses

BACKGROUND: It is widely reported that attending a graduate professional program is stressful, with academic performance inversely related to perceived stress. Research has identified curricular sources of stress to include the complexity and volume of material, time availability, examinations, and the ambiguity of expectations. Sources of stress in medical students have been related to performance anxiety and evaluation methods. In graduate psychology students, the factors underlying stress included time constraints, feedback from specific faculty, financial constraints, and lack of faculty assistance; female students and 3rd year students reported more stress. Other stressors have been associated with developmental demands of young adulthood, including intimate relationships, parental conflicts, and finances.

OBJECTIVES: This study examined issues related to stress levels and clinical confidence in 7th and 8th quarter chiropractic interns. The specific aims were to examine interns’ perceptions of stress and clinical confidence; the relationships between stress and confidence; and interns’ perception of faculty/school actions which reduce stress and/or increase confidence.

METHODS: The study was approved by the Institutional Review Board of Western States Chiropractic College. Students enrolled in 7th and 8th quarter courses were invited to participate. The qualitative instrument, constructed by the researchers, asked for ratings of current stress and confidence (0 = none to 10 = extreme). Five open-ended questions explored sources of stress, influences on confidence, and support that could be provided by the college/faculty. The tool required 15 minutes to complete.

RESULTS: Participants self-identified their academic status, with 38 interns reported as 7th quarter and 48 as 8th quarter. When compared with 8th quarter interns, 7th quarter interns reported significantly higher stress ratings (t = 2.8, p =0.07) and lower confidence ratings (t = -1.9, p <0.01). Stress was inversely related to confidence, although significant only for 8th quarter interns (r = 0.40, p = .004). Two themes, time constraints and relationship factors, emerged as influential to perceptions of stress and confidence. The lack of time was implied throughout many comments. Personal relationships as well relationships with faculty were identified sources of stress. However, additional interactions with clinical faculty were valued for instilling confidence.

DISCUSSION: Many of the factors which influenced stress and confidence are areas that faculty can address through introspection and discussion, without major curricular revision. Awareness of student perceptions may help faculty to become effective coaches and mentors. The findings highlight the value of asking, sharing, and attending to student perspectives. The response rate and thoughtful responses conveyed that stress and confidence are important issues for the respondents. Chiropractic interns identified similar sources of stress as those reported for students in other graduate professional programs. As young adults, chiropractic interns may be at-risk for similar psychological problems found in studies with medical interns, such as depression and substance abuse. The persistence of high stress and low confidence beyond the 7th quarter may be a salient marker of personal, academic or clinical distress. Further research using triangulated methods is needed to probe the significance of the stress-confidence relationship found with 8th quarter students.

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