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A Comparison of Students' Perceptions of Stress in Parallel Problem-Based and Lecture-Based Curricula

Wardley, C. Sonia MA; Applegate, E. Brooks PhD; Almaleki, A. Deyab MS; Van Rhee, James A. MS, PA-C

The Journal of Physician Assistant Education: March 2016 - Volume 27 - Issue 1 - p 7–16
doi: 10.1097/JPA.0000000000000060
Research Article

Purpose A 6-year longitudinal study was conducted to compare the perceived stress experienced during a 2-year master's physician assistant program by 5 cohorts of students enrolled in either problem-based learning (PBL) or lecture-based learning (LBL) curricular tracks. The association of perceived stress with academic achievement was also assessed.

Methods Students rated their stress levels on visual analog scales in relation to family obligations, financial concerns, schoolwork, and relocation and overall on 6 occasions throughout the program. A mixed model analysis of variance examined the students' perceived level of stress by curriculum and over time. Regression analysis further examined school work-related stress after controlling for other stressors and possible lag effect of stress from the previous time point.

Results Students reported that overall stress increased throughout the didactic year followed by a decline in the clinical year with statistically significant curricular (PBL versus LBL) and time differences. PBL students also reported significantly more stress resulting from school work than LBL students at some time points. Moreover, when the other measured stressors and possible lag effects were controlled, significant differences between PBL and LBL students' perceived stress related to school work persisted at the 8- and 12-month measurement points. Increased stress in both curricula was associated with higher achievement in overall and individual organ system examination scores.

Conclusion Physician assistant programs that embrace a PBL pedagogy to prepare students to think clinically may need to provide students with additional support through the didactic curriculum.

C. Sonia Wardley, MA, is a senior research analyst, Physician Assistant Department, Western Michigan University, Kalamazoo, MI.

E. Brooks Applegate, PhD, is a professor, Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI.

A. Deyab Almaleki, MS, is a PhD candidate, Evaluation Measurement and Research Program, Western Michigan University, Kalamazoo, Michigan. He is also a lecturer at Umm Al-Qura University, Mecca, Saudi Arabia.

James A. Van Rhee, MS, PA-C, is director of the Physician Associate Program, Yale University Medical School, New Haven, CT.

Correspondence should be addressed to: C. Sonia Wardley, MA, Physician Assistant Department, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5254. Telephone: (269) 387-5303; Email:

This study was funded by 2 Health Resources and Services Administration (HRSA) grants provided to Western Michigan University and approved by its Human Subject Institutional Review Board.

The authors declare no conflict of interest.

Copyright © 2016 Physician Assistant Education Association
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