Exploring the Manifestation of Examination Stress and Stress Resilience in Undergraduate Medical Students

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University students, and in particular medical students, often experience stress in the context of education and examination. Experiencing stress can have detrimental effects on mood, QoL and academic performance, and can even put students at risk of developing stress-related psychopathologies such as burn-out. The current paper will describe preliminary findings from a multi-year research project that aims to better understand the manifestation of exam stress, and the neurobiological factors underlying stress resilience, in the population of undergraduate medical students. This project involves the ambulatory, real-life recording of physiological and psychological indicators of stress over the course of an exam week and control week, by implementing wearable biosensors capable of recording physiological data, in combination with short daily surveys. Furthermore, the project implements a novel framework for understanding the neurological basis of stress resilience, by investigating if patterns of large-scale neural network activity under acute stress can predict individual differences in real-life stress reactivity. In addition, standardized tests for various domains of cognitive ability are used in this project to investigate potential stress-induced decrements in exam performance. The current paper aims to acquire initial validation of the methods used in our project, and to identify possible methodological problems. The current results indicate that exam weeks induce substantial increases in subjective measures of stress. However, the physiological measures (heart rate, skin conductance levels and cortisol) produced less straightforward results. Factors that could potentially explain this are discussed in detail. Furthermore, exploratory imaging results (fMRI) from a very limited sample indicate distinct changes in neural network activity under acute stress. Finally, some interesting results were obtained from the behavioral tests for cognitive ability, but their implications are limited due to the small sample size.
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