title: A Comparison of Students' Perceptions of Stress in Parallel Problem-Based and Lecture-Based Curricula.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: C Sonia
authors.initials: CS
authors.lastname: Wardley
authors.forename: E Brooks
authors.initials: EB
authors.lastname: Applegate
authors.forename: A Deyab
authors.initials: AD
authors.lastname: Almaleki
authors.forename: James A
authors.initials: JA
authors.lastname: Van Rhee
mesh_terms: D003479:Curriculum; D004517:Education, Professional / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D010823:Physician Assistants / Q000193:education* / Q000523:psychology*; D018794:Problem-Based Learning; D012044:Regression Analysis; D013315:Stress, Psychological