Introduction: Stress level in physical therapy students has been a focus of research due to multiple documented effects related to physical health, mental health, and ability to learn. Self-reflection has also been a focus of education research, relating it to personal learning, critical thinking, and demonstrable development of professional behaviors and skills. The aim of this study is to investigate student stress in response to programmatic changes wrought by the pandemic and whether stress impacted student self-reflection. Review of literature: Self-reflection is positively associated with growth of professional behavior and academic performance. Student level of self-reflection has been shown to be negatively impacted by stress. Subjects: A convenience sample of 35 students entering the program fall 2019 made up the participants. Methods: Outcome measures were collected six times over two academic years. The Self-Reflection Insight Scale (SRIS) consists of 20 statements rated on a 5-point Likert scale with 3 subscales: need for reflection (N), engaging in reflection (E), and insight (I), scoring from 10 to 100. The Perceived Stress Scale (PSS-10) is a 10-item questionnaire rated on a 4-point Likert scale, scoring from 0 to 40. Results: SRIS scores increased significantly from time 1 to 2, prior to the campus closure; no significant change for times 3 through 6. PSS scores indicated a higher percentage of students reporting a high level of stress at time 3 in the months after campus closure, decreasing significantly from time 3 to 4 during virtual/hybrid learning and increasing from time 5 to 6 as students prepared for clinical internship. No correlation was seen between SRIS and PSS, however a negative correlation was observed between SRIS subscale I and PSS at time 4 and 5. Discussion: Student perceived stress decreased during the study despite a universally stressful time. Student stress increased as students prepared for their first clinical internship experience, consistent with prior research. Initial gains in student self-reflection did not significantly change during the 1.5 years of the pandemic indicating that despite multiple academic and social challenges, students were able to maintain, but not grow, their level of professional self-reflection. Research is needed to further describe the relationship between stress and insight. Conclusion: The Program’s response to pandemic mandates may have positively influenced student stress.

Author Bio(s)

KeithAnn Halle PT, DPT is Director of Clinical Education and Clinical Assistant Professor of Physical Therapy at the University of Puget Sound in Tacoma, WA. She specializes in treatment of neurologic disorders.

Jennifer D. Hastings PT, PhD is a professor of physical therapy at the University of Puget Sound. She has over 35 years of clinical practice with multiple publications in the area of neurologic rehabilitation. This is her fourth project investigating aspects of PT education.


The authors would like to thank Johana Kontarovsky for her work in data collection.




Submission Location


To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.