Cortisol assay, stress & exams!

Volume 2 Issue 1 January, 2012

Consultation Liaison Psychiatry Focus: Physiology

One wonders what exactly drives students to perform better during exams more so during graduation especially in medical schools where exam pattern are considered tough compared to all other course. Though we know too many factor play role during stress & it’s equally difficult to assess all of them. We (I and Chandrashekara.S of Chanre Rheumatology & Immunology Clinic, Bengaluru) carried out an important study on one aspect of stress during exam.
Our objective: The perception of stress among medical students due to academics is variable. This perception of stress
may depend to some extent on the individual’s adjustment pattern as well as the nature of the situation. The study
was conducted to determine the influence of adjustment patterns and state anxiety on the stress perception (by serum
cortisol assay) & cognitive performance during a mental task related to academics.

Our Method: 58 M.B.B.S First year students of Bangalore Medical College were recruited for this study. Venous blood
samples were collected from these students on the day of their regular academic exam (written) between 8 – 9 a.m.
Two questionnaires a) The Bell’s Adjustment Inventory & b) State Trait Anxiety Inventory, State Form, were
administered to these students before collecting the blood samples. A third questionnaire, ‘Performance rating
questionnaire’ was administered after completing the exam. Serum cortisol assay from the blood samples thus
collected was done by ELISA technique, following the standard protocol. Results showed: Cortisol levels were
significantly higher (p=0.000) in the poor adjustment group & high anxiety group (p=0.009). Regression analysis
indicated that, adjustment had more significant influence (p=0.105) compared to anxiety (p=0.204) in changing the
cortisol levels. Performance in the academic exam showed a better match between results expected and obtained
among good adjustment compared to poor adjustment group of students.

Our conclusion: Adjustment abilities & not state anxiety can be considered as marker of Cortisol response to academic
stress (psychological stress) in medical students. Cortisol levels before facing a mental task determines the performance outcome of the task .It might be more important to educate students in all medical colleges and with
active co-operation of respective departments about how best can students plan and handle curriculum so that they
can develop better coping skills for stress during exam.

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