Prevalence and Predictors of Anxiety in Healthcare Professions Students

Grit, resilience and growth-mindset interventions in health professional students: A systematic review and meta-analysis

OBJECTIVES

Grit, resilience and a growth-mindset influence students' ability to positively adapt to the challenges of health professional training. However, it is unclear if interventions can improve these traits. This systematic review aimed to explore if interventions can improve these traits in health professional students (primary) and their impact on academic and/or wellbeing outcomes (secondary).

METHODS

A comprehensive search of CINAHL, MEDLINE, Eric and Embase was conducted from inception until 15 March 2023. Randomised or non-randomised controlled trials and single-group intervention studies that aimed to improve health professional students' resilience, grit and/or growth-mindset were eligible for inclusion. Two reviewers independently screened studies for inclusion and evaluated quality using the Mixed Methods Appraisal Tool. Post-intervention data from randomised and non-randomised control trials were pooled using a random-effects model to calculate standardised mean differences (SMD) and 95% confidence intervals (CIs).

RESULTS

Resilience interventions improved resilience by a moderate amount in 13 studies with 990 participants (pooled SMD 0.74, 95%CI 0.03 to 1.46) and a large amount when interventions were greater than one session duration in 10 trials with 740 participants (pooled SMD 0.97, 95%CI 0.08 to 1.85). Grit and growth-mindset interventions improved grit (pooled SMD 0.48, 95%CI -0.05 to 1.00, n = 2) and growth-mindset (pooled SMD 0.25, 95%CI -0.18 to 0.68, n = 2) by a small amount. Resilience interventions decreased perceived stress by a small amount (pooled SMD -0.38, 95%CI -0.62 to -0.14, n = 5).

CONCLUSIONS

Resilience interventions improve resilience and decrease perceived stress in health professional students. Preliminary evidence suggests grit and growth-mindset interventions may also benefit health professional students. Interventions may be most effective when they are longer than one session and targeted to students with low baseline levels of resilience and grit.

It's very difficult to set the boundaries, it's human nature to want to respond: exploring health professions educators' responses to student mental health difficulties through a positioning theory lens

By virtue of their teaching role and contact with students, health professions (HP) educators are often the first point of connection for students who are experiencing mental health difficulties. Educators are increasingly expected to include some form of pastoral care in their role. Mental health-related interactions with students may have a negative emotional impact on educators, particularly when roles and expectations are not clearly defined and where boundaries are not managed effectively. Using positioning theory as a lens, this study explored how educators experienced such interactions and how this manifested in positions, storylines, and speech acts. Interviews were conducted with 27 HP educators at a faculty of medicine and health sciences. Reflexive thematic analysis using inductive coding identified themes corresponding to the nearing, weighted, ambivalent, and distancing positions participants adopted in relation to students with mental health difficulties. There was fluidity in and between positions, and more than one position could be occupied simultaneously; participants each moved through different positions in response to different relational situations. Multiple storylines informed these positions, representing how moral- and care-informed responsibility intersected with responsiveness to make certain actions possible or impossible. Normative and personal value narratives were evident in storylines, in many cases underscored by care or justice ethics. The value of positioning theory in facilitating reflective faculty development initiatives for educators engaged in these interactions is discussed.

Generalized anxiety disorder in Brazilian undergraduate dental students during the COVID-19 pandemic: A cross-sectional study

OBJECTIVE

Explore the prevalence of generalized anxiety disorder (GAD) and associated factors in undergraduate dental students during the first wave of the COVID-19 pandemic in Brazil.

MATERIALS AND METHODS

Cross-sectional study. A semi-structured questionnaire addressing the variables of interest was shared with dental students between July 8 and 27 2020. The outcome was determined using the seven-item generalized anxiety disorder (GAD-7) scale. A 'positive' diagnosis was defined as a total of ≥10 points on the scale. Statistical analysis involved descriptive, bivariate and multivariate analyses, with the significance level set at 5%.

RESULTS

Among the 1050 students evaluated, 53.8% had a positive diagnosis for GAD. The multivariate analysis revealed that the prevalence of symptoms was higher among individuals who resided with more than three people, those enrolled at teaching institutions that suspended all clinical and laboratory activities, those who did not have an adequate home situation to maintain distance learning, those who had been diagnosed with COVID-19, those who felt anxious about having to see patients with a suspicion or diagnosis of COVID-19 and those who preferred to interrupt in-person academic activities until the population is vaccinated for the COVID-19 virus.

CONCLUSION

The prevalence of GAD was high. Aspects related to the composition and organization of the home, the suspension of academic activities, a history of COVID-19 contamination, feelings of anxiety in providing dental care to patients with symptoms/suspected of COVID-19 infection and the preference to interrupt in-person academic activities until the population is vaccinated for COVID-19 were factors predisposing the students to anxiety during the first wave of the pandemic.

Mental health status and stressful life events among postgraduate nursing students in Cyprus: a cross-sectional descriptive correlational study

BACKGROUND

Despite prior evidence supporting the association between stressful life events and mental health status, there are limited data on the number and severity of stressful life events and their effects on university students' mental health status. Therefore, the present study aimed to: (a) examine mental health status and subsequent predictors of clinically significant mental distress symptoms, (b) estimate the number and severity of stressful life events, and (c) explore the associations between mental health status, stressful life events (number and severity) and sociodemographic characteristics.

METHODS

This study was descriptive, cross-sectional, and correlational with internal comparisons. A convenience sample of 90 Master of Science in nursing and midwifery students, participated in the study. Participants with a General Health Questionnaire-28 (GHQ-28) total score ≥ 24 were considered to have clinically significant mental distress symptoms. Descriptive and inferential statistics were evaluated, and Pearson's chi-square test for group differences was used to analyse the data. Analysis of variance and t-tests were used for comparisons between two or more groups, and regression analyses were employed to identify the predictors of GHQ-28 scores and clinical mental distress symptoms.

RESULTS

The final sample comprised 90 students (response rate: 97.8%), 33 (36.7%) of whom reported clinically significant symptoms of mental distress. Students with divorced parents [29.92 (± 10.62), p < .05] scored high on the GHQ-28. Participants who had low/no satisfaction with the education system posted higher scores than participants who had high/very high satisfaction [24.82 (± 11.68) vs. 17.93 (± 9.78), p < .05]. In the subscale measuring depressive symptoms, there was a statistically significant gender difference, with men reporting higher scores than females. [3.0± (3.69) vs. 1.60 (± 2.42), p = .034]. In multiple analyses of sociodemographic characteristics and those who scored higher on the Life Events Scale for Students (LESS) scale (≥ 340), the loss of parent/s was associated with the total GHQ-28 score (B=-17.046, p < .001). In multiple analyses, chronic physical disorders or disabilities and numerous stressful life events among students (≥ 8 events) were correlated with higher overall GHQ-28 scores (B = 15.232, p < .005).

CONCLUSION

The high frequency of clinical symptoms of mental distress among postgraduate university nursing students and their correlation with stressful life events highlights the need for university counselling services to provide psychological support strategies to students.

The Impact of Therapy Dogs on Prelicensure Baccalaureate Nursing Student Test Anxiety

AIM

This study examined the impact of a therapy dog intervention on baccalaureate nursing student test anxiety.

BACKGROUND

Nursing student test anxiety may hinder academic performance and program outcomes. Considering this negative impact, it is essential to implement anxiety-reducing strategies. Interaction with therapy dogs is linked with test anxiety reduction; however, minimal studies have explored this topic.

METHOD

A pretest/posttest quasi-experimental design was used to examine the impact of a therapy dog intervention on test anxiety. Repeated measures included the State-Trait Anxiety Inventory, heart rate, and cortisol levels. The multisite convenience sample included 91 junior-level prelicensure BSN students.

RESULTS

The intervention had a statistically significant impact on test anxiety reduction, noted by a decrease in State-Trait Anxiety Inventory scores, heart rate, and salivary cortisol levels ( p = .00).

CONCLUSION

Therapy dog interactions are an effective strategy to reduce test anxiety. The findings from this study may assist educators to implement future interventions.

Faculty caring behavior and effect on dental hygiene students' worry or anxiety

PURPOSE/OBJECTIVES

Studies in health professional students have shown the students' perception of instructor caring behaviors had a positive impact on student behaviors and their anxiety. Health professional students are under high emotional and academic demands during entry-level programs which can lead to higher anxiety. The purpose of this study was to measure the relationship between worry or anxiety and dental hygiene students' perceptions of faculty caring behaviors.

METHODS

Cross-sectional survey research was conducted with a convenience sample of dental hygiene students (n = 355) in the United States using a web-based survey. The validated instruments Nursing Students' Perceptions of Instructor Caring (NSPIC) and Penn State Worry Questionnaire (PSWQ) were used for data collection. The NSPIC contains five subscales including instilling confidence through caring (CTC), supportive learning climate, appreciation of life's meanings, control versus flexibility (F), and respectful sharing (RS). Data analysis included descriptive, correlation, and multiple linear regression.

RESULTS

The completion rate was 66% (n = 235). Findings showed the NSPIC subscale, CTC had a statistically significantly higher median score than other NSPIC sub-scales (p < 0001). The NSPIC subscale RS had the second-highest median score. The results of the PSWQ showed that 48% of participants were in the chronic worrier category. Regression analysis showed CTC was a significant predictor of worry (p < 0.001) and a one-unit increase in CTC resulted in a 0.21 decrease in the PSWQ score.

CONCLUSION

Our findings suggested instilling CTC behaviors was the most significant faculty caring behavior and was associated with lower levels of student worry. The results from this study may aid in identifying and developing effective caring behaviors for faculty to support students during stressful dental and allied dental curricula.

Association Between Stress and Program Length in Underrepresented Minority Physician Assistant Students

INTRODUCTION

The purpose of this study was to determine if there was a relationship between physician assistant (PA) program length and stress measures in PA students, particularly PA students classified as underrepresented minorities in medicine. The stress measures included emotional and physical well-being.

METHODS

The 2019 End of Program survey data were analyzed using multiple regression to determine if emotional and physical well-being could be predicted by PA program length, age, gender, PA school debt, and UR minority in medicine status.

RESULTS

Shorter PA programs were associated with higher physical well-being scores, although there was no difference between UR minority in medicine and non-UR minority in medicine students. Older students, males, and students with higher levels of PA school debt had lower scores for emotional and physical well-being.

DISCUSSION

Shorter program lengths should be considered for optimal physical well-being in all students. Further research is needed to understand optimal program length and experiences of these students .

A year and a half later: Clinical experiences of intern nursing students in the COVID-19 Pandemic: A constructivist grounded theory

Aims

The aim of this study is to develop a theory to explore the clinical experiences of interns in clinical practice during the COVID-19 pandemic.

Background

The COVID-19 pandemic is a serious public health problem influencing the healthcare systems worldwide. Nursing students were excluded from clinical practice for a long time due to the pandemic. However, the prolonged and uncertain pandemic conditions required the inclusion of fourth-year nursing students in clinical practice.

Design

A qualitative research design based on the Constructivist Grounded Theory approach was used in this study.

Methods

The research data were collected from fourth-year nursing students doing an internship at a university hospital in Turkey. Fourteen nursing students (12 females and 2 males) in the clinical practice during the COVID-19 pandemic with a mean age of 22.64 ± 0.225 were included in the study. In the collection of data, firstly, the purposeful sample selection method, then the theoretical sample selection method was used. On the online interview platform, the data were collected through individual interviews with those agreeing to participate in the study between July 2021 and August 2021 using a semi-structured interview form. The results were analyzed with initial, focused and theoretical coding. The research was reported based on the Consolidated Criteria for Reporting Qualitative Research guide.

Results

A core category and five main categories emerged in the study. The core category is a lonely bird and the main categories are emotions, challenges, coping methods, nursing experiences and solution suggestions.

Conclusions

This research can help create a conceptual framework of clinical practice experiences of intern nursing students during the COVID-19 pandemic. It is thought that intern nursing students need to be supported by reliable authorities before and during the internship. Intern students stated that they experienced many emotions together and felt alone. Our study results revealed that intern nurses need more psychological support, especially during the pandemic period. A remarkable finding of the research is that interns now think of themselves as professional nurses. For interns to develop effective coping methods, intensive and regular training should be organized in cooperation with the hospital and school administration.

The experience of anxiety among Chinese undergraduate nursing students in the later period of their internships: findings from a qualitative study

Background

Clinical internships are a critical transition period for nursing students to develop into nursing professionals and are essential for the solidification of their professional attitudes. Undergraduate nursing students face multiple sources of severe anxiety that affect their nursing career development during this period. This study aimed to understand the anxiety experienced by undergraduate nursing students in the later period of their internship periods in a Chinese educational context.

Methods

A descriptive qualitative study was conducted. A purposive sample of 17 undergraduate nursing interns with experiences of anxiety was selected from three teaching hospitals in Hunan Province, China. Data were collected through semi-structured interviews and analyzed using the Colaizzi seven-step method for data analysis.

Results

Three themes emerged: the sources of perceived anxiety, the psychological journey of coping with anxiety, and suggestions for nursing management and education. The sub-themes for the first theme included career decision dilemmas, competitive pressures for employment, worries about progress of the graduation projects, challenges of the nursing licensure examination, and low self-confidence in clinical competence. The second theme consisted of two sub-themes: negative avoidance and retreat, and positive preparation and response. The third theme consisted of policy support to create more employment opportunities, comprehensive guidance from nursing schools and hospitals, and psychological assistance and counseling.

Conclusions

This study revealed that undergraduate nursing students were prone to anxiety during the later period of their clinical internships. Specific sources of anxiety encompassed career decision-making, job pursuit, graduation, and licensure examination. Undergraduate nursing students adopted both positive and negative approaches in coping with anxiety during the later period of their clinical internships. Nursing educators and administrators should develop appropriate instructions and support systems to reduce anxiety among undergraduate nursing students.

Factors affecting test anxiety: a qualitative analysis of medical students' views

BACKGROUND

Medical students are vulnerable to test anxiety (TA), which impacts their professional lives and jeopardizes the optimal health care of their patients. The qualitative exploration of TA among medical students is crucial to understanding the problem. Hence, this study examined medical students' insights into TA and their suggestions on how to reduce it.

METHODS

We conducted a phenomenological study on medical students at a public university. We utilized focus group discussions (FGDs) to investigate their experiences of TA. The FGDs were transcribed verbatim, and these transcripts were analyzed using Atlas.ti software. The thematic analysis followed the recommended guidelines.

RESULTS

Seven FGD sessions were conducted with 45 students. Three major themes emerged: the students, their academic resources, and the examiner. Each theme comprised mutually exclusive subthemes. The "students" theme was divided into negative vs. positive thoughts and self-negligence vs. self-care, "academic recources" into heavy curriculum vs. facilitative curricular aids, and "examiner" into criticism vs. feedback and strict vs. kind approaches.

CONCLUSION

This study provides a solid foundation for policymakers and decision makers in medical education to improve current assessment practices and student well-being. Medical students will be able to significantly alter and reduce TA if they are provided with additional psychological support and their examiners are trained on how to deal with examinees.

Morale and Perceived Threats as Predictors of Psychological Coping with Distress in Pandemic and Armed Conflict Times

The present study investigated predictors of psychological coping with adversity responses during the COVID-19 pandemic and an armed conflict. Two paired samples that represented the Israeli population that was exposed to both adversities were compared. Respondents rated five different psychological coping responses associated with the two adversities, such as anxiety or individual resilience. Perceived security, pandemic, economic, and political risks, as well as level of morale, were rated. Two major findings were disclosed by two path analyses. Morale improved the predictions of the varied coping responses in both the pandemic and conflict and was the best predictor of four out of five responses and the second-best predictor of the fifth response. Contrary to previous studies, our findings revealed that the concept of a single major predictor of coping responses under distress is an overgeneralization. In both cases, the coping responses were better explained by other perceived risks rather than by the risk of the investigated adversity. Rather than assume that a perceived security threat accounts for low levels of public moods, it is vital to study the antecedents of coping responses and to empirically examine additional potential predictors.

Prevalence of Generalised Anxiety Disorders Among Clinical Training Students at the University of Sharjah

Introduction

This study aimed to determine the prevalence of anxiety among clinical training students. Despite the existence of interventions that address anxieties, lack of data on the size of the problem, especially in the Middle East where mental health stigmatized, means that outcomesmay not be maximized.

Materials and Methods

Our study was cross-sectional survey of the University of Sharjah (UOS), the United Arab Emirates students undergoing clinical training in health sciences. The participants were selected from all the three UOS campuses: medical and science colleges; women's colleges; and men's colleges. A sample of 219 clinical training students were randomly sent an electronic link to participate on an online survey. The study received ethical approval from the UOS Research Ethics Committee number is REC-20-03-04-02-S.

Results

The mean score for state anxiety was 47.24±1.31 and the mean score for trait anxiety was 46.82±1.21. These scores indicated a high level of anxiety among students undertaking clinical training. Overall, 63% of the sample were classified as having high state anxiety, and 62% had high trait anxiety.

Conclusion

This study shows clinical training students experience high levels of state and trait anxiety. It is necessary to address this issue to improve the conditions and circumstances for students entering clinical training. It may also be necessary to implement strategies to enable students with anxiety to perform well in clinical training.

Mental health resources in pharmacy schools

INTRODUCTION

This study aims to examine the availability of mental health resources available to pharmacy students. Identifying if pharmacy schools have specific resources is important given the increasing prevalence of mental health disorders among pharmacy students.

METHODS

This study has two arms: (1) survey sent to representatives of student affairs of 11 pharmacy schools, and (2) website scan performed of all pharmacy schools in the United States. The survey collected information on mental health resources available including availability, location, and future plans. The website scan examined resources at each school listed on the doctor of pharmacy school directory on the Pharmacy College Application Service website, and the difficulty of locating this information. Microsoft Excel was used to perform descriptive statistics.

RESULTS

For the survey arm (n = 9), 83% of respondents were directors of student affairs. Top services located within the university campus, but not within the pharmacy school, were wellness activities (67%) and an on-site counselor (89%). Similarly, for the website scan (n = 150), most schools had availability of an on-site counselor; however, 83% of counselors were located within the university campus, not within the pharmacy school. For 77% of pharmacy schools, no information on mental health resources was found on their websites. The information was considered "somewhat" or "extremely difficult" to find for 45% of schools.

CONCLUSION

Both arms found that the most commonly available services, including an on-site counselor, were not located at the pharmacy school but instead part of university campus services.

Stress, Anxiety and Depression among a Cohort of Health Sciences Undergraduate Students: The Prevalence and Risk Factors

Stress, anxiety, and depression (SAD) have a negative impact on the learning and academic performance of university students. Hence, this study aimed to determine the prevalence, as well as the risk factors associated with SAD among a cohort of students pursuing undergraduate degree courses in health sciences. This is part of the strategy in building a healthy nation. A questionnaire containing socio-demographic factors and the short version of Depression, Anxiety, and Stress Scale-21 (DASS-21) was used to assess the likelihood of psychological distress. Logistic regression analysis was conducted to determine the risk factors of SAD. In total, 449 students completed the questionnaire (93.9% response rate). Of these, 65% had stress, 85.1% had anxiety and 51.4% had depression. Most cases of stress (74.6%) and depression (66.2%) were of normal-to-mild level, while 74.6% of them showed moderate-to-extremely severe anxiety. There was a statistically significant association between stress score and the year of study. In the regression analysis, poor sleep quality and fatigue were risk factors of anxiety and depression, whereas low-grade fever and frequent headaches were risk factors for stress and anxiety. Stress, anxiety, and depression scores were significantly higher among students studying medical imaging. A substantial proportion of health science students are suffering from SAD. This study recommends screening and close monitoring of the above-mentioned predictors and the formulation of comprehensive intervention strategies for students with SAD.

Evaluation of Anxiety, Suicidal Risk, Daily Stress, Empathy, Perceived Emotional Intelligence, and Coping Strategies in a Sample of Spanish Undergraduates

Anxiety disorders and suicide are commonly under-recognized issues that can be a public health problem. Adolescents are among the most affected population groups and studying them can prevent serious health problems. These two elements are related, but at the same time, they can only be understood from a multifactorial point of view, so other related variables such as emotional intelligence, empathy, or coping strategies are key to understand their effect on the population. In this study, a series of methods to measure the variables of interest were applied to a specific group of adolescents to determine their mental health levels, focusing on suicide and anxiety episodes. The results reflected average levels with a tendency to be high in the case of anxiety and nonalarming levels in terms of suicide risk, both parameters presenting more worrying values in women. In turn, the correlation between suicide and anxiety was demonstrated considering the other variables (coping strategies, empathy, emotional intelligence, and prosociality). This research has relevant implications for the diagnosis, orientation, and design of psychoeducational and clinical interventions that contribute to the improvement of their well-being and quality of life.

Prevalence of Mental Health Disorders Among Undergraduate University Students in the United States: A Review

The aim of the current review is to describe the prevalence and demographic correlates of mental health disorders among undergraduate university students in the United States. A search strategy was built and conducted using PubMed, PsycINFO, and CINAHL to identify studies published between 2009 and 2019 on the prevalence of mental health disorders, as defined in the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders, in undergraduate students in the United States. A total of 12 studies were included in the final data extraction. The highest prevalence rates were identified in eating disorders, which ranged from 19% to 48%, followed by compulsive disorders (2% to 12.27%), depression (22%), posttraumatic stress disorder (8%), and sleep disorders (9.4% to 36%). The identified prevalence of mental health disorders is high, and the subsequent impact on this population is worrying. There is an urgent need to develop strategies for early screening and management of mental health services in university settings. [Journal of Psychosocial Nursing and Mental Health Services, 59(2), 17-24.].

Dysregulated brain salience within a triple network model in high trait anxiety individuals: A pilot EEG functional connectivity study

Although previous studies have reported the association between large-scale brain networks alterations and pathological anxiety, abnormalities in the dynamic interaction among the triple network model in anxiety disorders and, especially, in trait anxiety is still poorly explored. Thus, the main aim of the current study was to investigate triple network functional dynamics in subjects with high trait anxiety during resting state (RS) through electroencephalography (EEG) connectivity. Twenty-three individuals with high-trait-anxiety (HTA) and forty-five participants with low-trait-anxiety (LTA) were enrolled. EEG analyses were conducted by means of the exact Low-Resolution Electromagnetic Tomography software (eLORETA). Compared to LTA participants, HTA subjects showed a decrease of alpha connectivity within the salience network (SN), between the dorsal anterior cingulate cortex (dACC) and both left and right anterior insula (AI). Furthermore, SN functional connectivity strength was negatively correlated with higher trait anxiety, even when controlling for potential confounding variables (e.g., depressive and obsessive-compulsive symptoms). Taken together, our results point out a specific functional connectivity pattern in HTA individuals, which consists in a dysfunctional communication within the SN, specifically in the AI-dACC pathway. This functional pattern could underline, at rest, saliency detection and brain correlates of altereted emotion regulation and cognitive control processes typically involved in anxiety.

Clinical placement anxiety in undergraduate nursing students: A concept analysis

OBJECTIVE

The primary aim of this review was to complete an in-depth analysis of clinical placement anxiety in undergraduate nursing students. Our overall goal was to establish a strong foundation for clinical education strategies and future research on clinical placement anxiety in nursing education.

DESIGN & METHODS

We utilized Walker and Avant's systematic 8-step approach to concept analysis as a framework to develop a comprehensive understanding of clinical placement anxiety in undergraduate students.

DATA SOURCES

A review of existing literature on clinical placement anxiety was conducted using the electronic databases of PubMed, CINAHL, and PsychInfo, as well as a grey literature and snowball search. Search terms included clinical placement, clinical experience, nursing students, undergraduate nursing students, and anxiety.

RESULTS

The literature search resulted in 81 articles that met the inclusion criteria. Five defining attributes were identified: a vague or unknown threat, psychological-emotional responses, psychological-cognitive responses, physiological responses, and unfamiliar environments or situations. Antecedents, consequences, and empirical referents of the concept were also highlighted.

CONCLUSIONS

Insights gleaned from this concept analysis may enhance the ability of clinical nursing educators to effectively prevent and manage student anxiety in the clinical setting. By contextualizing anxiety, we have also validated the importance of further exploration of the anxiety experienced by undergraduate nursing students during their clinical experiences. Thus, this concept analysis establishes the foundation for educational strategies, as well as future research in nursing education.

Predicting Success for Student Physical Therapists on the National Physical Therapy Examination: Systematic Review and Meta-Analysis

BACKGROUND

In physical therapist education, the National Physical Therapy Examination (NPTE) is the predominant measure of student success. Because the NPTE is a high-stakes examination, predicting NPTE performance is important for physical therapist students and programs.

PURPOSE

The purpose of this study was to determine the relationships between first attempt NPTE performance, physical therapist applicant variables, and physical therapist student variables. The 4 identified physical therapist applicant variables were undergraduate cumulative grade point average (GPA), undergraduate GPA for prerequisite courses, Graduate Record Examination verbal and quantitative subscale scores, and admission scores. The 4 identified physical therapist student variables were first- and third-year physical therapist student GPA, clinical performance scores (first and final clinical experiences), noncognitive student variables, and comprehensive examination scores.

DATA SOURCES

A systematic search was performed using the databases PubMed and EBSCO (1966-2018).

STUDY SELECTION

Studies included in the review met the following criteria: the physical therapist education program offered an entry-level master's or doctorate degree, pertinent data were available for each independent variable, the relationship between the independent variable and the NPTE was investigated, the NPTE was a continuous variable, the program was a US entry-level therapist education program, and the study was peer reviewed.

DATA EXTRACTION

Two independent reviewers completed data extraction and quality appraisal using the McMaster Appraisal Tool.

DATA SYNTHESIS

Random-effects meta-analyses using the Pearson product-moment correlation coefficient as the measure of effect size was used.

LIMITATIONS

Limitations of the review included a lack of homogeneity, high NPTE pass rates, modifications to the McMaster Appraisal Tool, small sample sizes, and publication bias.

CONCLUSIONS

No one physical therapist applicant variable should be used as an independent predictor of first attempt NPTE performance. For physical therapist students, first- and third-year physical therapist student GPA had a strong relationship with first attempt NPTE performance; clinical performance had a weak and nonsignificant relationship with first attempt NPTE performance.