Key result
Pre-examination stress reduces resting RMSSD by ~13 ms compared to baseline.
Why the study?
Professional medical examinations induce substantial psychological distress, prompting evaluation of within-participant shifts in cardiac autonomic modulation, resting blood pressure, endocrine markers, and perceived stress.
Does the anticipatory pre-examination period reduce 5-minute resting RMSSD compared to a baseline non-examination period in MBBS medical students?
Cohort (n=46)
Does the anticipatory pre-examination period reduce 5-minute resting RMSSD compared to a baseline non-examination period in MBBS medical students?
Professional examination stress in medical students is associated with significant reductions in vagally-mediated heart rate variability (RMSSD) alongside increases in heart rate, blood pressure, salivary stress biomarkers, and perceived stress.
Pre-examination stress was associated with lower RMSSD in students; leaves open whether stress mitigation preserves vagal tone.
Background: Professional medical examinations induce substantial psychological distress. This prospective longitudinal study evaluated within-participant shifts in cardiac autonomic modulation, resting blood pressure, endocrine markers, and perceived stress between a baseline non-examination period (T1) and an anticipatory pre-examination period (T2). Methods: In this prospective repeated-measures cohort, 50 MBBS students were enrolled and assessed at T1 (6–8 weeks before examinations) and T2 (1–3 days before the first professional examination); 46 students with complete, quality-assured paired data were analysed (aged 20.4 ± 1.2 years; 52.2% female). The primary outcome was 5-minute resting Root Mean Square of Successive Differences (RMSSD). Secondary outcomes included Standard Deviation of NN intervals (SDNN), Heart Rate (HR), blood pressure (SBP, DBP, MAP), salivary cortisol, salivary alpha-amylase 1 (AMY1) protein concentration (ELISA; enzymatic activity was not measured), and Perceived Stress Scale (PSS-10) scores. Paired t-tests and correlation analyses of paired differences (Δ = T2 − T1) were conducted. Results: Of 50 enrolled students, 46 (92%) had complete paired assessments meeting quality criteria and were analysed (2 lost to follow-up, 2 excluded for data quality). Resting RMSSD declined significantly from 42.8 ± 11.3 ms at T1 to 29.4 ± 9.6 ms at T2 (Δ = −13.4 ms, 95% CI: −16.1 to −10.7, p < 0.001, Cohen’s dz = 1.48). Significant increases occurred in resting HR (Δ = +9.2 bpm), SBP (Δ = +6.2 mmHg), DBP (Δ = +4.1 mmHg), salivary cortisol (Δ = +3.12 nmol/L), salivary AMY1 protein (Δ = +14.2 ng/mL), and PSS-10 (Δ = +6.8) (p < 0.001 for all). Within-person ΔRMSSD correlated moderately with ΔPSS-10 (r = −0.42, p = 0.004) but showed no significant correlation with Δcortisol (r = −0.19, p = 0.205). Conclusions: The pre-examination period was associated with reduced RMSSD, higher heart rate and blood pressure, and higher salivary cortisol, salivary AMY1 protein concentration and perceived stress. Changes in physiological and psychological measures were not uniformly correlated within individuals, suggesting domain-specific response patterns.
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Dr. Sonal Singh1, Dr. Moattar Raza Rizvi2, Dr. Ravi Vashistha3 (2026) conducted a cohort in Psychological distress during professional medical examinations (n=46). Anticipatory pre-examination period (T2, 1-3 days before first professional examination) vs. Baseline non-examination period (T1, 6-8 weeks before examinations) was evaluated on 5-minute resting Root Mean Square of Successive Differences (RMSSD) (MD -13.4 ms (Cohen's dz = 1.48), 95% CI -16.1 to -10.7, p=<0.001). Pre-examination stress significantly reduced 5-minute resting RMSSD compared to baseline (29.4 vs 42.8 ms; MD -13.4 ms, 95% CI -16.1 to -10.7; p<0.001).
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