Stress Reduction in Healthcare Students

Problem and Purpose

The critiqued article was authored by Barbosa et al. (2013) who addressed the issue of stress among graduate health care students. The authors clearly state the problem: students experience significant stressors, which is practically important because it can affect their education and further practice. The purpose was to evaluate the effect of mindfulness-based stress reduction (MBSR) training on students; the hypothesis was that the training “could reduce anxiety and increase empathy” (Barbosa et al., 2013, p. 13). Definitions for key terms were provided.

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Literature Review

Authors use relevant literature that supports their theoretical framework and provide existing knowledge and previously obtained findings on the issue of interest. However, there is no separate literature review section in the article; the results of such a review are distributed among other sections. The review is rather specific to the subject as opposed to either too broad or too narrow; however, the references are not recent; out of 34 sources used, only one was written after 2010, and most were written between 2004 and 2010. Bias was not detected.


The research design is quasi-experimental, which is a type of a quantitative study (Creswell, 2013). The participants were provided MBSR training and surveyed before and after the training. This was not an original study because the instruments the authors employed (specifically, the questionnaires for assessing anxiety, empathy, and burnout) had not been designed by them. The methods comply with the purpose of the study.


Thirteen students participated in the study (excluding the control group); the inclusion criteria were as follows: aged between 21 and 65, full-time student at Samuel Merritt University, and current GPA of 2.5 or higher. Any potential participants who were planning to discontinue psychiatric medication during the planned period of training were excluded. All the participants provided their informed consent, and their personal data and confidentially were properly protected according to general research ethics. The small sample is a major weakness of the study.


The independent variable was the MBSR training; the dependent variables were the participants’ levels of anxiety, empathy, and burnout. To manipulate the independent variable, the authors properly supported their training initiative with theoretical justification and the findings of previous similar studies. For the participants, the training consisted of attending weekly classes and completing home assignments related to mindfulness practices. It can be argued that the participants were properly protected from possible negative outcomes of the instructional intervention.


There are multiple components of the validity and reliability of a study (Bowling, 2014); primarily, for the results to be generalizable, it is necessary that the methods are acknowledged and properly used, and the sample is representative. It can be argued that Barbosa et al. ( 2013) used a sample that is too small to be representative. However, in terms of properly selected and applied research methods and measurement instruments, the study can be considered valid and reliable.

Statistical Procedures

Statistical procedures were conducted with the use of the SAS statistical software; the method was a chi-square test of independence, and the purpose of using this statistical analysis was to examine the dependent variables. T-tests were used to obtain mean values of the anxiety, empathy, and burnout levels and compare the values from baseline measurements to follow-up measurements and the results demonstrated by the control group. According to de Winter (2013), these statistical tools are valid for assessing the correlations even in small samples.

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Test Value and Level of Significance

The goal of reporting the test value by researchers is stating what is used as a frame of reference in a given study. When presenting their results, the authors explained how obtained values correspond to the generally expected results of the application of the three measuring instruments: the questionnaires for measuring the levels of anxiety, empathy, and burnout; however, the test value specifically was not discussed. Statistical significance indicates that there is, in fact, a correlation between dependent and independent variables in a study (“Statistical significance,” 2012), Barbosa et al. (2013) do state that the P value was less than 0.05.

Reliability and Validity of Tools

The measurement tools were Burns Anxiety Inventory (BAI), Jefferson Scale of Physician Empathy (JSPE) and Maslach Burnout Inventory (MBI). The mechanisms by which the three questionnaires help assess anxiety, empathy, and burnout respectively were explained; however, the authors did not specifically discuss the reliability or validity of these tools. Instead, the authors referred to relevant literature that provided instructions on how to use the tools.

Data Analysis

The authors obtained quantitative data and analyzed it with statistical tools (see Statistical Procedures). During data analysis, the hypothesis was confirmed, and the process of analyzing participants’ results complied with the purpose of the study. Barbosa et al. (2013) do not seem to question their research instruments; when discussing weaknesses, they do not refer to the use of the three questionnaires.

Support from Other Findings

The authors chose not to include a literature review section, but this does not necessarily indicate a lack of support from other findings. Throughout the article, the authors refer to various relevant materials, and the general impression is that proper support from reliable sources has been provided. Further, when discussing the results, the authors put their study in the context of researching the issue of interest in general and refer to other studies.


Major limitations of the study included the small sample and the quasi-experimental design. The two are interconnected: due to the small number of people who agreed to participate, complied with the inclusion criteria, and did not drop the training, it was not possible to use the randomized design. Also, the authors recognize that the levels of anxiety may be different among the participants because those were students from different disciplines. It can be argued that these limitations undermine the generalizability of the study.


Pursuing the research purpose, the study confirms that MBSR training can decrease anxiety and increase empathy in graduate health care students. This suggests that such training may be considered for incorporation into educational programs. However, the authors also acknowledge that further research is needed to identify long-term effects.

Personal Perspective

Although the study was dedicated to students specifically, I think the results can be applied to health care practitioners, too. It is important that Barbosa et al. (2013) specifically addressed the issues of anxiety and empathy because the former is a major factor in care providers’ education and work, and the latter is a crucial component of providing high-quality care. Since it is confirmed that MBSR practices can reduce anxiety and raise empathy, I will use it in my practice by considering mindfulness as a method of coping with stress. Eberth and Sedlmeier (2012) suggest that MBSR can ensure higher psychological well-being, and I believe that the critiqued article makes a valuable contribution to this recognition, which is why it can be used in health care providers’ practice.

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Barbosa, P., Raymond, G., Zlotnick, C., Wilk, J., Toomey, R., & Mitchell, J. (2013). Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Education for Health, 26(1), 9-14.

Bowling, A. (2014). Research methods in health: Investigating health and health services. Maidenhead, England: Open University Press.

Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). Thousand Oaks, CA: Sage.

De Winter, J. C. (2013). Using the student’s t-test with extremely small sample sizes. Practical Assessment, Research & Evaluation, 18(10), 1-12.

Eberth, J., & Sedlmeier, P. (2012). The effects of mindfulness meditation: A meta-analysis. Mindfulness, 3(3), 174-189.

Statistical significance. (2012). Web.

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