PERFORMA

Name Of The Student: _____________________________________

Gender:

Male Female

Type Of Student:

Dental Student Medical Student

Academic Year:

1st Year 2nd Year 3rd Year 4th Year 5th Year

Please Tick the following Boxes as appropriate to rate how stressful you find each one:

0=not pertinent,1=not stressful,2=slightly stressful,3=moderately stressful and 4=very stressful.

1 Amount of assigned coursework

0 1 2 3 4 2 Patients inability to complete the prescribed care plan

0 1 2 3 4 3 Difficulty of the coursework

0 1 2 3 4 4 Responsibilities for comprehensive patient care

0 1 2 3 4 5 Competition with classmates

0 1 2 3 4 6 Patients not available at prescribed times for treatment or examination

0 1 2 3 4 7 Examinations and grades

0 1 2 3 4

8 Difficulty in learning clinical procedures

0 1 2 3 4 9 Learning environment created by faculty

0 1 2 3 4 10 Relationships with other members of the class

0 1 2 3 4 11 Receiving criticism about work

0 1 2 3 4 12 Difficulty in learning precision manual skills required in clinical and laboratory work

0 1 2 3 4 13 Lack of confidence to be a successful professional student

0 1 2 3 4 14 Lack of time for relaxation

0 1 2 3 4 15 Amount of cheating in professional school

0 1 2 3 4 16 Rules and regulations of the school

0 1 2 3 4 17 Working on patients with poor personal hygiene

0 1 2 3 4 18 Lack of home atmosphere in living quarters

0 1 2 3 4 19 Completing graduation requirements

0 1 2 3 4 20 Having children at home

0 1 2 3 4 21 Marital/relationship adjustment problems

0 1 2 3 4 22 Your expectations of professional school versus reality

0 1 2 3 4 23 Fear of failing a course, a scholastic year, or a licensing exam

0 1 2 3 4 24 Insecurity concerning your professional future

0 1 2 3 4 25 Financial responsibilities

0 1 2 3 4 26 Lack of time to do assigned schoolwork

0 1 2 3 4 27 Lack of confidence in career decision

0 1 2 3 4 28 Forced postponement of marriage, engagement, or having children

0 1 2 3 4 29 Personal physical health

0 1 2 3 4 30 Attitudes of faculty toward professional students

0 1 2 3 4 31 Discrimination due to race, class status, ethnic group, or sexual orientation

0

1 2 3 4 32 Having a dual role of spouse/parent/partner and student/professional

0

1 2 3 4 33 Inconsistency of feedback on your work among different instructors

0 1 2 3 4 34 Fear of being unable to keep up with workload

0 1 2 3 4

PERFORMAPlease Tick the following Boxes as appropriate to rate how stressful you find each one:0=not pertinent,1=not stressful,2=slightly stressful,3=moderately stressful and 4=very stressful.1 Amount of assigned coursework2 Patients inability to complete the prescribed care plan