Dogs Offering Guidance: Therapeutic Observation for Reducing Examination Anxiety (DOGTOR). A Pilot Feasibility Study

Physiotherapy education should prepare graduates to become physiotherapists who work closely with patients to effectively assess, diagnose and treat a variety of conditions. Thus, it is essential that physiotherapy education should also include evaluation that assesses these key skills and competencies. This could be through both written examinations (to measure cognitive skills) and practical exams, such as Objective Structured Clinical Examinations (OSCEs), where students are required to apply their practical knowledge in a standardised, simulated environment. Practical exams usually include a student, a mock patient, a limited time in which a particular skill should be demonstrated and an assessor that provides a score of the student's performance. They are designed to determine whether a student has achieved a threshold of competence that will ideally ensure effective and safe practice in a real-world environment. Most students and assessors endorse practical examinations as a valuable form of feedback.

Despite their potential benefits, like other forms of examination, practical exams are a source of anxiety and stress for many students. Key sources of such exam stress include fear of failing (particularly in front of peers or assessors and "losing face"), not being able to retrieve knowledge under pressure, running out of time and inability to interpret the exam question. Practical exams require more preparation and have been reported to be more anxiety-inducing than other forms of examination, such as written exams. Examination stress is associated low self-esteem, anxiety, depression and poor sleep quality. While some exam-related stress can heighten exam performance, too much or too little stress can impact examination validity by impairing performance of actual ability. Therefore, in the interest of both student and assessor, it is imperative to reduce examination stress where possible so that student performance is better reflection of their actual skills and or competence.

One possible strategy to assist with reducing examination stress for students is canine interaction. In the inpatient hospital setting, animal-assisted therapy has found to be a safe and useful option for managing stress and has demonstrated greater stress reduction than other stress relieving methods such as reading, biofeedback and mindfulness. Within a university setting, canine interaction has been shown to improve mood, affect, well-being, reduce anxiety and stress. However, most of these studies did not investigate canine-intervention during an examination period, and of those which did, canine-intervention was performed some time before (from 60 minutes to two weeks), which allows time for additional stressors to influence findings. To date, there are no randomised studies that have been conducted specifically in physiotherapy students immediately before an OSCE. Therefore, the aims of this study are to (1) measure the impact of canine interaction immediately prior to a practical examination on perceived and physiological stress and (2) to determine if canine interaction impacts examination scores. Understanding the impact of canine interaction in this setting may provide a novel and relatively low-cost strategy to minimise examination stress immediately before an OSCE and boost grades.