20-ITEM MEDICAL STUDENTS STRESSOR QUESTIONNAIRE FORM

Personal details (confidential and for research purposes only)

Name: Date of birth:
Institution: Gender:
Address: Ethnic group:
Study stream:
Matrix No:
Telephone: Fax: IC No:
Email: Date:

Rating Scales

0 1 2 3 4

Causing no stres at Causing mild Causing moderate Causing high Causing severe
all stress stress stress stress

I II III IV V VI 2nd I II III IV V VI

1 Total

2 Divided by 5 4 3 3 2 3

3 Score

4
5 Score Domain Rating Item
6
3.51-4.00
7
8 4
3.01-3.50
9
10
2.51-3.00
11
12 3
2.01-2.50
13
14 1.51-2.00
15
16 2
1.01-1.50
17
18 0.51-1.00
19
20
1
0.01-0.50
Total
20-ITEM MEDICAL STUDENTS STRESSOR QUESTIONNAIRE FORM