Work pressure and the type A behavior pattern exam stress in male medical students.

The psychologic and physiologic effects of variations in occupational stress on Type A (coronary-prone) and Type B men have not previously been examined. Accordingly, 58 male medical students in two successive first-year classes (32 As, 26 Bs defined by interview) were tested for mood states, perception of work pressure, and for pituitary-adrenal and cardiovascular function during a period of minimal work pressure (no exams for 1 week) and during maximal work pressure (final exam week). All observations were made at the beginning of the school day, while the students were studying course material in the building where classes were held and study modules were located. Perceived stress and self-ratings of dysphoric moods increased significantly (ps less than 0.0005) for both groups during exams compared to no exams. Plasma cortisol concentrations increased significantly (+20%) from no exams to exams for both As and Bs. Heart rate increased significantly to exams (+8%) and did so slightly more for As (+9%) than for Bs (+7%), with As showing significantly higher rates in the work setting at both times. Systolic blood pressure increased nonsignificantly for both groups. The effect of the higher heart rate and the slight systolic blood pressure rise produced a significantly greater rate-pressure product for As than for Bs at both exams and no exams (p less than 0.005), with As showing a larger rise to exams than did Bs (+11% vs. +8%). Results indicate that the As had a higher level of tonic cardiovascular activation in the work place than the Bs, and that this was additive with the effects of increased work pressure.