33 Stress Inoculation in Emergency Medicine Residents: Effects of a Mental Performance Tool on Stress Response during a Simulated Resuscitation

Abstract

Acute stress impairs physician decision-making and clinical performance in resuscitations. Stress inoculation, a multi-step cognitive-behavioral approach, modulates stress response in high-performance fields. This study assessed: 1) the effects of implementing a stress inoculation program on emergency medicine (EM) resident stress response in simulated resuscitations; 2) EM resident perceptions of this program. This was a randomized, prospective, educational intervention trial of EM PGY-2 residents at 7 residencies. The intervention group received a 20-minute didactic one month prior to the study assessment, which discussed effects of acute stress on performance and introduced the “Breath, Talk, See, Focus” (BTSF) mental performance tool. The assessment was conducted at “Simtastic,” a case-based simulation evaluation of Chicago PGY2 EM residents. Thirty minutes prior to the study case, the intervention group received a 10-minute review of the BTSF tool. Subjective stress response was measured using the STAI-6, a validated psychological scale evaluating cognitive and somatic stress response. Scores were obtained during the Simtastic orientation period and after completing the simulated resuscitation. Objective stress response was measured using wearable monitors which calculated heart rate (HR) and heart rate variability (HRV). These data were acquired during the Simtastic orientation and the simulated resuscitation. Subjects completed surveys at enrollment and after the simulation case evaluating perceptions of the importance of stress inoculation training. Sixty-one of 87 eligible residents participated (intervention: 25; control: 36). The mean change in pre- and post-case STAI-6 scores were not significantly different between groups (-1.7 vs 0.4, p=0.38). There were no significant differences in mean HRV between groups (-3.8 vs -3.8 ms, p=0.58) (Table 1). There were no significant differences in responses between groups on the Pre-Intervention Survey. On the Post-Intervention Survey, however, in response to the question, “How relevant is the topic of stress inoculation to the resident physician?” 91% of the intervention group responded “very relevant” compared to 26% of the control group (p <0.01). In response to the question “How important is it to include education about stress inoculation topics in residency training?” 75% of the intervention group responded “very important” compared to 28% of the control group (p <0.01). This evaluation of a stress inoculation intervention demonstrated that residents value this training, but no significant differences in subjective or objective measures of stress response were demonstrated using this technique in a simulated resuscitation. Future investigations with longitudinal interventions are warranted.