Board 437 - Research Abstract Psychological and Physiological Effects of Briefing Videos in Simulation-Based Medical Training (Submission #980)

Abstract

Introduction/Background Team performance and medical technical skills may improve after multi-professional obstetric team training in a medical simulation center.1 Suspension of disbelief is necessary to create an effective training. To achieve suspension of disbelief, various introductions and briefing Methods can be used. In our medical simulation center in the Netherlands (medsim, Eindhoven) briefing videos are used in order to enlarge engagement of trainees and thereby the efficacy of the training. Our research question is whether briefing videos have an advantage over textual briefings. We hypothesized that the combination of visual and auditory stimuli is more likely to activate brain structures (priming), resulting in increased sympathetic activity. This activity may lead to better and faster engagement in medical simulation. The aim of this study is to measure the effect of an immersive briefing video on psychological stress, physiological activity, performance and suspension of disbelief, in comparison to a textual briefing. Methods Randomized controlled trial in which medical students were asked to participate in a medical simulation experiment. The students were randomly assigned to an experimental group (video briefing) or a control group (textual briefing). The scenario comprises of a resuscitation of an adult. The simulator used for this scenario was Resusci Anne® (Laerdal, Norway). Physiological parameters (heart rate (HR), HR variability and skin conductance) were measured with an ECG-necklace and wristband. This equipment is especially designed for measuring stress parameters by an open innovation center (Holst Centre, Belgium – the Netherlands). The Dutch (shortened) Profile of Mood States (POMS) was fulfilled before and after the briefing and at the end of the training.2 The six-item stress subscale of the POMS was used to measure emotional stress. Furthermore, a questionnaire about suspension of disbelief was accomplished at the end of the experiment. The scenarios were videotaped and performance was independently scored by two researchers, who were blinded to the allocation group. For assessment of medical performance a checklist, based on Dutch resuscitation guidelines was developed. Results Before entering the simulation scenario, the experimental group (N=14) saw a briefing video while the control group (N=14) read a textual briefing. Prior to the briefing, scores on the stress subscale were similar in both groups. Immediately after the briefing there was no significant difference between the experimental and control group (M(SD): 13.0(3.7) versus 14.0(4.1), p=.53). At the end of the experiment, the experimental group scored significantly higher on the stress subscale than the control group (M(SD): 8.1(2.0) versus 6.9(1.0), p=.04). The experimental group reported to feel more nervous (p=.03). The physiological parameters (HR, HR variability and skin conductance) showed an increase in sympathetic and a decrease in parasympathetic activity, from baseline to briefing and from briefing to evaluation. However, there were no differences in physiological parameters between the groups. We found no significant difference in items about suspension of disbelief between the two groups. Resuscitation was better performed in the control group (M(SD): 23.5(4.2) versus 18.7(4.1), p<.01)). Conclusion Briefing videos in medical simulation settings seem to contribute to increased stress. Not immediately after the briefing, but after the evaluation, differences in emotional stress were found between the groups, suggesting a delay in emotional response. However, there is no difference in achieving suspension of disbelief between video and textual briefing. The control group showed a better resuscitation performance than the experimental group. However, this performance does not automatically represent the efficacy of the training. To optimize efficacy, cognitive and physiological processes should be appropriately challenged, inducing a risk of failure.3,5 This could possibly explain the difference in performance between the groups. Future research will focus on the contribution of briefing videos to learning effects of simulation training.