Abstract
BackgroundAcute stress impairs physician decision-making and clinical performance in resuscitations. Mental skills training, a component of the multistep, cognitive-behavioral technique of stress inoculation, modulates stress response in high-performance fields.ObjectiveWe assessed the effects of mental skills training on emergency medicine (EM) residents’ stress response in simulated resuscitations as well as residents’ perceptions of this intervention.MethodsIn this prospective, educational intervention trial, postgraduate year-2 EM residents in seven Chicago-area programs were randomly assigned to receive either stress inoculation training or not. One month prior to assessment, the intervention group received didactic training on the “Breathe, Talk, See, Focus” mental performance tool. A standardized, case-based simulation was used for assessment. We measured subjective stress response using the six-item short form of the Spielberger State-Trait Anxiety Inventory (STAI-6). Objective stress response was measured through heart rate (HR) and heart rate variability (HRV) monitoring. We measured subjects’ perceptions of the training via survey.ResultsOf 92 eligible residents, 61 participated (25 intervention; 36 control). There were no significant differences in mean pre-/post-case STAI-6 scores (−1.7 intervention, 0.4 control; p = 0.38) or mean HRV (−3.8 milliseconds [ms] intervention, −3.8 ms control; p = 0.58). Post-assessment surveys indicated that residents found this training relevant and important.ConclusionThere was no difference in subjective or objective stress measures of EM resident stress response after a didactic, mental performance training session, although residents did value the training. More extensive or longitudinal stress inoculation curricula may provide benefit.
Highlights
Emergency medicine (EM) residents often encounter highly stressful clinical situations and must perform life-saving interventions with limited time, resources, and background information
What was the research question? We studied the effects of mental skills training on EM resident stress response in simulated resuscitations, as well as resident perceptions of this intervention
What was the major finding of the study? There was no difference in subjective or objective stress measures of EM resident stress response after a didactic mental performance training session, residents did value the training
Summary
Emergency medicine (EM) residents often encounter highly stressful clinical situations and must perform life-saving interventions with limited time, resources, and background information. A multistep, cognitive behavioral technique, has been demonstrated to be effective across numerous high-performance domains.[8,9,10,11] Stress inoculation involves three phases: 1) learning about the effects of acute stress on performance; 2) acquiring and rehearsing specific mental skills and coping strategies to optimize performance under stress; and 3) applying these skills and strategies to real-world, high-stress environments.[8] Mental skills training has been shown to enhance performance and coping in stressful situations in pilots, police, military special forces, professional athletes, and surgeons.[12,13,14,15,16] While resident physicians frequently encounter stressful clinical resuscitations, there are no formal Accreditation Council for Graduate Medical Education (ACGME) recommendations for educating resident physicians about the impacts of acute stress on performance; nor is there mention of the potential role of mental skills training to optimize performance under stress. A component of the multistep, cognitive-behavioral technique of stress inoculation, modulates stress response in high-performance fields
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