LO39: Stress inoculation training: a critical review for emergency medicine

Abstract

Introduction: In high stakes, performance-oriented professions, the ability to execute in stressful situations is both a prerequisite and an intense focus of training. Stress Inoculation Training (SIT) is a three-step cognitive-behavioural intervention aimed at reducing stress that may play a role in helping EM teams prepare for high acuity events. We conducted a systematic review of literature in medicine and performance-oriented professions to inform the development of an EM-focused SIT curriculum. Methods: An electronic search of Ovid MEDLINE, Web of Science Core Collection, PsychINFO, ProQuest and Scopus was conducted. Inclusion criteria were studies investigating the impact of stress inoculation training on performance and anxiety reduction. Data extraction included recording of performance and anxiety domains measured in each study and the details of how the stress inoculation training was delivered. Screening of articles, data extraction, and summarization were conducted by two independent reviewers using a standardized data extraction tool. Results: Our search yielded 431 studies; 40 were screened for full-text review and 10 met inclusion criteria. A total of 930 trainees throughout the 10 studies were enrolled. Four studies consisted of students in varying disciplines, including law, technology, education, and general undergraduate students, and 4 studies were composed of military personnel. No papers directly examined the effect of stress inoculation training on performance in healthcare. A change in performance and a reduction in anxiety and/or stress was noted in 90% of studies. Training length, experience of trainer, or group size did not appear to impact outcomes. Notably, heart rate variability (HRV) did not appear to be affected throughout the studies included, while cortisol and subjective stress were consistently reduced. Conclusion: SIT is an effective tool for enhancing performance and reducing stress and anxiety in high intensity environments. Studies examining the effect of EM-focused SIT on individual, team and patient-orient outcomes are needed.