Abstract
Introduction: Simulation-based training (SBT) has become an increasingly important method by which doctors learn. Stress has an impact upon learning, performance, technical, and non-technical skills. However, there are currently no studies that compare stress in the clinical and simulated environment. We aimed to compare objective (heart rate variability, HRV) and subjective (state trait anxiety inventory, STAI) measures of stress theatre with a simulated environment.Methods: HRV recordings were obtained from eight anesthetic trainees performing an uncomplicated rapid sequence induction at pre-determined procedural steps using a wireless Polar RS800CX monitor © in an emergency theatre setting. This was repeated in the simulated environment. Participants completed an STAI before and after the procedure.Results: Eight trainees completed the study. The theatre environment caused an increase in objective stress vs baseline (p = .004). There was no significant difference between average objective stress levels across all time points (p = .20) between environments. However, there was a significant interaction between the variables of objective stress and environment (p = .045). There was no significant difference in subjective stress (p = .27) between environments.Discussion: Simulation was unable to accurately replicate the stress of the technical procedure. This is the first study that compares the stress during SBT with the theatre environment and has implications for the assessment of simulated environments for use in examinations, rating of technical and non-technical skills, and stress management training.
Highlights
Simulation based training (SBT) has become an increasingly important method by which doctors learn
Simulation was unable to accurately replicate the stress of the technical procedure. This is the first study that compares the stress during SBT with the theatre environment and has implications for the assessment of simulated environments for use in examinations, rating of technical and non-technical skills, and stress management training
Rapid sequence induction (RSI) was chosen as the criterion procedure as trainees are increasingly trained in this procedure in the simulated environment as it is often performed in an emergency situation, the pathway is usually reproducible between patients, infrequently complicated, and requires minimal levels of physical activity by the performer that may otherwise affect Heart Rate Variability (HRV) recordings
Summary
Simulation based training (SBT) has become an increasingly important method by which doctors learn. Stress has an impact upon learning, performance, technical, and non-technical skills. Simulation based training (SBT) is ‘a technique to replace or amplify real-patient experiences with guided experiences, artificially contrived, that evokes or replicates substantial aspects of the real world in a fully interactive manner’ (Gaba 2004). SBT has become increasingly important within medical education and often forms a mandatory part of training and examinations, pioneered by anaesthesia (Gaba & DeAnda 1988; Holzman et al 1995). There is a lack of evidence for the assumption that highfidelity simulations lead to better learning (Norman et al 2012), and some have suggested that the term ‘fidelity’ is abandoned altogether (Hamstra et al 2014), instead focussing on specific factors that impact upon educational effectiveness enabling educators to consider the value of a particular simulation for learners of varying experience who have different ‘learning curves’ (Aggarwal et al 2010)
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