SP11.15 Stress Exposure Training in Surgery – A Narrative and Systematic Review

Abstract

Abstract Aim The operating theatre is an environment associated with intense cognitive stimulus. The coordinated application of technical and non-technical skills is necessary to achieve optimal patient care. Surgeons may undergo a significant “stress response”, activated when perceived demands of a situation exceed perceived resources, leading to measurable variations in physiological and biochemical parameters. This results in impaired performance, demonstrated most acutely in junior and trainee surgeons. Methods A narrative and literature was undertaken searching for stress response, exposure, inoculation in healthcare, medicine, or surgery. 1332 eligible papers were identified, refined to 100 on abstract, with 37 undergoing full text review. Results Stress Exposure Training (SET) facilitates high performances in acutely stressful situations by inoculating individuals from the psychological and physiological impacts of stress. SET was initially a clinical intervention to treat stress-induced psychopathology. Routed in cognitive-behavioural therapy principles, it is now a generalisable training approach implemented by other high-stress high-performance industries, including the military and aeronautics. High-fidelity simulation training is a recognised tool that is commonly applied in medical education. It promotes decision-making, team-working, and technical and communication skills in a controlled environment. Importantly, this tool has been shown to elicit an equivalent stress response to “live” clinical scenarios. Conclusion This review explores the current literature on mitigating stress responses in surgeons and SET, including its current applications and research localised to surgical education. Finally, we propose a high-fidelity simulation training programme, aimed at junior surgeons-in-training based on the principles of SET comprised of gradually increasing stressors and appropriate psychological training in stress-response management.