Effects of Simulation Versus Traditional Tutorial-Based Training on Physiologic Stress Levels Among Clinicians: A Pilot Study

Bong, Choon Looi; Lightdale, Jenifer R.; Fredette, Meghan E.; Weinstock, Peter

doi:10.1097/sih.0b013e3181e98b29

Cited by 91 publications

(63 citation statements)

References 13 publications

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“…A growing number of studies have reported that simulated scenarios may provoke substantial acute stress in doctors, nurses and other allied professionals 7 - 10 , 34 - 36 . Some authors have suggested that the potential of a simulated scenario to induce acute stress in learners may be an indicator of realism, fidelity and engagement, 15 , 16 especially in regards to what some authors have defined as psychological, 20 phenomenal 19 or high emotional and experiential fidelity 17 …”

Section: Discussionmentioning

confidence: 99%

Acute stress in residents playing different roles during emergency simulations: a preliminary study

Dias

Scalabrini-Neto

2017

Int J Med Educ

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ObjectivesTo investigate acute stress response in residents playing nurse and physician roles during emergency simulations. MethodsSixteen second-year internal medicine residents participated in teams of four (two playing physician roles and two playing nurse roles). Stress markers were assessed in 24 simulations at baseline (T1) and immediately after the scenario (T2), using heart rate, systolic and diastolic blood pressure, salivary α-amylase, salivary cortisol and salivary interleukin-1β. The State-Trait Anxiety Inventory was applied at T2. Continuous data were summarized for the median (1st-3rd interquartile ranges), and the Mann-Whitney U Test was used to compare the groups. ResultsThe percent variations of the stress markers in the physician and nurse roles, respectively, were the following: heart rate: 70.5% (46.0-136.5) versus 53.0% (29.5-117.0), U=89.00, p=0.35; systolic blood pressure: 3.0% (0.0-10.0) versus 2.0% (-2.0-9.0), U=59.50, p=0.46; diastolic blood pressure: 5.5% (0.0-13.5) versus 0.0% (0.0-11.5), U=91.50, p=0.27; α-amylase: -5.35% (-62.70-73.90) versus 42.3% (12.4-133.8), U=23.00, p=0.08; cortisol: 35.3% (22.2-83.5) versus 42.3% (12.4-133.8), U=64.00, p=0.08); and interleukin-1β: 54.4% (21.9-109.3) versus 112.55% (29.7-263.3), U= 24.00, p=0.277. For the physician and nurse roles, respectively, the average heart rate was 101.5 (92.0-104.0) versus 91.0 (83.0-99.5) beats per minute, U=96.50, p=0.160; and the state anxiety inventory score was 44.0 (40.0-50.0) versus 42.0 (37.50-48.0) points, U= 89.50, p=0.319. ConclusionsDifferent roles during emergency simulations evoked similar participants’ engagement, as indicated by acute stress levels. Role-play strategies can provide high psychological fidelity for simulation-based training, and these results reinforce the potential of role-play methodologies in medical education.

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Section: Discussionmentioning

confidence: 99%

Acute stress in residents playing different roles during emergency simulations: a preliminary study

Dias

Scalabrini-Neto

2017

Int J Med Educ

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“…Commentators have also advocated using techniques such as functional magnetic resonance imaging 32 and eye tracking, 33 but these research areas are in their infancy and applications to the physically active learning environments in healthcare simulation will be challenging. Simulation researchers have also measured salivary cortisol 34 and heart rate variability as markers of stress, but the complex relationship between stress and cognitive load is not completely understood (see later); further research into the best physiologic markers for each is needed.…”

Section: Intrinsic Cognitive Loadmentioning

confidence: 98%

Cognitive Load Theory for the Design of Medical Simulations

Fraser

Ayres

Sweller

2015

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare

209

164

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Simulation-based education (SBE) has emerged as an effective and important tool for medical educators, but research about how to optimize training with simulators is in its infancy. It is often difficult to generalize results from experiments on instructional design issues in simulation because of the heterogeneity of learner groups, teaching methods, and rapidly changing technologies. We have found that cognitive load theory is highly relevant to teaching in the simulation laboratory and a useful conceptual framework to reference when designing or researching simulation-based education. Herein, we briefly describe cognitive load theory, its grounding in our current understanding of cognitive architecture, and the evidence supporting it. We focus our discussion on a few well-established cognitive load effects with examples from simulation training and recommend some instructional applications with theoretical potential to improve learning outcomes.

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“…However, there were also some indications of drawbacks, which include high levels of anxiety and stress [20,21]. Although little is known about which personal and contextual factors facilitate or impair transfer of learning from a simulation based setting to the clinical setting, it is thought to be important to provide feedback early on in order to support optimal performance [22].…”

Section: Discussionmentioning

confidence: 99%

Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized educational trial

Oestergaard

Bjerrum²,

Maagaard

et al. 2012

BMC Med Educ

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BackgroundSeveral studies have found a positive effect on the learning curve as well as the improvement of basic psychomotor skills in the operating room after virtual reality training. Despite this, the majority of surgical and gynecological departments encounter hurdles when implementing this form of training. This is mainly due to lack of knowledge concerning the time and human resources needed to train novice surgeons to an adequate level. The purpose of this trial is to investigate the impact of instructor feedback regarding time, repetitions and self-perception when training complex operational tasks on a virtual reality simulator.Methods/DesignThe study population consists of medical students on their 4th to 6th year without prior laparoscopic experience. The study is conducted in a skills laboratory at a centralized university hospital. Based on a sample size estimation 98 participants will be randomized to an intervention group or a control group. Both groups have to achieve a predefined proficiency level when conducting a laparoscopic salpingectomy using a surgical virtual reality simulator. The intervention group receives standardized instructor feedback of 10 to 12 min a maximum of three times. The control group receives no instructor feedback. Both groups receive the automated feedback generated by the virtual reality simulator. The study follows the CONSORT Statement for randomized trials. Main outcome measures are time and repetitions to reach the predefined proficiency level on the simulator. We include focus on potential sex differences, computer gaming experience and self-perception.DiscussionThe findings will contribute to a better understanding of optimal training methods in surgical education.Trial RegistrationNCT01497782

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Effects of Simulation Versus Traditional Tutorial-Based Training on Physiologic Stress Levels Among Clinicians: A Pilot Study

Cited by 91 publications

References 13 publications

Acute stress in residents playing different roles during emergency simulations: a preliminary study

Acute stress in residents playing different roles during emergency simulations: a preliminary study

Cognitive Load Theory for the Design of Medical Simulations

Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized educational trial

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