How stressful is doctor–patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations

The effect of communication skills training on residents’ physiological arousal in a breaking bad news simulated task

“…This goes in line with Gaillard distinction between mental load and stress where mental load manifests itself as a temporary normal mental effort (a healthy coping strategy) whereas stress is seen as an enhanced activation that fails to improve performance and to facilitate recovery [16]. Hulsman et al study suggests that part of the observed physiological response could also be attributed to the novelty of the task [11]. Beyond that, the impact of a stressor is also modulated by biological predispositions, personality patterns, learning history and available coping resources [17,18].…”

“…The lower level of elevation in heart rate in untrained residents may be explained by the fact that, being for a second time exposed to an already experimented task -that they have not learned to perform better -residents deal with the task as they do ''usually''. An additional explanation for this lower elevation in untrained residents' heart rate may be residents' habituation to the simulated task [11].…”

“…Perceived stress, psychological distress and poor communication were not associated with increased cardiovascular responses in the bad news scenario contrary to doctors' inexperience and fatigue. The fourth study in a medical student population showed that BBN consultations provoked elevated heart rate responses compared to history taking consultations [11].…”

“…Although reviews on BBN have insisted on the stressfulness of the BBN task, to our knowledge, only four studies until now have investigated physicians' physiological and psychological stress responses during BBN [9][10][11][12]. In the first study, medical students were randomly assigned to a bad news delivery task, a good news delivery task or a control task (reading magazines).…”

Salivary Cortisol Increases after One Immersive Simulation but the Repetition of Sessions does not Blunt it

“…Stress response can be explored with multiple components [43], according to the physiological axes of stress. In other words, HPA axis (leading to the increase in cortisol) seems to be a physiological response to simulated life-threatening events, whereas management of events might depend on the other axes (ANS, and immune systems) [44] or psychological stress [19,45]. Therefore, it could be of interest to consider stress markers of HPA, ANS, and psychological stress pathways not as competitive markers (and choose between them as equivalent markers), but as complementary ones.…”