Stress Management Training Improves Overall Performance during Critical Simulated Situations

Abstract

Background High-fidelity simulation improves participant learning through immersive participation in a stressful situation. Stress management training might help participants to improve performance. The hypothesis of this work was that Tactics to Optimize the Potential, a stress management program, could improve resident performance during simulation. Methods Residents participating in high-fidelity simulation were randomized into two parallel arms (Tactics to Optimize the Potential or control) and actively participated in one scenario. Only residents from the Tactics to Optimize the Potential group received specific training a few weeks before simulation and a 5-min reactivation just before beginning the scenario. The primary endpoint was the overall performance during simulation measured as a composite score (from 0 to 100) combining a specific clinical score with two nontechnical scores (the Ottawa Global Rating Scale and the Team Emergency Assessment Measure scores) rated for each resident by four blinded independent investigators. Secondary endpoints included stress level, as assessed by the Visual Analogue Scale during simulation. Results Of the 134 residents randomized, 128 were included in the analysis. The overall performance (mean ± SD) was higher in the Tactics to Optimize the Potential group (59 ± 10) as compared with controls ([54 ± 10], difference, 5 [95% CI, 1 to 9]; P = 0.010; effect size, 0.50 [95% CI, 0.16 to 0.91]). After specific preparation, the median Visual Analogue Scale was 17% lower in the Tactics to Optimize the Potential group (52 [42 to 64]) than in the control group (63 [50 to 73]; difference, −10 [95% CI, −16 to −3]; P = 0.005; effect size, 0.44 [95% CI, 0.26 to 0.59]. Conclusions Residents coping with simulated critical situations who have been trained with Tactics to Optimize the Potential showed better overall performance and a decrease in stress level during high-fidelity simulation. The benefits of this stress management training may be explored in actual clinical settings, where a 5-min Tactics to Optimize the Potential reactivation is feasible prior to delivering a specific intervention. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Impact of stress management strategies and experience on electrodermal activity during high-fidelity simulation of critical situations

“…This is in agreement with the decreased subjective feeling of stress in TOP participants. 1 Furthermore, the better regulation of phasic EDA in TOP participants reinforces the concept of downregulation of the amygdala observed with functional MRI after other cognitive therapy, 9 as the amygdala, part of the limbic system, controls the phasic component of the sympathetic nervous system. 10 Using the components of EDA, we show for the first time that experience and stress management strategies may modulate two different pathways controlling the stress reaction.…”

“…7 The mapEDA is a reliable marker of sympathetic activity, 2 which has been reported to increase in residents practising high-fidelity simulation. 8 As the mapEDA was steady in TOP participants but not in controls during the simulation scenario, 1 Correspondence -e411 regulation and reduced sympathetic activation. This is in agreement with the decreased subjective feeling of stress in TOP participants.…”

“…Residents trained in stress management strategies (tactics to optimise potential [TOP]) show improved performance when coping with critical situations during high-fidelity simulation (HFS). 1 Performance enhancement might result from the effect of TOP on stress regulation, leading to a more controlled biological stress reaction or balanced arousal with the subject being better prepared for action. Separating electrodermal activity (EDA) into its tonic (i.e.…”

“…4 Both stress dimensions were better controlled in senior residents, indicating that experience reduces perceived stress. 5 As TOP decreases perceived stress in residents, 1 we wanted to explore the impact of TOP on the EDA components.…”

“…The effect of TOP on the performance of 128 anaesthesia residents facing a critical situation in HFS was studied in a prospective RCT. 1 Assessment of the mechanism of action of TOP through EDA analysis was an ancillary objective. The study protocol was pre-registered on October 6, 2016 on ClinicalTrials.gov (NCT02926599) and was approved by the Institutional Review Board of the Comit e de Protection des Personnes SUD-EST II (2016-089).…”