Does simulation-based training in medical education need additional stressors? An experimental study

Abstract The increased curricular integration of simulation-based training (SBT) in medical education is accompanied by researchers’ calls to examine the effectiveness of SBT. We address conflicting results regarding effects of an added stressor on learning outcomes. In an experimental setting, one group of medical students (N = 20) performed cardiopulmonary resuscitation on a patient simulator. For a second group (N = 21) the scenario differed in that they encountered a defect defibrillator. We found participants of both groups to show increased biological stress-levels, independent of group allocation. Paradoxically, participants who encountered the equipment failure subjectively reported less stress. We discuss the implications of the comparable high stress levels in both groups with regards to future studies. We further discuss the result regarding subjective stress levels within the framework of attribution theory. Practitioner summary: The results of our experimental study underline the need for evidence-based choices of additional stressors for the design of simulation scenarios. We describe the choice of stimuli and setting in detail to maximise practical value for the construction of simulation-based medical trainings.

[1]  Annette Kluge,et al.  Retention of a standard operating procedure under the influence of social stress and refresher training in a simulated process control task , 2019, Ergonomics.

[2]  E. Michinov,et al.  When team member familiarity affects transactive memory and skills: a simulation-based training among police teams , 2018, Ergonomics.

[3]  Lorraine Clarke.  Motivation to Learn During Simulation-Based Learning: An Examination of Learner Characteristics in Health Science Students , 2018 .

[4]  R. Dias,et al.  Acute stress in residents during emergency care: a study of personal and situational factors , 2017, Stress.

[5]  Oliver T Wolf,et al.  Stress and memory retrieval: mechanisms and consequences , 2017, Current Opinion in Behavioral Sciences.

[6]  A. Kluge,et al.  Does teaching non-technical skills to medical students improve those skills and simulated patient outcome? , 2017, International journal of medical education.

[7]  O. Wolf,et al.  Enhanced startle responsivity 24 hours after acute stress exposure. , 2016, Behavioral neuroscience.

[8]  R. Dias,et al.  Stress levels during emergency care: A comparison between reality and simulated scenarios. , 2016 .

[9]  The impact of simulated patient death on medical students’ stress response and learning of ACLS , 2016, Medical teacher.

[10]  J. Soar,et al.  European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. , 2015, Resuscitation.

[11]  C. Kirschbaum,et al.  Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients , 2015, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[12]  Elizabeth T. Hsiao-Wecksler,et al.  Physiological responses to simulated firefighter exercise protocols in varying environments , 2015, Ergonomics.

[13]  A. Kluge,et al.  Development and first validation of the PLBMR for lab-based microworld research , 2015 .

[14]  S. Hamstra,et al.  Reconsidering fidelity in simulation-based training. , 2014, Academic medicine : journal of the Association of American Medical Colleges.

[15]  V. LeBlanc,et al.  Impact of Acute Stress on Resident Performance During Simulated Resuscitation Episodes: A Prospective Randomized Cross-Over Study , 2014, Teaching and learning in medicine.

[16]  Noel O’Regan,et al.  The Comprehensive Textbook of Healthcare Simulation , 2014, Canadian Journal of Anesthesia/Journal canadien d'anesthésie.

[17]  Lars Schwabe,et al.  Stress and multiple memory systems: from ‘thinking’ to ‘doing’ , 2013, Trends in Cognitive Sciences.

[18]  Jason H. Szostek,et al.  Comparative effectiveness of instructional design features in simulation-based education: Systematic review and meta-analysis , 2013, Medical teacher.

[19]  S. DeMaria,et al.  The Use of Stress to Enrich the Simulated Environment , 2013 .

[20]  Impact of Group Size on the Effectiveness of a Resuscitation Simulation Curriculum for Medical Students , 2011, Teaching and learning in medicine.

[21]  S. Hunziker,et al.  Perceived stress and team performance during a simulated resuscitation , 2011, Intensive Care Medicine.

[22]  Charlotte Ringsted,et al.  Setting a research agenda for simulation-based healthcare education: a synthesis of the outcome from an Utstein style meeting. , 2011, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[23]  Jodee Anderson,et al.  Using simulation to enhance the acquisition and retention of clinical skills in neonatology. , 2011, Seminars in perinatology.

[24]  R. Deinzer,et al.  Endocrine and psychological stress responses in a simulated emergency situation , 2011, Psychoneuroendocrinology.

[25]  E. Bryson,et al.  Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance , 2010, Medical education.

[26]  Gavin D Perkins,et al.  European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. , 2010, Resuscitation.

[27]  Luis Santos Rodríguez,et al.  Physiological response of beach lifeguards in a rescue simulation with surf. , 2010, Ergonomics.

[28]  Pamela B Andreatta,et al.  The impact of stress factors in simulation-based laparoscopic training. , 2010, Surgery.

[29]  Dimitrios Stefanidis,et al.  Increased stress levels may explain the incomplete transfer of simulator-acquired skill to the operating room. , 2010, Surgery.

[30]  Nick Sevdalis,et al.  The impact of stress on surgical performance: a systematic review of the literature. , 2010, Surgery.

[31]  Andrea Dodge Ackermann,et al.  Investigation of Learning Outcomes for the Acquisition and Retention of CPR Knowledge and Skills Learned with the Use of High-Fidelity Simulation , 2009 .

[32]  Andreas Fichtner,et al.  Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study. , 2009, Resuscitation.

[33]  U. Nater,et al.  Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: Current state of research , 2009, Psychoneuroendocrinology.

[34]  Nicolas Rohleder,et al.  Determinants of salivary α-amylase in humans and methodological considerations , 2009, Psychoneuroendocrinology.

[35]  Alan F Merry,et al.  Human factors and the cardiac surgical team: a role for simulation. , 2007, The journal of extra-corporeal technology.

[36]  Guillaume Alinier,et al.  A typology of educationally focused medical simulation tools , 2007, Medical teacher.

[37]  P. Bradley.  The history of simulation in medical education and possible future directions , 2006, Medical education.

[38]  Jane Kidd,et al.  The effects of stress on surgical performance. , 2006, American journal of surgery.

[39]  C. Rauen,et al.  Simulation as a teaching strategy for nursing education and orientation in cardiac surgery. , 2004, Critical care nurse.

[40]  S. Dickerson,et al.  Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. , 2004, Psychological bulletin.

[41]  L. Huetti.  Competency assessment. , 1996, Nevada RNformation.

[42]  R. Harden,et al.  Assessment of clinical competence using an objective structured clinical examination (OSCE). , 1979, Medical education.

[43]  W. L. Davis,et al.  Internal-external control and attribution of responsibility for success and failure. , 1972, Journal of personality.

[44]  G. Kunz.  Internal-external control , 1964 .

[45]  Kenneth P Reinschmidt,et al.  Use of Stress , 1964 .