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Learning Objective 1: The learner will be able to describe measures of psychological and physiological stress during simulation activity.
Learning Objective 2: The learner will be able to explain the relationship between stress measures and performance.
Background:Learning to provide emergency care in the clinical environment imposes unexplored stresses on novice caregivers. It is unclear whether stress inhibits or promotes performance and learning when academic programs utilize simulation to teach patient care.
Methods:Twenty-seven volunteer participants recruited from nursing, medicine, pharmacy, physical therapy, occupational therapy and speech therapy programs of study were assigned to teams in either a simulation treatment or a control group. Teams participated in two simulations scenarios where a fallen patient required assistance. Subjects in the simulation treatment groups received a standardized training module between simulation experiences. Mean heart rate, maximal mean heart rate, salivary alpha amylase levels, and salivary cortisol levels were compared at intervals before, during, and after each simulation scenario. Psychological stress was evaluated using the Stressor Appraisal Scale (SAS). Team performance was scored by independent evaluators using a checklist adapted from a commercially available training module.
Results: Performance scores improved in all teams during the second simulation. Mean performance scores of the simulation intervention teams (M = 14.1, SD = 1.43) were significantly higher (t = 4.54, p < .01) than the performance scores of the control teams (M = 10.6, SD= .96). Psychological and physiological measures did not significantly predict performance. Psychological and physiological indicators were reactive across time, but did not differ significantly between control and simulation intervention groups.
Conclusions: This investigation explored the multi-dimensional nature of stress in health professions students while learning. Simulation intervention did significantly improve group performance, but did not mitigate individual stress. Future research should include study of working professionals to determine whether performance and stress measures differ with experience and expertise.