Dynamics and association of different acute stress markers with performance during a simulated resuscitation

Hunziker, Sabina; Semmer, Norbert K.; Tschan, Franziska; Schuetz, Philipp; Müeller, Beat; Marsch, Stephan

doi:10.1016/j.resuscitation.2011.11.013

Cited by 67 publications

(63 citation statements)

References 31 publications

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“…While participation in both high- and low-stress simulation scenarios was associated with increased heart rate compared to baseline, they found no significant difference in heart rate elevation between the high and low-stress conditions, while cortisol levels and subjective stress measurement were significantly higher in the high-stress scenario. A study of CPR performance by Hunziker et al similarly found that perceived stress was inversely correlated with heart rate variability (a finding observed elsewhere in studies of physiologic stress response), but showed no significant relationship with heart rate elevation [17,18]. And a study by Girzadas et al found no relationship between heart rate elevation and perceived stress among residents performing airway simulations [19].…”

Section: Discussionmentioning

confidence: 99%

Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot study

et al. 2014

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BackgroundHigh-fidelity patient simulation has been praised for its ability to recreate lifelike training conditions. The degree to which high fidelity simulation elicits acute emotional and physiologic stress among participants – and the influence of acute stress on clinical performance in the simulation setting – remain areas of active exploration. We examined the relationship between residents’ self-reported anxiety and a proxy of physiologic stress (heart rate) as well as their clinical performance in a simulation exam using a validated assessment of non-technical skills, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS).MethodsThis was a prospective observational cohort study of emergency medicine residents at a single academic center. Participants managed a simulated clinical encounter. Anxiety was assessed using a pre- and post-simulation survey, and continuous cardiac monitoring was performed on each participant during the scenario. Performance in the simulation scenario was graded by faculty raters using a critical actions checklist and the Ottawa GRS instrument.ResultsData collection occurred during the 2011 academic year. Of 40 eligible residents, 34 were included in the analysis. The median baseline heart rate for participants was 70 beats per minute (IQR: 62 – 78). During the simulation, the median maximum heart rate was 140 beats per minute (IQR: 137 – 151). The median minimum heart rate during simulation was 81 beats per minute (IQR: 72 – 92), and mean heart rate was 117 beats per minute (95% CI: 111 – 123). Pre- and post-simulation anxiety scores were equal (mean 3.3, IQR: 3 to 4). The minimum and maximum Overall Ottawa GRS scores were 2.33 and 6.67, respectively. The median Overall score was 5.63 (IQR: 5.0 to 6.0). Of the candidate predictors of Overall performance in a multivariate logistic regression model, only PGY status showed statistical significance (P = 0.02).ConclusionsSimulation is associated with physiologic stress, and heart rate elevation alone correlates poorly with both perceived stress and performance. Non-technical performance in the simulation setting may be more closely tied to one’s level of clinical experience than to perceived or actual stress.

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Section: Discussionmentioning

confidence: 99%

Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot study

et al. 2014

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“…Similarly, for physiological measures, while some variables have been recorded in simulator training modules, 9 nothing has been collected during real-time “in the field” patient care activities. Thus, there is a major knowledge gap in the quantifiable psychological and physiological effects of the profound occupational stress associated with novice medical residents transitioning to residency training.…”

Section: Introductionmentioning

confidence: 99%

The Psychological and Physiological Effects of Acute Occupational Stress in New Anesthesiology Residents

Eisenach

Šprung²,

Clark³

et al. 2014

Anesthesiology

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Background Occupational stress in resident physicians has profound implications for wellness, professionalism, and patient care. This observational pilot trial measured psychological and physiological stress biomarkers before, during, and after the start of anesthesia residency. Methods Eighteen physician interns scheduled to begin anesthesia residency were recruited for evaluation at three time points: baseline (collected remotely before residency in June 2013); first month visit 1 (July); and follow-up visit 2 (residency month 3–5, Sept–Nov). Validated scales were used to measure stress, anxiety, resilience, and wellness at all 3 time points. During visits 1 and 2, we measured resting heart rate variability, responses to laboratory mental stress (hemodynamic, catecholamine, cortisol, and interleukin-6) and chronic stress indices (C-reactive protein, 24 h ambulatory heart rate and blood pressure, 24 h urinary cortisol and catecholamines, overnight heart rate variability). Results Thirteen interns agreed to participate (72% enrollment). There were seven men and six women, ages 27–33 years. The mean ± SD of all study variables are reported. Conclusion The novelty of our report is the prospective design in a defined cohort of residents newly exposed to the similar occupational stress of the operating environment. Because of the paucity of literature specific to the measures and stress conditions in this investigation, no data were available to generate a priori definition of primary outcomes and a data analytic plan. These findings will allow power analysis for future design of trials examining occupational stress and stress-reducing interventions. Given the importance of physician burnout in our country, the impact of chronic stress on resident wellness requires further study.

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“…Another reason that could explain our result is the stressful situation created by a CA, which could enhance physician skills as reported by Hunziker et al [8], who found that stress was associated significantly with time to start CPR. In the same way, cortisol awakening response appears at the end of the night [9].…”

Section: Discussionmentioning

confidence: 56%

Weaker compressions after night shift? The WeCAN manikin study

Philippon

Nguyen²,

Raynal

et al. 2016

European Journal of Emergency Medicine

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To assess whether the quality of chest compressions (CC) differs before and after a night shift. We carried out a cluster randomized study in three Emergency Departments and three ICUs in Paris, France. Physicians were assessed on a control day and immediately following after a night shift. The primary endpoint was the proportion of CC with a depth greater than 50 mm. We analyzed 67 participants. The proportion of CC with a depth greater than 50 mm was similar on a control day and after a night shift [52% in both groups, mean difference of 0 (95% confidence interval: -17 to 17)]. Other indicators of CC quality were unchanged after a night shift, except for the mean depth of CC (51 vs. 48 mm, P=0.01). We report in our sample that the quality of CC after a night shift is not inferior to a control day.

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Dynamics and association of different acute stress markers with performance during a simulated resuscitation

Cited by 67 publications

References 31 publications

Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot study

Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot study

The Psychological and Physiological Effects of Acute Occupational Stress in New Anesthesiology Residents

Weaker compressions after night shift? The WeCAN manikin study

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