Salivary Cortisol Concentrations, Grit, and the Effect of Time

Abstract

Background: Stress is a common experience in the emergency department (ED) and is a balance of personal capabilities versus demands. Residency training is meant to improve individuals' capabilities and therefore may attenuate an individual's stress response. Grit is a personality trait that may attenuate stress in individuals. In this study we explore the relationship between time of year, postshift salivary cortisol concentrations, and the influence of grit among attendings and residents in an academic ED.Methods: Thirty-nine residents and 17 attendings were enrolled and followed for two academic years at an urban academic medical center. Postwork salivary cortisol samples were collected quarterly, and Duckworth 12point Grit Scales were administered annually. Data from the relative quarters of the first and second years were combined, and the results were analyzed using descriptive statistics and generalized estimating equations. Results:We analyzed 216 cortisol samples and 87 grit scores over 2 academic years. Between the first and fourth quarters of the academic year, the percentage of subjects with a detectable postshift cortisol sample decreased from 47.6% (30 of 62) to 18.4% (9 of 49). In the fourth academic quarter compared to the first, the odds that an individual had a detectable cortisol were significantly lower overall (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.10 to 0.59, p = 0.01), including the subset of only trainees (OR = 0.26, 95% CI = 0.07 to 0.88, p = 0.01), and adjusting for grit did not meaningfully change the ORs. Conclusion:Over the course of the academic year, the odds that an individual's postshift salivary cortisol concentration will be above detectable concentration significantly decrease over time, and this relationship is not confounded by grit.From the

Biophysiological stress markers relate differently to grit and school engagement among lower‐ and higher‐track secondary school students

“…Empirical studies investigating the relationship of cortisol, alpha‐amylase and oxidative stress with grit and engagement in academic contexts are scarce and have mainly been investigated with adult samples. For example, a study of 39 residency trainees enrolled at an urban academic medical centre revealed no significant relationship between trainees’ salivatory cortisol and their status as part of the high‐ or low‐grit group (Wong et al, 2019). However, another study investigating 122 military personnel found lower cortisol levels measured in the hair of gritty individuals (Gucciardi et al, 2021).…”

Pulse Rate Variability in Emergency Physicians During Shifts: Pilot Cross-Sectional Study

“…This approach is founded on the notion that as trainees gain experience in their role over the course of a year, perception of stressors and their physiologic manifestations among the trainees—as well as among the attending physicians directly responsible for them—should decrease. For example, it has been shown that the odds that an individual EP will register a detectable concentration of salivary cortisol after completing a shift significantly decrease over the course of a year [32]. An additional analysis will be restricted to the resident-only subgroup to investigate whether patterns in PR and PRV may be specific to EM trainees.…”