Stress response in the daily lives of simulation repeaters. A randomized controlled trial assessing stress evolution over one year of repetitive immersive simulations

Abstract

Background Simulations in healthcare reproduce clinical situations in stressful conditions. Repeated stress exposure might influence the learning process in simulation as well as real-life. Objectives 1) To record heart rate and heart rate variability evolution during one-day simulation over one year; 2) To analyze the effect of repetitive high-fidelity simulations on the risk of post-traumatic stress disorder. Study design Single-center, investigator-initiated RCT. 48 participants were randomized in 12 multidisciplinary teams of French Emergency Medical Services to manage infant shock in high-fidelity simulations. In the experimental group, 6 multidisciplinary teams were exposed to 9 different simulation sessions over 1 year. In the control group, 6 multidisciplinary teams participated in only 3 simulation sessions, in common with those of the experimental group (initial, intermediate after 6 months, and finally after 1 year). Heart rate (HR) and heart rate variability (HRV) were analyzed on a 24-hour Holter from the day prior to simulation until the end of simulation. Questionnaires of Impact of Event Scale-Revised at 7 days and Post-traumatic Check-List Scale at 1 month were used to detect possible post-traumatic stress disorder in participants. p<0.05 was considered significant. Results Stress increased during each simulation in the two groups. After analysis on the 24-hour period, there was no significant difference between the two groups during the initial simulation session in terms of heart rate and heart rate variability. In the 24-hour period of the intermediate and final simulation sessions, the level of stress was higher in the control group during the diurnal (p = 0.04) and nocturnal periods (p = 0.01). No participant developed post-traumatic stress disorder after the 72 simulation sessions. Conclusions Despite the stress generated by simulation, the more the sessions were repeated, the less were their repercussions on the daily lives of participants, reflected by a lower sympathetic activity. Moreover, repetition of simulations did not lead to post-traumatic stress disorder. Trial registration ClinicalTrials.gov NCT02424890 .

Simulation-based education for selected communication skills: exploring the perception of post-graduate dental students

“…On the other hand, some participating students reported that going through SBE can decrease their stress levels on the long run when they are faced with similar situations, in their clinical practice. This is in agreement with another study that showed SBE induced stress to decline with repetition [ 30 ]. From this perspective, it will be interesting for future studies, investigating the effect of SBE, to longitudinally assess the changes of stress levels across time before, during, and after conducting the SBE intervention.…”

Stress level experienced by participants in realistic simulation: a systematic review

“…All works included are RCT, in which 15 used some physiologic pattern in the evaluation of the stress and, among them, only 4 included measures to minimize gauging or reported the exclusion of a participant for not adopting measures that could alter the physiologic parameters. Among the measures and care, we had measurement of progesterone and estrogen in salivary samples (27) , guidance on food, alcohol, caffeine, and nicotine consumption half an hour before the evaluation and not exercising 24 hours before collection (28) , past illnesses that could induce related changes or even worsen due to stress, previous psychiatric illness, if patients were not under treatment, use of hormones like steroids or hormone replacement therapy, verification if any participant worked the night shift the day before the simulation and if the participants had been faced with a stressful event the day before or the day of the simulation (29) , exclusion of students with a history of beta-blocker use and a history of recent antidepressant use (30) , exclusion of those who used beta-agonist inhalers, steroids, oral contraceptive pill, and caffeine (31) . Of the studies found, 13 were in the medical field, and only 2 surveys carried out the study with a team from different areas, like doctors, nurses, paramedics and ambulance drivers (29) , and medical and nursing students (24) .…”

“…Among the measures and care, we had measurement of progesterone and estrogen in salivary samples (27) , guidance on food, alcohol, caffeine, and nicotine consumption half an hour before the evaluation and not exercising 24 hours before collection (28) , past illnesses that could induce related changes or even worsen due to stress, previous psychiatric illness, if patients were not under treatment, use of hormones like steroids or hormone replacement therapy, verification if any participant worked the night shift the day before the simulation and if the participants had been faced with a stressful event the day before or the day of the simulation (29) , exclusion of students with a history of beta-blocker use and a history of recent antidepressant use (30) , exclusion of those who used beta-agonist inhalers, steroids, oral contraceptive pill, and caffeine (31) . Of the studies found, 13 were in the medical field, and only 2 surveys carried out the study with a team from different areas, like doctors, nurses, paramedics and ambulance drivers (29) , and medical and nursing students (24) . Six studies evaluated the stress in the simulation with practitioners who graduated in medicine and nursing (24,(27)(28)(29)(32)(33) , and 11 studies were carried out with nursing undergraduate students and Medicine (30)(31)(34)(35)(36)(37)(38)(39)(40)(41)(42) .…”

“…Of the studies found, 13 were in the medical field, and only 2 surveys carried out the study with a team from different areas, like doctors, nurses, paramedics and ambulance drivers (29) , and medical and nursing students (24) . Six studies evaluated the stress in the simulation with practitioners who graduated in medicine and nursing (24,(27)(28)(29)(32)(33) , and 11 studies were carried out with nursing undergraduate students and Medicine (30)(31)(34)(35)(36)(37)(38)(39)(40)(41)(42) .…”

“…The other studies evaluated simulation with another aspect within the simulation itself, such as go under more trainings or not (29) , have the presence of one or five observers (30) , have an instructor before the simulation or not (42) , go under repeated sessions of simulation or not (1) , simulation in situ and clinic simulation (32) , use of standardized patient or simulator (41) , have training on communication or not (28) , have a previous training on how to deal with stress or not (38) , high or low fidelity simulation (36) , previous training on suture or not (40) , be leader of member of the simulation team (33) , be criticized during the scenarios or not (37) , high or low-stress scenario (39) , silent or noisy simulation (31) .…”