Use of saliva stress biomarkers to estimate novice male endoscopist’s stress during training in a high-end simulator

Abstract

Objective: Simulated endoscopic training can be challenging and stressful for the novice trainee. The absence of a reliable stress detection method during simulated endoscopic training makes estimating trainees' mental stress difficult to quantify. This study concomitantly measures the responses of four saliva stress biomarkers and compares them to the video score (VS) achieved by novice endoscopists in a reproducibly stressful simulation environment. Methods: Thirty-six male endoscopy naïve surgery residents were enrolled. After an orientation phase, a saliva specimen was collected for cortisol (sC), alpha-amylase (sAA), Chromogranin A (sCgA), and immunoglobulin A (sIgA) measurements (baseline phase, BL). Thereafter, the simulation exercise phase (E) started, practicing in the Fundamentals of Endoscopic Surgery Skills module (GI-Bronch Mentor). Immediately after, a second saliva sample for measuring the above-cited biomarkers was collected. The whole experiment was videotaped, and the VS was calculated. The percentage (E-BL) diff of each of the four saliva biomarkers was calculated and examined for correlation to VS. Results: sCgA diff showed the best correlation with VS, followed by sAA diff . Conclusions: sCgA and sAA, are saliva stress biomarkers that are easy to collect non-invasively and showed the best correlation with novice endoscopist's performance in our simulation setting, and therefore, they could be used for monitoring stress.

Stress in surgical educational environments: a systematic review

“…Box trainers were used in 25 articles [ 21 , 23 , 24 , 58 , 66 , 68 – 70 , 72 , 73 , 80 , 88 , 89 , 91 , 92 , 94 , 96 – 98 , 108 , 109 , 112 , 113 , 119 , 120 ]. Monitoring methods used during training set-ups with box trainers included all described monitoring methods in this review.…”

“…Effect of stress on simulator-based performance (for box trainers and VR simulators) was analyzed in 31 studies [ 15 , 20 , 21 , 23 , 24 , 66 – 70 , 72 – 74 , 76 , 77 , 84 , 88 , 89 , 91 , 92 , 94 , 96 , 98 – 100 , 103 , 108 , 109 , 112 , 113 , 119 ]. The stress levels were assessed through measures of HR and HRV [ 15 , 20 , 23 , 24 , 66 – 70 , 73 , 74 , 76 , 77 , 84 , 88 , 91 , 109 , 112 , 119 ], respiration frequency [ 73 ], questionnaire [ 89 , 108 , 112 , 113 ], EDA [ 94 ], perinasal thermal imaging [ 96 – 98 ], gaze [ 100 ], EEG [ 99 ], and STAI [ 103 ]. In addition, the effect of mental training methods on surgical technical performance was assessed in 9 articles [ 69 – 71 , 73 , 80 , 82 , 89 , 90 , 92 ].…”

“…Performance based scoring system rewarding precision and speed. [ 23 , 61 , 66 , 68 , 89 , 91 , 98 , 103 , 109 ] Fundamentals of Endoscopic Surgery™ (FES) performance metrics [ 123 ] Test of endoscopic manual skills. Performance based on assessment of five exercises: bimanual navigation, loop reduction targeting, mucosal evaluation and retroflexion.…”

“…Performance based on assessment of five exercises: bimanual navigation, loop reduction targeting, mucosal evaluation and retroflexion. [ 91 ] O’Connor Tweezer Dexterity performance metrics [ 124 ] Test of fine motor dexterity using tweezers to pick up pegs individually. Performance measured as the time that lapses between placement of the first and last pegs.…”

“…The tasks performed in the box trainers were basic technical skills. In studies using box trainers, the surgical tasks performed were able to trigger stress responses [ 21 , 23 , 24 , 66 , 72 , 73 , 88 , 91 , 96 – 98 , 112 , 113 , 119 ].…”