Stress and Clinical Reasoning in Medical Students

Stress Clinical Trial

Official title:

Physiological and Psychological Responses to Stress in Year 6 Medical Students Faced to Ambulatory Symptomatic Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01061255
• Other study ID #: BRD/09/08-M
• Status: Completed
• Phase: N/A
• Start date: November 9, 2009
• Est. completion date: April 12, 2010

Study information

• Verified date: September 2021
• Source: Nantes University Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Solving a problem in ambulatory setting may contain peripheral stress due to socio-evaluative stressors (patient's expectations about explanations) and task contingent stress due to time pressure, the necessity to take into account patient's mood, to deal with uncertainty of their own data collection and with complex clinical situations. In France, excepted for family medicine, undergraduate medical students and residents are currently not trained to perform consultations and are never exposed to ambulatory patients during training. The investigators postulate that this lack of practice may generate a significant state of stress during the first consultations and consequently modify or even impair clinical reasoning.

The primary objective of this study is to compare subjective and physiological levels of acute stress in ambulatory versus hospitalization setting in medical students confronted to a real patient with a diagnostic problem.

Measures: The French version of the Anxiety Spielberger test is administered just before and after each problem solving session.

Cortisol salivary samples are taken before and after each problem solving session. Salivary cortisol levels have been shown to be correlated to stressful situations and some personality traits but with some difference according to gender.

Cognitive appraisal (threat/challenge) is assessed before and after the tasks by the ratio of primary appraisal to secondary appraisal according to Tomaka et al.

Description:

Participants and Method:

Year 6 medical students who attend a one-month full-time course in an Internal Medicine Department are eligible.

Since no consultations in the ambulatory setting are currently structured for medical students, the following adjustments have been done within the internal medicine consultation department, with the approval of the department director:

• the consultation duration has been increased (1 hour instead of 30 minutes)

• during the first 30 minutes, consultation is performed by the participant

• during the following 30 minutes, the patient is examined by his/her own physician.

• The consent of the patient has been obtained by phone (prior to the consultation).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 62
• Est. completion date: April 12, 2010
• Est. primary completion date: April 12, 2010
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Year 6 medical students who attend a one-month full-time course in an Internal Medicine Department

Exclusion Criteria:

• Student who repeats his year 6 of medicine

• Student treated with corticoids

Related Conditions & MeSH terms

• Stress

Intervention

Other:
• Evaluation of the stress
Medical Students having to solve a medical problem in ambulatory setting (studied group) vs. in hospitalisation setting (control group). Measures: The French version of the Anxiety Spielberger test is administered just before and after each problem solving session. Cortisol salivary samples are taken before and after each problem solving session. Salivary cortisol levels have been shown to be correlated to stressful situations and some personality traits but with some difference according to gender.

Locations

Country	Name	City	State
France	Nantes University Hospital	Nantes

Sponsors (1)

Lead Sponsor	Collaborator
Nantes University Hospital

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Increase in salivary cortisol and in Spielberger score		one hour
Secondary	Difference in the cognitive appraisal (challenge or threat)		one hour