Stress Clinical Trial
Official title:
Impact of Unexpected Death in Simulation: Skill Retention, Stress and Emotions
Some educational researchers deliberately induce stress upon learners to in order to enhance retention; this practice is controversial and its utility must be weighed against the negative emotional effects it may have on participants. In this study we investigate the effect of the unexpected death of a simulation mannequin on the retention of non-technical and technical crisis resource management skills and consider the emotional impact of this acute stressor.
Background High-fidelity simulation is an increasingly used teaching tool that is proven to
be effective for learning. According to the literature, by gradually increasing stress and
emotions, more effective learning can be achieved. However, allowing the simulated patient to
"die", as a deliberate stressor, is controversial. There is no previous research on the
educational effect of letting a simulated patient die. We aim to evaluate the effects of
simulated unexpected death on skill retention, stress levels, and emotions. We hypothesize
that the occurrence of unexpected death will impact skill retention, and will be associated
with higher stress levels and stronger emotions.
Methods After Institutional Research Ethics Board approval, 56 residents and fellows of
different medical specialties will be randomized to either the intervention (unexpected
death) or control (survive) group. Participants from both groups will have to individually
manage a simulated cardiac arrest crisis. In the intervention group, the scenario will end by
the death of the simulated patient, whilst in the control group the simulated patient will
survive. Each participant will be immediately debriefed by a trained instructor. Three months
later, skill retention will be assessed in a similar scenario. Crisis management performance
of all scenarios will be rated by 2 blinded raters. Biological stress, cognitive appraisal,
and emotions will be measured during both scenarios.
Implications The impact of simulated unexpected death on skill retention of residents and
fellows will provide instructors with evidence to optimize scenario design and approach the
role of stress and emotions in simulation-based education.
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