Stress Clinical Trial
Official title:
Effects of Stress on Observers and Their Subsequent Performance During High Fidelity Simulation-based Training: A Randomized Controlled Trial.
This randomized controlled trial aims to determine if the stress response and performance of
trainees who are observers in simulation training is similar to trainees who are actively
participating in simulation training in the 'hotseat' during 3 consecutive simulation
sessions.
We hypothesize that trainees experience less stress when they are observers in the first 2
simulation sessions. However, when they are placed in the 'hotseat' during the third
session, their stress response, as well as their performance, will be similar to trainees
who spend all 3 simulation sessions in the 'hotseat'.
Background: High fidelity simulation-based training (SBT) using sophisticated manikins
instead of real patients for medical teaching is now commonly practiced worldwide. We
previously showed that SBT causes significant stress in the trainees, as evidenced by a rise
in their heart rate and salivary cortisol(; and that repeated exposure to SBT was associated
with the same level of stress, despite performance improving. From our studies, participants
in the 'hot-seat' actively managing the clinical crisis experience the highest levels of
stress but benefit the most from the learning experience. However, the stress experienced by
observers (who are in the same room but not actively managing the crisis) and their learning
outcomes have not been studied.
Objectives: We aim to determine: 1) If observers of SBT experience less stress when compared
to the trainees in the 'hot-seat' and; 2) if trainees who were observers in prior SBT
sessions perform as well as trainees who were in the 'hot-seat' during subsequent SBT
sessions.
Methodology: Thirty-six trainee anaesthetists are randomized into 2 groups to undergo three
SBT scenarios. 18 Trainees randomized to the Observer group will first undergo two SBT
scenarios as observers followed by a third session in the 'hot-seat'. 18 Trainees in the
Control group will undergo all 3 sessions in the 'hot seat'. For each session, stress
response is measured by salivary cortisol and amylase while performance is measured using
the Anaesthetists Non Technical Skills (ANTS) score.
Clinical Significance: If we find that trainees who are observers of the first 2 SBT
scenarios experience less stress than the 'hot-seat' trainees but yet achieve similar level
of performance during the third SBT session, we can potentially make SBT less stressful and
reduce the total number of simulation required, thus improving the efficiency of simulation
training.
;
Allocation: Randomized, Intervention Model: Single Group Assignment, Masking: Open Label
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