The effects of active (hot-seat) versus observer roles during simulation-based training on stress levels and non-technical performance: a randomized trial
Tóm tắt
Active ‘hands-on’ participation in the ‘hot-seat’ during immersive simulation-based training (SBT) induces stress for participants, which is believed to be necessary to improve performance. We hypothesized that observers of SBT can subsequently achieve an equivalent level of non-technical performance as ‘hot-seat’ participants despite experiencing lower stress. We randomized 37 anaesthesia trainees into two groups to undergo three consecutive SBT scenarios. Eighteen ‘hot-seat’ trainees actively participated in all three scenarios, and 19 ‘observer’ trainees were directed to observe the first two scenarios and participated in the ‘hot-seat’ only in scenario 3. Salivary cortisol (SC) was measured at four time points during each scenario. Primary endpoint for stress response was the change in SC (ΔSC) from baseline. Performance was measured using the Anaesthetist’s Non-Technical Skills (ANTS) Score. Mean SC increased in all participants whenever they were in the ‘hot-seat’ role, but not when in the observer role. Hot-seat ΔSC (mcg/dL) for scenarios 1, 2, and 3 were 0.122 (p = 0.001), 0.074 (p = 0.047), and 0.085 (p = 0.023), respectively. Observers ΔSC (mcg/dL) for scenarios 1, 2, and 3 were −0.062 (p = 0.091), 0.010 (p = 0.780), and 0.144 (p = 0.001), respectively. Mean ANTS scores were equivalent between the ‘hot-seat’ (40.0) and ‘observer’ (39.4) groups in scenario 3 (p = 0.733). Observers of SBT achieved an equivalent level of non-technical performance, while experiencing lower stress than trainees repeatedly trained in the ‘hot-seat’. Our findings suggest that directed observers may benefit from immersive SBT even without repeated ‘hands-on’ experience and stress in the hot-seat. The directed observer role may offer a less stressful, practical alternative to the traditional ‘hot-seat’ role, potentially rendering SBT accessible to a wider audience. ClinicalTrials.gov Identifier
NCT02211378
, registered August 5, 2014, retrospectively registered.
Tài liệu tham khảo
Nestel D, Walker K, Simon R, Aggarwal R, Andreatta P. Nontechnical skills—an inaccurate and unhelpful descriptor? Simul Healthc. 2011;6:2–3.
Hamstra SJ, Brydges R, Hatala R, Zendejas B, Cook DA. Reconsidering fidelity in simulation-based training. Acad Med. 2014;89(3):387–92.
Weinstock PH, Kappus LJ, Garden A, et al. Simulation at the point of care: reduced-cost, in situ training via a mobile cart. Pediatr Crit Care Med. 2009;10(2):176–81. doi:10.1097/PCC.0b013e3181956c6f.
McFetrich J. A structured literature review on the use of high fidelity patient simulators for teaching in emergency medicine. Emerg Med J. 2006;23(7):509–11. doi:10.1136/emj.2005.030544.
Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693–700.
Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care. 2004;13 Suppl 1:i80–4.
Yee B, Naik V, Joo HS, et al. Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology. 2005;103(2):241–8.
Bong C, Lightdale J, Fredette M, et al. Effects of simulation versus traditional tutorial-based training on physiologic stress levels among clinicians: a pilot study. Simul Healthc. 2010;5(5):272–8.
Müller MP, Hänsel M, Fichtner A, et al. Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study. Resuscitation. 2009;80:919–24.
Valentin B, Grottke O, Skorning M, et al. Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients. Scand J Trauma Resusc Emerg Med (England). 2015;23(1):31.
Kolb DA. Experiential learning: experience as the source of learning and development. 2nd ed. New Jersay: Pearson Education Inc; 2015.
Cahill L, Gorski L, Le K. Enhanced human memory consolidation with post-learning stress: interaction with the degree of arousal at encoding. Learn Mem. 2003;10(4):270–4.
Vedhara K, Hyde J, Gilchrist ID, et al. Acute stress, memory, attention and cortisol. Psychoneuroendocrinology. 2000;25:535–49.
Klein G. The effect of acute stressors on decision making. In: Driskell JE, Salas E, editors. Stress and human performance. Mahwah, NJ: Lawrence Erlbaum Associates; 1996.
LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med. 2009;84(10):s25–33.
McGaghie WC, Issenberg SB, Petrusa ER, et al. A critical review of simulation‐based medical education research: 2003–2009. Med Educ. 2010;44(1):50–63.
Stocker M, Burmester M, Allen M. Optimisation of simulated team training through the application of learning theories: a debate for a conceptual framework. BMC Med Educ. 2014;14:69.
Cheng A, Donoghue A, Gilfoyle E, et al. Simulation-based crisis resource management training for pediatric critical care medicine: a review for instructors. Pediatr Crit Care Med. 2012;13(2):197–203. doi:10.1097/PCC.0b013e3182192832.
Dorn LD, Lucke JF, Loucks TL, et al. Salivary cortisol reflects serum cortisol: analysis of circadian profiles. Ann Clin Biochem. 2007;44:281–4.
Gozansky WS, Lynn JS, Laudenslager ML, et al. Salivary cortisol determined by enzyme immunoassay is preferable to serum total cortisol for assessment of dynamic hypothalamic–pituitary–adrenal axis activity. Clin Endocrinol (Oxf). 2005;63(3):336–41.
Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foundation; 1995.
Fletcher G, Flin R, McGeorge P, et al. Anaesthetists’ Non-Technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth. 2003;90:580–8.
Keitel A, Ringleb M, Schwartges I, et al. Endocrine and psychological stress responses in a simulated emergency situation. Psychoneuroendocrinology. 2011;36:98–108.
Quilici AP, Pogetti RS, Fontes B, et al. Is the advanced trauma life support simulation exam more stressful for the surgeon than emergency department trauma care? Clinics. 2005;60(4):287–92.
Jones T, Goss S, Weeks B, et al. The effects of high-fidelity simulation on salivary cortisol levels in SRNA students: a pilot study. Sci World J. 2011;11:86–92. doi:10.1100/tsw.2011.8.
O'Regan S, Molloy E, Watterson L, Nestel D. Observer roles that optimise learning in healthcare simulation education: a systematic review. Adv Simul. 2016;1:4.
Bandura A. Social learning theory. New York City: General Learning Press; 1971.
Meichenbaum D, Deffenbacher JL. Stress inoculation training. Couns Psychol. 1988;16:69–90.
Saunders T, Driskell JE, Johnston JH, et al. The effect of stress inoculation training on anxiety and performance. J Occup Health Psychol. 1996;1(2):170–86.
Peterlini M, Tiberio IFLC, Saadeh A, et al. Anxiety and depression in the first year of medical residency training. Med Educ. 2002;36:66–72.
Toews JA, Lockyer JM, Dobson DJG, et al. Stress among residents, medical students, and graduate science (MSc/PhD) students. Acad Med. 1993;68 Suppl 10:S46–8.
Bozovic D, Racic M, Ivkovic N. Salivary cortisol levels as a biological marker of stress reaction. Med Arh. 2013;67(5):374–7.