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Updated: Jun 4, 2026
10:16
Psychophysiological Stress Assessment Using Biofeedback
Published on: July 31, 2009
Effects of simulation versus traditional tutorial-based training on physiologic stress levels among clinicians: a
Choon Looi Bong1, Jenifer R Lightdale, Meghan E Fredette
1Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore 249972, Republic of Singapore. clbong1@gmail.com
Summary
Simulation-based training (SBT) increases physiologic stress in clinicians compared to traditional education. This study measured heart rate and cortisol levels to understand stress responses in medical training.
Area of Science:
- Medical Education
- Physiology
- Healthcare Simulation
Background:
- Emotionality and anxiety in medical simulations may enhance learning, but the stress response curve is not well understood.
- Physiologic stress during training is a key factor in learning outcomes.
Purpose of the Study:
- To quantify the physiologic stress induced by simulation-based training (SBT) versus interactive education (IET).
- To compare stress responses to simulation activities among different pediatric provider groups.
Main Methods:
- Twenty-seven gastroenterology physicians were randomized to SBT or IET.
- Heart rate and salivary cortisol levels were measured at multiple time points.
- RNs and technicians also participated in SBT exercises.
Main Results:
- Physicians in the SBT group showed increased heart rate (+17 beats/min) and salivary cortisol (+70% over baseline) compared to the IET group.
- The IET group showed a decrease in heart rate (-4 beats/min) and salivary cortisol (-20% under baseline).
- Technicians had a smaller increase in salivary cortisol compared to physicians and nurses.
Conclusions:
- High-fidelity SBT increases physiologic stress (heart rate, cortisol) in clinicians regardless of role, compared to traditional IET.
- This provides data for understanding the dose-response curve of simulation to optimize learning.
- Further research can use these findings to refine simulation-based medical education.
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