Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

Area of Science:

• Medical Education
• Anesthesiology
• Human Factors Engineering

Background:

• Simulation-based training (SBT) is crucial for medical education, but its effectiveness may be influenced by stress.
• The impact of stress on learning, performance, and skills in clinical versus simulated settings is not well-understood.
• Objective (heart rate variability, HRV) and subjective (State Trait Anxiety Inventory, STAI) stress measures have not been directly compared between theatre and simulation environments.

Purpose of the Study:

• To compare objective and subjective stress levels experienced by anesthetic trainees during a simulated rapid sequence induction versus the actual theatre environment.
• To determine if simulation accurately replicates the physiological and psychological stress of a clinical procedure.
• To inform the development and application of simulation-based training in medical education.

Main Methods:

• Eight anesthetic trainees underwent HRV monitoring and completed STAI questionnaires during a rapid sequence induction in both an emergency theatre and a simulated environment.
• Objective stress was measured using HRV, while subjective stress was assessed via STAI scores before and after each procedure.
• Data were analyzed to compare stress levels between baseline, theatre, and simulation settings, considering interactions between stress and environment.

Main Results:

• The theatre environment significantly increased objective stress compared to baseline (p=.004).
• No significant difference in average objective stress levels was found between the theatre and simulation environments (p=.20).
• A significant interaction effect between objective stress and environment was observed (p=.045), and no significant difference in subjective stress was found between environments (p=.27).

Conclusions:

• Simulation-based training currently fails to fully replicate the objective stress experienced in a real clinical theatre setting.
• This study is the first to directly compare stress during SBT with the theatre environment.
• Findings have implications for the validity of simulated environments in assessments, skills evaluation, and stress management training.