Stress: A Factor Explaining the Gap Between Simulated and Clinical Procedure Success

Area of Science:

• Medical Education
• Emergency Medicine
• Procedural Skills Training

Background:

• Stress is a known factor that can negatively affect procedural outcomes in emergency medicine.
• Understanding resident stress during critical procedures like lumbar punctures (LPs) is essential for improving patient care.

Purpose of the Study:

• To evaluate stress levels experienced by residents during simulated versus clinical lumbar punctures (LPs).
• To determine the correlation between stress and performance/success rates in LPs.
• To identify factors contributing to stress during these procedures.

Main Methods:

• A prospective study involving 33 residents performing 35 LPs in a pediatric emergency department.
• Residents underwent mastery and just-in-time training before clinical LPs.
• Stress was measured using the Stress-O-Meter scale; performance and success rates were recorded by supervisors.

Main Results:

• No significant stress was reported during simulated LPs.
• Stress levels markedly increased during clinical LPs (P < 0.0001).
• While performance remained consistent, success rates significantly decreased in clinical settings (P < 0.0001), with fear of technical errors and fatigue cited as primary stressors.

Conclusions:

• Simulation performance does not reliably predict clinical success for LPs.
• Increased stress and factors like fear of errors and fatigue in real-world conditions can impair procedural success, even with adequate training.