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Stress responses in surgical trainees during simulation-based training courses in laparoscopy.

Maria Suong Tjønnås1,2, Sébastien Muller3, Cecilie Våpenstad3,4,5

  • 1Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway. lethi@stud.ntnu.no.

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Summary

Surgical trainees experience higher stress during laparoscopic simulation training, with no significant differences between simulators. More experience correlates with higher physiological stress but lower self-reported stress.

Keywords:
CortisolHeart rate variabilityLaparoscopic skillsSTAI-6Simulation-based learningStress responseSurgical trainee

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Area of Science:

  • Medical Education
  • Surgical Training
  • Human Physiology

Background:

  • Laparoscopic simulation training is crucial for surgical education.
  • Mastering laparoscopic skills is challenging and induces stress in trainees.
  • Limited data exists on stress responses during simulation training and the impact of prior experience.

Purpose of the Study:

  • To investigate physiological, endocrine, and self-reported stress responses in surgical trainees during simulation-based laparoscopic skills training.
  • To explore the correlation between previous laparoscopic experience and stress responses.

Main Methods:

  • Prospective observational study of 24 surgical trainees over a three-day basic laparoscopic skills course.
  • Trainees used D-box, P.O.P. trainer, and LAPMentor™ simulators.
  • Stress was measured using heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6).

Main Results:

  • Stress measures (HRV, STAI-6) were significantly higher during simulation training compared to rest across all simulators.
  • A significant increase in saliva cortisol was observed during D-box simulation.
  • No significant differences in stress responses were found between the three simulators.
  • Surgical experience showed moderate correlations with physiological and endocrine stress measures and self-reported stress.

Conclusions:

  • Simulation-based laparoscopic training significantly increases trainee stress compared to resting conditions.
  • No single simulator demonstrated a higher stress response than others.
  • The D-box simulator, potentially due to time pressure, induced higher cortisol levels.
  • Increased surgical experience is linked to higher physiological stress but lower perceived stress during simulation training.