Emergency Department and EMS, University Hospital of Bichat, Paris, France; Ilumens - Simulation Laboratory, University of Paris-Diderot, Paris, France; ABS Lab - Simulation Laboratory, Faculty of Medicine, University of Poitiers, France; Clinical Investigation Center CIC-INSERM1402, University Hospital of Poitiers, France.
Emergency Medical Service, University Hospital of Necker, Paris, France; Clinical Investigation Center CIC-INSERM1402, University Hospital of Poitiers, France.
Aust Crit Care. 2018 Jul;31(4):226-233. doi: 10.1016/j.aucc.2017.07.001. Epub 2017 Jul 27.
Stress might impair clinical performance in real life and in simulation-based education (SBE). Subjective or objective measures can be used to assess stress during SBE. This monocentric study aimed to evaluate the effects of simulation of life-threatening events on measurements of various stress parameters (psychological, biological, and electrophysiological parameters) in multidisciplinary teams (MDTs) during SBE. The effect of gender and status of participants on stress response was also investigated. Twelve emergency MDTs of 4 individuals were recruited for an immersive simulation session. Stress was assessed by: (1) self-reported stress; (2) Holter analysis, including heart rate and heart rate variability in the temporal and spectral domain (autonomic nervous system); (3) salivary cortisol (hypothalamic pituitary adrenal axis). Forty-eight participants (54.2% men, <7years of experience) were included. Measures were performed at baseline (T0), after simulation (T1), after debriefing (T2), and 30min after debriefing (T3). There was an increase in stress level at T1 (p<0.001) and a decrease at T2 (p<0.001). However, the variations of stress parameters induced by simulation (T0-T1 difference and T1-T2 difference) estimated by the three approaches were not correlated, while, as expected, Holter parameters were well-correlated to each other. Immersive SBE produced a change of stress level in all MDT members with no evidence for status effect but with gender difference. None developed a PTSD. These results support the hypothesis of a complementarity of the stress paths (collective reaction with increased stress level during simulation and a decrease during debriefing) but with relative independence of these paths (lack of correlation to each other). This study also suggests that because of the lack of correlation, stress response should be assessed by a combination of psychological, biological and electrophysiological parameters.
压力可能会影响现实生活和基于模拟的教育（SBE）中的临床表现。可以使用主观或客观的措施来评估 SBE 期间的压力。这项单中心研究旨在评估在 SBE 期间，模拟危及生命的事件对多学科团队（MDT）的各种压力参数（心理、生理和电生理参数）测量的影响。还研究了参与者的性别和地位对压力反应的影响。招募了 12 个由 4 人组成的紧急 MDT 进行沉浸式模拟课程。通过以下方式评估压力：（1）自我报告的压力；（2）Holter 分析，包括时域和频域的心率和心率变异性（自主神经系统）；（3）唾液皮质醇（下丘脑-垂体-肾上腺轴）。共纳入 48 名参与者（54.2%为男性，<7 年工作经验）。在基线（T0）、模拟后（T1）、汇报后（T2）和汇报后 30 分钟（T3）进行测量。T1 时压力水平升高（p<0.001），T2 时压力水平降低（p<0.001）。然而，三种方法估计的模拟引起的压力参数变化（T0-T1 差异和 T1-T2 差异）没有相关性，而 Holter 参数之间的相关性则符合预期。沉浸式 SBE 使所有 MDT 成员的压力水平发生变化，没有证据表明地位的影响，但存在性别差异。没有人发展为 PTSD。这些结果支持了以下假设：压力途径（模拟期间集体反应导致压力水平升高，汇报期间压力水平降低）具有互补性，但这些途径相对独立（彼此之间缺乏相关性）。本研究还表明，由于缺乏相关性，应通过结合心理、生理和电生理参数来评估压力反应。
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