James Osian P, Robinson David B T, Hopkins Luke, Bowman Chris, Powell Arfon G M T, Brown Chris, Bailey Damian M, Egan Richard J, Lewis Wyn G
School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK.
Department of Surgery, Royal Gwent Hospital, Newport, UK.
BMJ Simul Technol Enhanc Learn. 2020 Aug 13;7(4):188-193. doi: 10.1136/bmjstel-2020-000631. eCollection 2021.
Competitive physical performance is routinely monitored by wearable technology (biosensors), yet professional healthcare is not, despite high prevalence of trainee stress and burnout, notwithstanding the corresponding risk to patient safety. This study aimed to document the physiological stress response of UK Core Surgical Trainees (CSTs) during simulation training.
CSTs (n=20, 10 male) were fitted with Vital Scout Wellness Monitors (VivaLNK, Campbell, California, USA) for an intensive 3-day training bootcamp. In addition to physiological parameters, CST demographics, event diaries and Maslach Burnout Inventory scores were recorded prospectively during exposure to three scenarios: interactive lectures, clinical skills simulation and non-technical (communication) training.
Baseline heart rate (BHR, 60 bpm (range 39-81 bpm)) and baseline respiratory rate (14/min (11-18/min)) varied considerably and did not correlate (rho 0.076, p=0.772). BHR was associated with weekly exercise performed (66 bpm (<1 hour) vs 43 bpm (>5 hour), rho -0.663, p=0.004). Trainee response (standardised median heart rate vs BHR) revealed heart rate was related proportionately to lectures (71 bpm, p<0.001), non-technical skills training (79 bpm, p<0.001) and clinical skills simulation (88 bpm, p<0.001). Respiratory rate responded similarly (p<0.001 in each case). Heart rate during clinical skills simulation was associated with (rho 0.493, p=0.044), but maximum heart rate was unrelated to CSTs' perceived peak stressors.
Stress response, as derived from positive sympathetic heart rate drive varied over two-fold, with a direct implication on oxygen uptake and energy expenditure, and highlighting the daily physical demands placed upon clinicians.
可穿戴技术（生物传感器）常用于监测竞技体育表现，但尽管实习医生压力大和职业倦怠现象普遍，且存在对患者安全的相应风险，专业医疗保健领域却未采用这种技术。本研究旨在记录英国核心外科实习医生（CSTs）在模拟训练期间的生理应激反应。
20名CSTs（10名男性）在为期3天的强化训练新兵训练营期间佩戴了Vital Scout健康监测仪（VivaLNK，美国加利福尼亚州坎贝尔）。除生理参数外，还前瞻性记录了CSTs的人口统计学信息、事件日记和马氏职业倦怠量表得分，期间经历了三种场景：互动讲座、临床技能模拟和非技术（沟通）培训。
静息心率（BHR，60次/分钟（范围39 - 81次/分钟））和静息呼吸频率（14次/分钟（11 - 18次/分钟））差异很大且无相关性（rho 0.076，p = 0.772）。BHR与每周运动量有关（<1小时为66次/分钟，>5小时为43次/分钟，rho -0.663，p = 0.004）。实习医生的反应（标准化中位数心率与BHR）显示，心率与讲座（71次/分钟，p < 0.001）、非技术技能培训（79次/分钟，p < 0.001）和临床技能模拟（88次/分钟，p < 0.001）成比例相关。呼吸频率反应相似（每种情况p < 0.001）。临床技能模拟期间的心率与……相关（rho 0.493，p = 0.044），但最大心率与CSTs感知到的最大应激源无关。
由积极的交感神经心率驱动产生的应激反应变化超过两倍，这直接影响氧气摄取和能量消耗，并突出了临床医生日常的体力需求。
