Russ Stephanie J, Morrison Ian, Bell Cheryl, Morse Jeremy Charles, Mackenzie Rhoda Katharine, Johnston Marie K
Institute for Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK.
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
BMJ Simul Technol Enhanc Learn. 2018 Oct 4;4(4):171-178. doi: 10.1136/bmjstel-2017-000276. eCollection 2018.
Acute stress has been linked to impaired clinical performance in healthcare settings. However, few studies have measured experienced stress and performance simultaneously using robust measures in controlled experimental conditions, which limits the strength of their findings.
In the current study we examined the relationship between acute stress and clinical performance in second-year medical students undertaking a simulated ECG scenario. To explore this relationship in greater depth we manipulated two variables (clinical urgency and cognitive load), and also examined the impact of trait anxiety and task self-efficacy.
Second-year medical students were asked to conduct a 12-lead ECG on a simulated patient. Students were randomly assigned to one of four experimental conditions according to clinical urgency (high/low) and cognitive load (high/low), which were manipulated during a handover prior to the ECG. As part of the scenario they were asked to describe the ECG trace to a senior doctor over the phone and to conduct a drug calculation. They then received a performance debrief. Psychological stress and physiological stress were captured (via self-report and heart rate, respectively) and various aspects of performance were observed, including technical competence, quality of communication, work rate and compliance with patient safety checks. Trait anxiety and task self-efficacy were also captured via self-report.
Fifty students participated. While there was little impact of experimental condition on stress or performance, there was a significant relationship between stress and performance for the group as a whole. Technical competence was poorer for those reporting higher levels of psychological stress prior to and following the procedure. Neither trait anxiety nor task self-efficacy mediated this relationship.
This study has provided evidence for a link between acute stress and impaired technical performance in medical students completing a simulated clinical scenario using real-time measures. The implications for patient safety and medical education are discussed.
急性应激与医疗环境中临床操作表现受损有关。然而，很少有研究在可控的实验条件下使用可靠的测量方法同时测量所经历的应激和操作表现，这限制了研究结果的说服力。
在本研究中，我们调查了在进行模拟心电图场景测试的二年级医学生中急性应激与临床操作表现之间的关系。为了更深入地探究这种关系，我们操控了两个变量（临床紧急程度和认知负荷），并考察了特质焦虑和任务自我效能感的影响。
要求二年级医学生对一名模拟患者进行12导联心电图检查。根据临床紧急程度（高/低）和认知负荷（高/低），学生被随机分配到四种实验条件之一，这些变量在心电图检查前的交接过程中进行操控。作为场景的一部分，要求他们通过电话向一名资深医生描述心电图波形并进行药物计算。然后他们接受操作表现汇报。采集心理应激和生理应激（分别通过自我报告和心率），并观察操作表现的各个方面，包括技术能力、沟通质量、工作效率和对患者安全检查的依从性。特质焦虑和任务自我效能感也通过自我报告采集。
50名学生参与了研究。虽然实验条件对应激或操作表现影响不大，但整个组中应激与操作表现之间存在显著关系。对于那些在操作前和操作后报告心理应激水平较高的学生，其技术能力较差。特质焦虑和任务自我效能感均未介导这种关系。
本研究提供了证据，表明在使用实时测量方法完成模拟临床场景的医学生中，急性应激与技术操作表现受损之间存在关联。文中讨论了这对患者安全和医学教育的启示。
