Hall Andrew, Kawai Kosuke, Graber Kelsey, Spencer Grant, Roussin Christopher, Weinstock Peter, Volk Mark S
Department of Otolaryngology, University Hospital of Wales and Noah's Ark Children's Hospital for Wales, Cardiff, UK.
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.
BMJ Simul Technol Enhanc Learn. 2021 Apr 13;7(6):471-477. doi: 10.1136/bmjstel-2020-000727. eCollection 2021.
Stress may serve as an adjunct (challenge) or hindrance (threat) to the learning process. Determining the effect of an individual's response to situational demands in either a real or simulated situation may enable optimisation of the learning environment. Studies of acoustic analysis suggest that mean fundamental frequency and formant frequencies of voice vary with an individual's response during stressful events. This hypothesis is reviewed within the otolaryngology (ORL) simulation environment to assess whether acoustic analysis could be used as a tool to determine participants' stress response and cognitive load in medical simulation. Such an assessment could lead to optimisation of the learning environment.
ORL simulation scenarios were performed to teach the participants teamwork and refine clinical skills. Each was performed in an actual operating room (OR) environment (in situ) with a multidisciplinary team consisting of ORL surgeons, OR nurses and anaesthesiologists. Ten of the scenarios were led by an ORL attending and ten were led by an ORL fellow. The vocal communication of each of the 20 individual leaders was analysed using a long-term pitch analysis PRAAT software (autocorrelation method) to obtain mean fundamental frequency (F0) and first four formant frequencies (F1, F2, F3 and F4). In reviewing individual scenarios, each leader's voice was analysed during a non-stressful environment (WHO sign-out procedure) and compared with their voice during a stressful portion of the scenario (responding to deteriorating oxygen saturations in the manikin).
The mean unstressed F0 for the male voice was 161.4 Hz and for the female voice was 217.9 Hz. The mean fundamental frequency of speech in the ORL fellow (lead surgeon) group increased by 34.5 Hz between the scenario's baseline and stressful portions. This was significantly different to the mean change of -0.5 Hz noted in the attending group (p=0.01). No changes were seen in F1, F2, F3 or F4.
This study demonstrates a method of acoustic analysis of the voices of participants taking part in medical simulations. It suggests acoustic analysis of participants may offer a simple, non-invasive, non-intrusive adjunct in evaluating and titrating the stress response during simulation.
压力可能是学习过程的辅助因素（挑战）或阻碍因素（威胁）。确定个体在真实或模拟情境中对情境需求的反应效果，可能有助于优化学习环境。声学分析研究表明，在压力事件中，语音的平均基频和共振峰频率会随个体的反应而变化。本研究在耳鼻喉科（ORL）模拟环境中对这一假设进行了验证，以评估声学分析是否可作为一种工具，用于确定医学模拟中参与者的应激反应和认知负荷。这样的评估可能会优化学习环境。
进行ORL模拟场景，以教授参与者团队合作并完善临床技能。每个场景都在实际手术室（OR）环境中（现场）进行，由多学科团队组成，包括ORL外科医生、手术室护士和麻醉师。其中10个场景由ORL主治医师主持，10个场景由ORL住院医师主持。使用长期音高分析PRAAT软件（自相关法）对20位个体领导者的语音交流进行分析，以获得平均基频（F₀）和前四个共振峰频率（F₁、F₂、F₃和F₄）。在回顾各个场景时，分析了每位领导者在非压力环境（世界卫生组织签出程序）下的声音，并将其与场景中压力部分（对人体模型中不断恶化的血氧饱和度做出反应）时的声音进行比较。
男性声音的平均无压力F₀为161.4赫兹，女性声音的平均无压力F₀为217.9赫兹。在场景的基线部分和压力部分之间，ORL住院医师（主刀医生）组的语音平均基频增加了34.5赫兹。这与主治医师组中观察到的平均变化-0.5赫兹有显著差异（p = 0.01）。F₁、F₂、F₃或F₄没有变化。
本研究展示了一种对参与医学模拟的参与者声音进行声学分析的方法。研究表明，对参与者的声学分析可能为评估和调节模拟过程中的应激反应提供一种简单、无创、非侵入性的辅助手段。
