Evans Leigh V, Bonz James W, Buck Samuel, Gerwin Jeffrey N, Bonner Shacelles, Ikejiani Suzette, Moylan Tatiana, Joseph Melissa, de Oliveira Almeida Gustavo, Ray Jessica M, Dziura James D, Venkatesh Arjun K, Wong Ambrose H
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, United States of America.
PLoS One. 2025 Sep 3;20(9):e0331488. doi: 10.1371/journal.pone.0331488. eCollection 2025.
Stressful work environments and burnout in emergency medicine (EM) physicians adversely impact patient care quality. The future EM workforce will need to prioritize clinician well-being to ensure optimal patient care.
This prospective, randomized, controlled study aimed to determine whether an adaptive simulation intervention, COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS), decreased physiologic stress as measured by heart rate variability (HRV) in front-line EM physicians during the COVID-19 pandemic. HRV was measured with smart shirts and self-reported State-Trait Anxiety Inventory (STAI) were collected at baseline and during four 8-hour clinical shifts for all participants. The intervention group (n = 40) received a 3-hour virtual educational simulation intervention consisting of four simulation scenarios (CRI:SIS). The control group (n = 41) received no simulation intervention.
There were no significant differences in demographics between groups. HRV data collected from 81 physicians across a total of 324 clinical shifts showed an increase in HRV (decrease in physiologic stress) in shifts immediately following CRI:SIS in the intervention group as measured by a root mean square standard deviation (RMSSD) difference of 11.55 ms (95% CI, -19.90 to -3.20; P = 0.007) compared to the control group. Post-intervention STAI did not significantly differ between intervention and control.
An adaptive simulation-based educational intervention led to decreased physiologic stress (increased HRV) among emergency physicians who received a simulation education intervention. Reduced physiologic stress generated by adaptive simulation interventions may improve both patient safety and clinician well-being.
急诊医学（EM）医生面临的工作环境压力和职业倦怠会对患者护理质量产生不利影响。未来的急诊医学劳动力需要将临床医生的福祉放在首位，以确保提供最佳的患者护理。
这项前瞻性、随机对照研究旨在确定一种适应性模拟干预措施——COVID-19响应干预：系统改进模拟（CRI:SIS），是否能降低COVID-19大流行期间一线急诊医学医生通过心率变异性（HRV）测量的生理压力。所有参与者在基线时以及四个8小时临床班次期间，使用智能衬衫测量HRV，并收集自我报告的状态-特质焦虑量表（STAI）。干预组（n = 40）接受了为期3小时的虚拟教育模拟干预，包括四个模拟场景（CRI:SIS）。对照组（n = 41）未接受模拟干预。
两组之间在人口统计学方面无显著差异。从81名医生在总共324个临床班次中收集的HRV数据显示，干预组在CRI:SIS后的班次中HRV增加（生理压力降低），与对照组相比，均方根标准差（RMSSD）差异为11.55毫秒（95%CI，-19.90至-3.20；P = 0.007）。干预后干预组和对照组的STAI无显著差异。
基于适应性模拟的教育干预可降低接受模拟教育干预的急诊医生的生理压力（增加HRV）。适应性模拟干预产生的生理压力降低可能会改善患者安全和临床医生的福祉。
