Effects of Stress on Observers and Their Subsequent Performance During High Fidelity Simulation-based Training.
Condition: Stress
Study type: Interventional

Summary: 
      This randomized controlled trial aims to determine if the stress response and performance of
      trainees who are observers in simulation training is similar to trainees who are actively
      participating in simulation training in the 'hotseat' during 3 consecutive simulation
      sessions.

      We hypothesize that trainees experience less stress when they are observers in the first 2
      simulation sessions. However, when they are placed in the 'hotseat' during the third session,
      their stress response, as well as their performance, will be similar to trainees who spend
      all 3 simulation sessions in the 'hotseat'.
    

Detailed description: 
      Background: High fidelity simulation-based training (SBT) using sophisticated manikins
      instead of real patients for medical teaching is now commonly practiced worldwide. We
      previously showed that SBT causes significant stress in the trainees, as evidenced by a rise
      in their heart rate and salivary cortisol(; and that repeated exposure to SBT was associated
      with the same level of stress, despite performance improving. From our studies, participants
      in the 'hot-seat' actively managing the clinical crisis experience the highest levels of
      stress but benefit the most from the learning experience. However, the stress experienced by
      observers (who are in the same room but not actively managing the crisis) and their learning
      outcomes have not been studied.

      Objectives: We aim to determine: 1) If observers of SBT experience less stress when compared
      to the trainees in the 'hot-seat' and; 2) if trainees who were observers in prior SBT
      sessions perform as well as trainees who were in the 'hot-seat' during subsequent SBT
      sessions.

      Methodology: Thirty-six trainee anaesthetists are randomized into 2 groups to undergo three
      SBT scenarios. 18 Trainees randomized to the Observer group will first undergo two SBT
      scenarios as observers followed by a third session in the 'hot-seat'. 18 Trainees in the
      Control group will undergo all 3 sessions in the 'hot seat'. For each session, stress
      response is measured by salivary cortisol and amylase while performance is measured using the
      Anaesthetists Non Technical Skills (ANTS) score.

      Clinical Significance: If we find that trainees who are observers of the first 2 SBT
      scenarios experience less stress than the 'hot-seat' trainees but yet achieve similar level
      of performance during the third SBT session, we can potentially make SBT less stressful and
      reduce the total number of simulation required, thus improving the efficiency of simulation
      training.
    

Intervention name(s): Observer; Hotseat
Intervention type(s): Other; Other
Intervention description(s): Trainees are in the role of observers (not actively participating in simulation scenario) during first 2 simulation sessions, then placed in the role in the 'hotseat' actively participating during the third simulation session.; Trainees in the hotseat group are placed in the 'hotseat' to actively participate and manage the simulated medical crises in the simulation scenarios.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Keywords: stress; performance; cortisol