title: Is the Advanced Trauma Life Support simulation exam more stressful for the surgeon than emergency department trauma care?
abstract: BACKGROUND
  Stress affects surgeons both during training and during professional activity.
  
  
  OBJECTIVE
  To compare stress levels affecting surgical residents during the simulated initial assessment and management in the Advanced Trauma Life Support practical exam vs initial assessment and management of trauma patients in the emergency room.
  
  
  METHODS
  Eighteen surgical residents were evaluated under basal conditions, during the Advanced Trauma Life Support simulation, and during emergency room initial care. Heart rate, systolic arterial pressure, and diastolic arterial pressure were measured. The Student t test was used to test for differences between means, with statistical significance declared when P < .05.
  
  
  RESULTS
  Heart rate and systolic arterial pressure were increased at the beginning and at the end of Advanced Trauma Life Support simulation and emergency room initial care. Diastolic arterial pressure was only increased at the end of the Advanced Trauma Life Support simulation. Comparing values obtained during the Advanced Trauma Life Support simulation with those obtained during emergency room initial care, heart rate and systolic arterial pressure were significantly higher during the Advanced Trauma Life Support simulation both at the beginning and end of the test events. However, diastolic arterial pressure was only significantly higher for Advanced Trauma Life Support simulation compared emergency room at the end of the procedures. These results suggest that the simulation in the practical exam portion of the Advanced Trauma Life Support course is more stressful for the resident surgeon than is the actual initial assessment and care of trauma patients in an emergency room.
authors.affiliation: Emergency Surgery Service, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Quilici
authors.forename: Renato Sergio
authors.initials: RS
authors.lastname: Pogetti
authors.forename: Belchor
authors.initials: B
authors.lastname: Fontes
authors.forename: Luis Fernando Correa
authors.initials: LF
authors.lastname: Zantut
authors.forename: Eliana Torrea
authors.initials: ET
authors.lastname: Chaves
authors.forename: Dario
authors.initials: D
authors.lastname: Birolini
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002055:Burnout, Professional / Q000523:psychology*; D004635:Emergency Medicine / Q000193:education; D013502:General Surgery / Q000193:education*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007396:Internship and Residency; D008020:Life Support Care / Q000523:psychology*; D016544:Patient Simulation; D014194:Traumatology / Q000193:education*