title: Endocrine and psychological stress responses in a simulated emergency situation.
abstract: BACKGROUND
  Several studies have assessed the effects of training using patient simulation systems on medical skills. However, endocrine and psychological stress responses in a patient simulation situation and the relationship between stress reactivity and medical performance have been studied rarely, so far.
  
  
  METHODS
  Medical students (18 males and 16 females) who had completed at least two months anaesthesiology training participated in the study. In a counterbalanced cross-over design they were subjected to three conditions: rest, laboratory stress (LS; public speaking), and simulated emergency situation (SIM; myocardial ischemia and ventricular fibrillation). Salivary cortisol and psychological responses (visual analogue scales, VAS) were assessed every 15 min from 15 min prior to until 60 min after intervention. Differences between stress and rest conditions were analysed. Medical performance was assessed according to the European Resuscitation Council's Guidelines for Resuscitation.
  
  
  RESULTS
  As compared to rest, cortisol increased significantly in both stress conditions with different time courses in LS and SIM. Psychological responses in SIM exceeded those in LS. Cortisol increase in LS (r(s)=.486; p=.019) but not in SIM (r(s)=.106; p=.631) correlated significantly with medical performance.
  
  
  CONCLUSIONS
  A simulated emergency situation is a profound stressor. The positive relationship between endocrine stress responsiveness in a standard laboratory situation and medical performance in a simulated emergency situation indicates that high stress responsiveness might be a predictor of good performance. At the same time the high stress response might counteract educational efforts associated with training using high-fidelity patient simulation.
authors.affiliation: Department of Psychology, General Psychology II and Biological Psychology, University of Osnabrueck, Seminarstr. 20, 49074 Osnabrueck, Germany.
authors.forename: Ariane
authors.initials: A
authors.lastname: Keitel
authors.forename: Matthias
authors.initials: M
authors.lastname: Ringleb
authors.forename: Ingo
authors.initials: I
authors.lastname: Schwartges
authors.forename: Ulrike
authors.initials: U
authors.lastname: Weik
authors.forename: Olaf
authors.initials: O
authors.lastname: Picker
authors.forename: Ursula
authors.initials: U
authors.lastname: Stockhorst
authors.forename: Renate
authors.initials: R
authors.lastname: Deinzer
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000328:Adult; D000776:Anesthesiology / Q000193:education; D018592:Cross-Over Studies; D004630:Emergencies / Q000523:psychology*; D004632:Emergency Medical Services; D004703:Endocrine System / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D013315:Stress, Psychological / Q000378:metabolism / Q000503:physiopathology*; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult