title: Effects of simulation versus traditional tutorial-based training on physiologic stress levels among clinicians: a pilot study.
abstract: BACKGROUND
  Emotionality and heightened anxiety during medical simulation encounters have been hypothesized to contribute to improved cognition and learning, but the overall stress "dose response curve" of experiential learning remains unclear. We sought to (1) identify the degree and time course of physiologic stress induced in physicians by simulation-based training (SBT), when compared with a traditional tutorial-based interactive-education training (IET) and (2) compare differences in stress responses to simulation activities among pediatric provider groups.
  
  
  METHODS
  Twenty-seven gastroenterology physicians were randomized among six crisis resource management courses taught by SBT versus IET. Eleven RNs and four technicians participated in the SBT exercises. Heart rate (HR) and salivary cortisol (SC) levels were measured in all participants at four time points before, during, and after participation in the SBT sessions and at two time points before and after the IET sessions.
  
  
  RESULTS
  Physicians who underwent SBT (n = 13) demonstrated increased tachycardia at the end of the session (+17 beats/min), when compared with those in the IET group (n = 14) who demonstrated an overall negative response (-4 beats/min, P = 0.001). Similarly, physicians in the SBT group demonstrated increased SC (+0.140 μg/dL, 70% over baseline), when compared with physicians in the IET group who had a median decrease in SC (-0.015 μg/dL, 20% under baseline, P = 0.001). There were similar increases in HR in all participants after SBT, but technicians experienced a relatively smaller increase in SC compared with physicians and nurses.
  
  
  CONCLUSIONS
  After high-fidelity SBT within the gastroenterology suite, clinicians independent of their role demonstrated increased physiologic stress levels-as measured by HR and SC levels-compared with traditional IET sessions. The study provides novel calibration data compared with a traditional baseline for future investigations aimed at further understanding the dose-response curve of simulation-based experiences to optimize emotionality, cognition, and learning.
authors.affiliation: Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore 249972, Republic of Singapore. clbong1@gmail.com
authors.forename: Choon Looi
authors.initials: CL
authors.lastname: Bong
authors.forename: Jenifer R
authors.initials: JR
authors.lastname: Lightdale
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Fredette
authors.forename: Peter
authors.initials: P
authors.lastname: Weinstock
mesh_terms: D000328:Adult; D001007:Anxiety; D002983:Clinical Competence; D003071:Cognition; D003479:Curriculum; D004521:Educational Measurement; D004644:Emotions; D005260:Female; D005762:Gastroenterology / Q000193:education* / Q000379:methods; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D012307:Risk Factors; D012846:Singapore; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013312:Stress, Physiological; D013315:Stress, Psychological; D013610:Tachycardia / Q000209:etiology / Q000523:psychology; D013663:Teaching / Q000379:methods*; D055815:Young Adult