title: Effect of Extrinsic and Intrinsic Stressors on Clinical Skills Performance in Third-Year Medical Students.
abstract: BACKGROUND
  Both enhancements and impairments of clinical performance due to acute stress have been reported, often as a function of the intensity of an individual's response. According to the broader stress literature, peripheral or extrinsic stressors (ES) and task-contingent or intrinsic stressors (IS) can be distinguished within a stressful situation. The objective of this study was to assess the impact of IS and ES on clinical performance.
  
  
  METHODS
  A prospective randomized crossover study was undertaken with third-year medical students conducting two medical experiences with simulated patients. The effects of severity of the disease (IS) and the patient's aggressiveness (ES) were studied. A total of 109 students were assigned to four groups according to the presence of ES and IS. Subjective stress and anxiety responses were assessed before and after each experience. The students' clinical skills, diagnostic accuracy and argumentation were assessed as clinical performance measures. Sex and student-perceived cognitive difficulty of the task were considered as adjustment variables.
  
  
  RESULTS
  Both types of stressors improved clinical performance. IS improved diagnostic accuracy (regression parameter β = 9.7, p = 0.004) and differential argumentation (β = 5.9, p = 0.02), whereas ES improved clinical examination (β = 12.3, p < 0.001) and communication skills (β = 15.4, p < 0.001). The student-perceived cognitive difficulty of the task was a strong deleterious factor on both stress and performance.
  
  
  CONCLUSIONS
  In simulated consultation, extrinsic and intrinsic stressors both have a positive but different effect on clinical performance.
authors.affiliation: Department of Internal Medicine, University Hospital Center, Faculty of Medicine, University of Nantes, CHU Nantes, Place Alexis Ricordeau, Nantes, 44093, France, pierre.pottier@univ-nantes.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pottier
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Hardouin
authors.forename: Thomas
authors.initials: T
authors.lastname: Dejoie
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Castillo
authors.forename: Anne-Gaelle
authors.initials: AG
authors.lastname: Le Loupp
authors.forename: Bernard
authors.initials: B
authors.lastname: Planchon
authors.forename: Angélique
authors.initials: A
authors.lastname: Bonnaud
authors.forename: Vicki
authors.initials: V
authors.lastname: LeBlanc
mesh_terms: D000374:Aggression; D002983:Clinical Competence; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D011446:Prospective Studies; D013315:Stress, Psychological / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult