title: The impact of simulated patient death on medical students' stress response and learning of ACLS.
abstract: BACKGROUND
  There is considerable controversy as to whether the simulator should die during high-fidelity simulation (HFS). We sought to describe the physiologic and biochemical stress response induced by simulated patient death as well as the impact on long-term retention of Advanced Cardiovascular Life Support (ACLS) knowledge and skills.
  
  
  METHODS
  Twenty-six subjects received an American Heart Association (AHA) ACLS provider course. Following the course, subjects participated in HFS and were randomized to simulated death or survival. Heart rate and salivary cortisol (SC) and dihydroepiandrosterone (DHEA) were collected at this time. Subjects returned six months later for a follow-up simulation in which ACLS knowledge and skills were tested.
  
  
  RESULTS
  For all participants, there was an increase in heart rate during simulation compared with baseline heart rate (+ 32 beats/minute), p < 0.0001. Similarly, SC and DHEA were higher compared with baseline levels (+ 0.115 μg/dL, p <0.01 and + 97 pg/mL, p < 0.001, respectively). However, the only statistically significant difference between groups was an increase in heart rate response at the end of the simulation compared with baseline in the death group (+ 29.2 beats/minute versus + 18.5 beats/minute), p < 0.05. There was no difference on long-term knowledge or skills.
  
  
  CONCLUSIONS
  Learners experience stress during high-fidelity simulation; however, there does not appear to be a readily detectable difference or negative response to a simulated patient death compared with simulated survival.
authors.affiliation: a Department of Anesthesiology , Icahn School of Medicine at Mount Sinai , New York , NY , USA ;
authors.forename: Samuel
authors.initials: S
authors.lastname: DeMaria
authors.affiliation: b Department of Anesthesiology , Montefiore Medical Center , New York , NY , USA ;
authors.forename: Eric R
authors.initials: ER
authors.lastname: Silverman
authors.affiliation: a Department of Anesthesiology , Icahn School of Medicine at Mount Sinai , New York , NY , USA ;
authors.forename: Kyle A B
authors.initials: KA
authors.lastname: Lapidus
authors.affiliation: c Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Williams
authors.affiliation: d Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: John
authors.initials: J
authors.lastname: Spivack
authors.affiliation: a Department of Anesthesiology , Icahn School of Medicine at Mount Sinai , New York , NY , USA ;
authors.forename: Adam
authors.initials: A
authors.lastname: Levine
authors.affiliation: a Department of Anesthesiology , Icahn School of Medicine at Mount Sinai , New York , NY , USA ;
authors.forename: Andrew
authors.initials: A
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000193:education*; D015415:Biomarkers; D002983:Clinical Competence; D003643:Death; D003687:Dehydroepiandrosterone / Q000032:analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007858:Learning; D008297:Male; D008348:Manikins; D012463:Saliva / Q000737:chemistry; D000066908:Simulation Training / Q000379:methods*; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology*
chemical_list: D015415:Biomarkers; D003687:Dehydroepiandrosterone; D006854:Hydrocortisone