title: Evaluation of stress patterns during simulated laparoscopy in residency.
abstract: BACKGROUND
  Laparoscopy simulation offers realistic complexity of tasks and required skills, and helps to develop competencies. However the relationship of stress to the experience has not been comprehensively explored. Objectives were: 1) to evaluate stress level before and during laparoscopy in surgery interns (PGY-1) and surgery residents (PGY-2); 2) to evaluate performance in simulated laparoscopy in both groups; 3) to study the correlation between stress pathways themselves and to study which factors mediate the relationship between stress and performance.
  
  
  METHODS
  Seven PGY-1 (didactic course plus 2-hour hands-on session) and 6 PGY-2 who usually operate by laparoscopy were included. Performance assessment used the MISTELS scale. Salivary cortisol (SC) was measured the day prior (T0) to simulation, and immediately before (T1), and after the session (T2). Electrophysiological indicators of stress were assessed by Holter: heart rate (HR) and its variability (pNN50) at the same time. Perceived stress was determined at T1.
  
  
  RESULTS
  All parameters were similar at T0. Regarding the whole study population, simulation induced stress. However response varied by subgroups. For PGY-1, levels of SC, HR and pNN50 were similar between T0 and T1. Afterwards, SC and HR significantly increased with a parallel decrease in pNN50 at T2. For PGY-2, a significant increase in HR and decrease in pNN50 were observed from T0 to T1, and remained stable at T2. No change in SC level or perceived stress was noted. Performance score was significantly higher in PGY-2. Stress patterns were not correlated between each other but a correlation was found between electrophysiological parameters and performance.
  
  
  CONCLUSIONS
  Two stress patterns were identified: PGY-1 exhibited an increase in stress level during the procedure, whereas in PGY-2 it occurred prior to the procedure. This suggests that the impact of simulation on stress parameters might be different according to the experience of the learners.
authors.affiliation: Simulation Laboratory, Faculty of Medicine, University of Poitiers, Poitiers, France - aiham@hotmail.com.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Ghazali
authors.forename: Jean P
authors.initials: JP
authors.lastname: Faure
authors.forename: Cyril
authors.initials: C
authors.lastname: Breque
authors.forename: Denis
authors.initials: D
authors.lastname: Oriot
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D003198:Computer Simulation; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008297:Male; D013315:Stress, Psychological / Q000378:metabolism*; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D006854:Hydrocortisone