title: Evolution of stress in anaesthesia registrars with repeated simulated courses: An observational study.
abstract: OBJECTIVE
  High-fidelity medical simulation is a source of stress for participants. The aim of this study was to assess if repeated simulated courses decrease perceived stress and/or physiological stress level and increase performance in anaesthesiology registrars.
  
  
  METHODS
  Fourteen anaesthesiology specialty registrars participated individually in three successive sessions of crisis simulation in the operating room. Participants' perceived stress levels were measured by self-assessment (simple numerical scale from 0 to 10 [0=no stress, 10=maximum stress]) and physiological stress was estimated via the maximal heart rate measured by a Holter system). Technical and non-technical performances were also assessed. Data are expressed as medians with interquartile ranges and extremes (median (IQR [Min-Max])).
  
  
  RESULTS
  Between the first and third session, simulation repetition was associated with a decrease in perceived stress (9 (8-10 [5-10]) versus 7 (5-8 [2-9]) from session 1 to session 3 respectively, P=0.02), whereas physiological stress assessed by the maximum heart rate remained unchanged (130 beats per minute (116-141 [85-170]) and 123 beats per minute (115-136 [88-166]) between sessions 1 and 3 respectively). There was also a significant inverse correlation between perceived stress levels experienced by registrars during the session and non-technical performance (P=0.008).
  
  
  CONCLUSIONS
  We observed a reduction in perceived stress levels experienced by registrars while physiological stress was unchanged with repeating simulation sessions combining simulated practice and debriefing. Learning through simulation could improve perceived stress management in critical situations.
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: dr.antoine.gouin@gmail.com.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gouin
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: cedric.damm@chu-rouen.fr.
authors.forename: Cédric
authors.initials: C
authors.lastname: Damm
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: gregory.wood@chu-rouen.fr.
authors.forename: Grégory
authors.initials: G
authors.lastname: Wood
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: sebtaran@free.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Cartier
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, AP-HP Groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France. Electronic address: borel.marie@gmail.com.
authors.forename: Marie
authors.initials: M
authors.lastname: Borel
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: k_villette@hotmail.com.
authors.forename: Karen
authors.initials: K
authors.lastname: Villette-Baron
authors.affiliation: Department of Anaesthesiology; The Ottawa Hospital Research Institute; University of Ottawa Skills and Simulation Centre (uOSSC) of The Ottawa Hospital & The Academy for Innovation in Medical Education, University of Ottawa, 501, Smyth Road, Ottawa, K1H 8L6, ON, Canada. Electronic address: sylvainboet@gmail.com.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: vincent.compere@chu-rouen.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Compère
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care, Rouen University Hospital and University of Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: bertrand.dureuil@chu-rouen.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dureuil
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D015716:Electrocardiography, Ambulatory; D005602:France; D006339:Heart Rate; D006801:Humans; D007396:Internship and Residency; D016544:Patient Simulation; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*
keywords: Anaesthesiology; High-fidelity simulation; Perceived stress; Physiological stress; Skills