title: Effect of simulated patient death on emergency worker's anxiety: a cluster randomized trial.
abstract: OBJECTIVE
  Simulation-based teaching offers promising and diverse teaching possibilities. We aim to assess whether the death of the manikin increased anxiety amongst learner compared to similar simulation-based course where the manikin stays alive.
  
  
  METHODS
  We conducted a cluster randomized study amongst multidisciplinary teams of emergency workers. Teams of physicians, nurses, and healthcare assistants were randomly assigned to participate in a simulation-based course where the simulated patient died (death group) or not (life group). We assessed anxiety at 1 month after the teaching using Spielberger STAI-state anxiety questionnaire. We compared reduction of anxiety when facing a life-threatening situation in both groups.
  
  
  RESULTS
  We included 25 teams for a total of 129 participants. We analysed 63 participants in the death group and 57 in the life group. Baseline characteristics were similar in both groups, including baseline anxiety (STAI-state score 39.6 (7.8) in the death group vs 38.6 (7.1) in the life group). We report a significant reduction in both groups 1 month after the training: 6.6 (7.8) vs 6 (8.0), mean difference 0.5 (-2.4; 3.4). At 3 months, we report a significant greater reduction of anxiety in the death group (mean difference 4 [0.1; 7.9]).
  
  
  CONCLUSIONS
  We observed in our sample that unexpected simulated patient death did not increase anxiety amongst multidisciplinary emergency workers.
authors.affiliation: UPMC Univ-Paris 6, UMRS INSERM 1166, IHU ICAN, Paris Sorbonne Université, Paris, France.|Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors.forename: A L
authors.initials: AL
authors.lastname: Philippon
authors.affiliation: Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Bokobza
authors.affiliation: Emergency Department, Barts Health NHS Trust, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Bloom
authors.affiliation: Pneumology and Medical Intensive Care Unit, Hôpital Pitié-Salpêtrière, APHP, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Hurbault
authors.affiliation: UPMC Univ-Paris 6, UMRS INSERM 1166, IHU ICAN, Paris Sorbonne Université, Paris, France.|Pneumology and Medical Intensive Care Unit, Hôpital Pitié-Salpêtrière, APHP, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Duguet
authors.affiliation: UPMC Univ-Paris 6, UMRS INSERM 1166, IHU ICAN, Paris Sorbonne Université, Paris, France.|Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Riou
authors.affiliation: UPMC Univ-Paris 6, UMRS INSERM 1166, IHU ICAN, Paris Sorbonne Université, Paris, France. yonathan.freund@aphp.fr.|Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France. yonathan.freund@aphp.fr.
authors.forename: Y
authors.identifier: http://orcid.org/0000-0002-0262-3848
authors.initials: Y
authors.lastname: Freund
keywords: Anxiety; Emergency; Simulated patient death; Simulation