title: Residual anxiety after high fidelity simulation in anaesthesiology: An observational, prospective, pilot study.
abstract: BACKGROUND
  High fidelity simulation (HFS) in anaesthesiology intentionally provides stress on students, but anxiety may be detrimental if it goes on through debriefing. The primary goal of this study was to estimate the proportion of students with significant anxiety remaining after debriefing (residual anxiety [RA]). Secondary goals were to evaluate the instructors' ability to estimate students' RA and to identify potential risk factors for high RA.
  
  
  METHODS
  Following IRB approval and informed consent, data from a cohort of subjects were prospectively collected by an independent expert. State-anxiety after debriefing (RA) was prospectively measured using the State-Trait Anxiety Inventory (a score varying from 20 to 80/80). RA was considered significant when≥36/80. Instructors simultaneously estimated the levels of subjects' RA via a visual analogue scale. Data about subjects, stress during scenarios (including continuous heart rate monitoring), and debriefings (including DASH©quality scores) were also collected.
  
  
  RESULTS
  Seventy study subjects (30 residents, 26 nurses and 14 anaesthetists) were enrolled during 52 HFS sessions. As concerns the primary endpoint, RA was≥36/80 in 15 subjects (21%; 95% CI: 13-32). The median RA was 30/80 [25-35]. For secondary endpoints, the instructors' estimations poorly correlated with measurements: rho=0.36 (P<0.01); limits of agreement: -16 and 22. Subjects with RA≥36/80 had significantly higher trait-anxiety (P<0.01). An easy scenario (P=0.04) and low quality debriefing (P=0.04) were associated with higher RAs.
  
  
  CONCLUSIONS
  Most students experienced low anxiety after debriefing. Instructors seem to be unable to reliably estimate students' RA. Students with an anxious personality are more likely to be anxious after debriefing.
authors.affiliation: Division anesthésie réanimation urgences douleur, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France; Centre de simulation médicale SIMHU-Nîmes, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France. Electronic address: jnevain@hotmail.com.
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Evain
authors.affiliation: Division anesthésie réanimation urgences douleur, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France; Centre de simulation médicale SIMHU-Nîmes, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France.
authors.forename: Lana
authors.initials: L
authors.lastname: Zoric
authors.affiliation: Division anesthésie réanimation urgences douleur, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France; Centre de simulation médicale SIMHU-Nîmes, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mattatia
authors.affiliation: Division anesthésie réanimation urgences douleur, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France; Centre de simulation médicale SIMHU-Nîmes, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Picard
authors.affiliation: Division anesthésie réanimation urgences douleur, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France; Centre de simulation médicale SIMHU-Nîmes, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Ripart
authors.affiliation: Division anesthésie réanimation urgences douleur, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France; Centre de simulation médicale SIMHU-Nîmes, groupe hospitalo-universitaire Carémeau, CHU de Nîmes, 30900 Nîmes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cuvillon
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D001007:Anxiety / Q000523:psychology*; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D000070856:High Fidelity Simulation Training / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009719:Nurse Anesthetists; D010551:Personality; D010865:Pilot Projects; D011446:Prospective Studies; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology; D013337:Students, Medical / Q000523:psychology
keywords: Anaesthesiology; Anxiety; Debriefing; High fidelity simulation; Medical education; Stress