title: The Impact of Neonatal Simulations on Trainees' Stress and Performance: A Parallel-Group Randomized Trial.
abstract: OBJECTIVE
  Assess impact of neonatal simulation and simulated death on trainees' stress and performance.
  
  
  METHODS
  A parallel-group randomized trial (November 2011 to April 2012).
  
  
  METHODS
  Sainte-Justine University Hospital, Montreal, Canada.
  
  
  METHODS
  Sixty-two pediatric trainees eligible, 59 consented, and 42 completed the study.
  
  
  METHODS
  Trainees performed two simulations where a term neonate was born pulseless. They were randomized to start with either survival (manikin responded to appropriate resuscitation) or death scenario (manikin remained pulseless despite resuscitation).
  
  
  RESULTS
  Performance was assessed using the Neonatal Resuscitation Program megacode score sheet by two reviewers. Subjective stress was assessed with a questionnaire. Three salivary cortisol (objective stress) values were compared: at baseline (T0: during lecture), presimulation (T1), and postsimulation (T2: after first scenario). Performance scores were similar in both groups in the first (83% vs 82%; p = 0.85) and second scenarios (82% vs 79 %; p = 0.87). Salivary cortisol levels at T0 (0.10 vs 0.10; p = 0.54), T1 (0.15 vs 0.11; p = 0.35), and T2 (0.23 vs 0.17; p = 0.23) did not differ between groups. Perceived stress level was six out of 10 in survival group versus seven out of 10 in death group (p = 0.19). Salivary cortisol increased significantly from T0 to T1 (p < 0.01). T2 cortisol levels were significantly higher than T1 (p< 0.001), yet this increase was not scenario dependent (p = 0.41) nor associated with performance on either scenario. Subscores for bag mask ventilation were lower than subscores for advanced resuscitation skills.
  
  
  CONCLUSIONS
  Neonatal simulations cause significant anticipatory and participatory stress. Despite this, trainees' performance score in simulation was over 80%. Simulated death did not impact performance, magnitude of rise in salivary cortisol level, and perceived stress level. Trainees performed better at advanced resuscitation skills (which are rarely needed) compared with basic skills routinely performed in practice.
authors.affiliation: 1Divison of Neonatology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada. 2Clinical Ethics Unit, University of Montreal and CHU Sainte-Justine, Montreal, QC, Canada. 3Clinical Ethics and Family Partnering Research Unit, CHU Sainte-Justine, Montreal, QC, Canada. 4Department of Pediatrics, Hôpital Pierre-Boucher, Longueuil, QC, Canada. 5Douglas Hospital Research Center, Department of Psychiatry, McGill University, Montreal, QC, Canada. 6Mother-Child Simulation Center, CHU Sainte-Justine, Montreal, QC, Canada.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Lizotte
authors.forename: Annie
authors.initials: A
authors.lastname: Janvier
authors.forename: Véronique
authors.initials: V
authors.lastname: Latraverse
authors.forename: Christian
authors.initials: C
authors.lastname: Lachance
authors.forename: Claire-Dominique
authors.initials: CD
authors.lastname: Walker
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Barrington
authors.forename: Ahmed
authors.initials: A
authors.lastname: Moussa
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D002170:Canada; D002983:Clinical Competence; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007231:Infant, Newborn; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008348:Manikins; D066087:Perinatal Death; D012151:Resuscitation / Q000193:education* / Q000523:psychology; D012463:Saliva / Q000378:metabolism; D000066908:Simulation Training / Q000379:methods; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone