Psychophysiological fidelity: A comparative study of stress responses to real and simulated clinical emergencies.
Psychophysiological fidelity: A comparative study of stress responses to real and simulated clinical emergencies.
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心理生理保真度：对真实和模拟临床紧急情况的压力反应的比较研究。
DOI：
10.1111/medu.15155
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发表时间：
2023
影响因子：
6
通讯作者：
Peek R
中科院分区：
文献类型：
--
作者：
Peek R
心理压力会影响临床医生在急诊中的表现。虽然模拟在医疗保健教育中被广泛使用，但模拟是否有效地复制了现实世界条件下的心理生理压力尚不清楚。因此，本研究探讨了在模拟和现实世界的临床实践中，对急性应激的心理生理反应是否存在可测量的差异。方法在这项受试者内观察性研究中，在为期6个月的新生儿医学培训中，记录了模拟和现实世界紧急情况下的压力评估、状态焦虑和心率变异性（HRV）。11名研究生学员和1名高级新生儿执业护士参加。参与者平均（SD）年龄为33(8)岁；8名参与者（67%）是女性。数据在模拟和现实世界新生儿紧急情况发生前、发生期间和发生后20分钟收集。现场模拟情景是根据认可的新生儿基本生命支持训练中使用的情景进行建模的。压力评估和状态焦虑分别使用需求资源评估分数和短状态特质焦虑量表进行评估。高频功率，与副交感神经张力相关的HRV成分，来源于心电图记录。结果模拟与更高的威胁评估可能性和更高的状态焦虑相关。高频HRV在模拟和现实紧急情况下从基线下降，但在模拟事件发生20分钟后进一步恢复到基线。对于观察到的条件之间的差异，可能的解释包括参与者先前的经验和对模拟的期望，以及模拟后的汇报和反馈的影响。本研究确定了对模拟和现实世界紧急情况的心理生理应激反应的重要差异。威胁评估、状态焦虑和副交感神经戒断在教育和临床上都具有重要意义，因为它们已知与表现、社会功能和健康调节有关。虽然模拟可以促进旨在优化临床医生压力反应的干预措施，但确认结果转移到现实世界的临床实践是至关重要的。
IntroductionExperiencing psychological stress may affect clinician performance in acute emergencies. While simulation is used extensively in healthcare education, it is unknown whether simulation effectively replicates the psychophysiological stress of real‐world conditions. Thus, this study explored whether measurable differences exist in psychophysiological responses to acute stress in simulated compared with real‐world clinical practice.MethodsIn this within‐subjects observational study, stress appraisals, state anxiety and heart rate variability (HRV) were recorded during simulated and real‐world emergencies in a 6‐month training placement in neonatal medicine. Eleven postgraduate trainees and one advanced neonatal nurse practitioner participated. Mean (SD) participant age was 33 (8) years; and eight participants (67%) were female. Data were collected at rest and immediately before, during and 20 min after simulated and real‐world neonatal emergencies. In situ simulation scenarios were modelled on those used in accredited neonatal basic life support training. Stress appraisals and state anxiety were assessed using Demand Resource Evaluation Scores and the short State‐Trait Anxiety Inventory, respectively. High‐frequency power, a component of HRV associated with parasympathetic tone, was derived from electrocardiogram recordings.ResultsSimulation was associated with greater likelihood of threat appraisal and higher state anxiety. High‐frequency HRV reduced from baseline in simulated and real‐world emergencies but recovered further towards baseline 20 min after simulated events. Possible explanations for the observed differences between conditions include participants' previous experiences and expectations of simulation and the effect of post‐simulation debrief and feedback.DiscussionThis study identifies important differences in psychophysiological stress responses to simulated and real‐world emergencies. Threat appraisals, state anxiety and parasympathetic withdrawal are educationally and clinically significant, given their known associations with performance, social functioning and health regulation. While simulation may facilitate interventions aimed at optimising clinicians' stress responses, it is vital to confirm that outcomes transfer to real‐world clinical practice.