Identifying Stress-Associated Factors to Develop Advanced Emergency Medicine Simulation

项目总结/摘要 周围充斥着不和谐的声音，重症患者，沮丧的家庭成员，以及频繁的 中断，急诊医生在一个令人难以置信的复杂环境中提供护理， 大量的工作压力。压力已被证明会对决策产生负面影响， 技术技能和团队互动，因此有可能对患者护理产生负面影响 和患者结局。长期的职业压力也会导致倦怠， 医生离开专科，从而限制了可用的提供者来照顾病人。而 急诊医生长期以来一直报告与工作有关的压力，但对真正的压力知之甚少- 急诊科工作环境的诱发因素。此外，模拟是一个重要的 培训医生教育的组成部分，然而，模拟，因为它通常用于医疗保健 具有较低的心理保真度，或模拟唤起相同心理的能力， 作为真实的环境。心理上的忠诚度与改善情感的转移有关， 在模拟中学到的技能在现实世界的环境中练习。在具体目标1中，我们将开始 使用一个解释急诊室环境的压力相关因素的工作， 创新的方法，从其他高风险行业（如航空业）的战略发展而来， 使用工作中医生的不引人注目的生理反应监测来评估压力诱导 因素这里发现的因素将使用半结构化的 具体目标2中的访谈和定性方法，以及由此产生的强大的压力分类- 急诊科工作环境中的相关因素。此分类法将用于 具体目标3：开发初步模拟情景， 这个项目的最终结果。这些设想方案将作为2010年后续提案的基础。 我们将开发压力管理技术，并在一个随机的，对照的 在改进的模拟场景的设置时尚。

Project Summary/Abstract Surrounded by a cacophony of sounds, severely ill patients, frustrated family members, and frequent interruptions, emergency physicians provide care in an incredibly complex environment and report significant amounts of job-related stress. Stress has been shown to negatively affect decision-making, technical skills, and team interactions, and therefore has the potential to negatively affect patient care and patient outcomes. Prolonged occupational stress also contributes to burnout, and emergency physicians leaving the specialty, thereby limiting available providers to care for patients. While emergency physicians have long reported work-related stress, little is known about the true stress- inducing factors of the emergency department work environment. Additionally, simulation is an important component of education for physicians-in-training, however simulation as it is used in healthcare usually features low psychological fidelity, or the ability of the simulation to evoke the same psychological response as the true environment. Psychological fidelity has been linked to improved transference of skills learned in simulation to practice in real-world environments. In Specific Aim 1 we will begin the work of elucidating the stress-associated factors of the emergency department environment by using an innovative method, developed from strategies used in other high-risk industries such as aviation, of using unobtrusive physiologic response monitoring of physicians at work to evaluate stress-inducing factors. The factors discovered here will be further evaluated and validated using semi-structured interviews and qualitative methods in Specific Aim 2, with a resulting robust taxonomy of stress- associated factors in the emergency department work environment. This taxonomy will be used in Specific Aim 3 to develop preliminary simulation scenarios with improved psychological fidelity as the final outcome of this project. These scenarios will serve as the foundation for a follow-on proposal in which we will develop stress-management techniques and evaluate these in a randomized, controlled fashion in the setting of the improved simulation scenarios.