Abstract
Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant’s heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N–N interval (SDNN), Root mean square standard deviation of the N–N interval (RMSSD), Percentage of successive R–R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anton, N. E., Rendina, M. A., Hennings, J. M., Stambro, R., Stanton-Maxey, K. J., & Stefanidis, D. (2021). Association of medical students’ stress and coping skills with simulation performance. Simulation in Healthcare : Journal of the Society for Simulation in Healthcare, 16(5), 327–333. https://doi.org/10.1097/SIH.0000000000000511
Association, A. H. (2014). Positions for six-person high-quality CPR teams. http://www.heart.org/idc/groups/heart-public/@wcm/@cmc/documents/downloadable/ucm_465186.pdf
Bhoja, R., Guttman, O. T., Fox, A. A., Melikman, E., Kosemund, M., & Gingrich, K. J. (2020). Psychophysiological stress indicators of heart rate variability and electrodermal activity with application in healthcare simulation research. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 15(1), 39–45. https://doi.org/10.1097/SIH.0000000000000402
Corp, I. (2020). Windows SPSS statistics for windows (No. 27).
Daglius Dias, R., & Scalabrini Neto, A. (2016). Stress levels during emergency care: A comparison between reality and simulated scenarios. Journal of Critical Care, 33, 8–13. https://doi.org/10.1016/j.jcrc.2016.02.010
Dias, R. D., & Scalabrini-Neto, A. (2017). Acute stress in residents playing different roles during emergency simulations: A preliminary study. International Journal of Medical Education, 8, 239–243. https://doi.org/10.5116/ijme.5929.60f1
Electrophysiology, T. F. of the E. S. of. (1996). Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation, 93(5), 1043–1065.
Gaba, D., Fish, K., & Howard, S. (1994). Teaching anesthesia crisis management. Churchill Livingstone.
Goldberger, J. J., Challapalli, S., Tung, R., Parker, M. A., & Kadish, A. H. (2001). Relationship of heart rate variability to parasympathetic effect. Circulation, 103(15), 1977–1983. https://doi.org/10.1161/01.cir.103.15.1977
Harms, P. D., Credé, M., Tynan, M., Leon, M., & Jeung, W. (2017). Leadership and stress: A meta-analytic review. The Leadership Quarterly, 28(1), 178–194. https://doi.org/10.1016/j.leaqua.2016.10.006
Hermans, E. J., Battaglia, F. P., Atsak, P., de Voogd, L. D., Fernández, G., & Roozendaal, B. (2014). How the amygdala affects emotional memory by altering brain network properties. Neurobiology of Learning and Memory. https://doi.org/10.1016/j.nlm.2014.02.005
Howard, S. (2019). Increasing fidelity and realism in simulation. Lippincott nursing education blog. https://nursingeducation.lww.com/blog….
Huang, V. W., Jones, C. B., & Gomez, E. D. (2020). State of the art of virtual reality simulation in anesthesia. International Anesthesiology Clinics, 58(4), 31–35. https://doi.org/10.1097/AIA.0000000000000298
Issenberg, S. B., McGaghie, W. C., Hart, I. R., Mayer, J. W., Felner, J. M., Petrusa, E. R., Waugh, R. A., Brown, D. D., Safford, R. R., Gessner, I. H., Gordon, D. L., & Ewy, G. A. (1999). Simulation technology for health care professional skills training and assessment. JAMA, 282(9), 861–866. https://doi.org/10.1001/jama.282.9.861
Joseph, B., Parvaneh, S., Swartz, T., Haider, A. A., Hassan, A., Kulvatunyou, N., Tang, A., Latifi, R., Najafi, B., & Rhee, P. (2016). Stress among surgical attending physicians and trainees: A quantitative assessment during trauma activation and emergency surgeries. Journal of Trauma and Acute Care Surgery, 81(4), 723–728. https://doi.org/10.1097/TA.0000000000001162
Keitel, A., Ringleb, M., Schwartges, I., Weik, U., Picker, O., Stockhorst, U., & Deinzer, R. (2011). Endocrine and psychological stress responses in a simulated emergency situation. Psychoneuroendocrinology, 36(1), 98–108. https://doi.org/10.1016/j.psyneuen.2010.06.011
Lateef, F. (2010). Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma, and Shock, 3(4), 348–352. https://doi.org/10.4103/0974-2700.70743
Leblanc, V. R., Regehr, C., Tavares, W., Scott, A. K., Macdonald, R., & King, K. (2012). The impact of stress on paramedic performance during simulated critical events. Prehospital and Disaster Medicine, 27(4), 369–374. https://doi.org/10.1017/S1049023X12001021
Lo, E.-W.V., Wei, Y.-H., & Hwang, B.-F. (2020). Association between occupational burnout and heart rate variability: A pilot study in a high-tech company in Taiwan. Medicine, 99(2), e18630. https://doi.org/10.1097/MD.0000000000018630
McGraw, L. K., Out, D., Hammermeister, J. J., Ohlson, C. J., Pickering, M. A., & Granger, D. A. (2013). Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation. Psychoneuroendocrinology, 38(1), 135–144. https://doi.org/10.1016/j.psyneuen.2012.05.009
Moss, M., Good, V. S., Gozal, D., Kleinpell, R., & Sessler, C. N. (2016). An official critical care societies collaborative statement—Burnout syndrome in critical care health-care professionals: A call for action. Chest, 150(1), 17–26. https://doi.org/10.1016/j.chest.2016.02.649
Prince, C. R., Hines, E. J., Chyou, P.-H., & Heegeman, D. J. (2014). Finding the key to a better code: Code team restructure to improve performance and outcomes. Clinical Medicine & Research, 12(1–2), 47–57. https://doi.org/10.3121/cmr.2014.1201
Saunders, T., Driskell, J. E., Johnston, J. H., & Salas, E. (1996). The effect of stress inoculation training on anxiety and performance. Journal of Occupational Health Psychology, 1(2), 170–186. https://doi.org/10.1037//1076-8998.1.2.170
Schubert, C., Lambertz, M., Nelesen, R. A., Bardwell, W., Choi, J.-B., & Dimsdale, J. E. (2009). Effects of stress on heart rate complexity–a comparison between short-term and chronic stress. Biological Psychology, 80(3), 325–332. https://doi.org/10.1016/j.biopsycho.2008.11.005
Seyedjavadi, M., Samadi, N., Mohammadi, R., Osmani, A., Bakhtiari Kohsareh, F., & Seyedjavadi, M. (2014). Assessment of Stress in Medical Emergency Staff in Ardabil Province, Iran TT - بررسی میزان استرس در کارکنان شاغل 115 استان اردبیلMuq-Journal, 7(6), 41–45.
Vogel, S., & Schwabe, L. (2016). Learning and memory under stress: Implications for the classroom. Npj Science of Learning, 1(1), 16011. https://doi.org/10.1038/npjscilearn.2016.11
Wetzel, C. M., Black, S. A., Hanna, G. B., Athanasiou, T., Kneebone, R. L., Nestel, D., Wolfe, J. H., & Woloshynowych, M. (2010). The effects of stress and coping on surgical performance during simulations. Annals of Surgery, 251(1), 171–176.
Funding
No external Funding was utilized for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no competing interests between any of the study authors and no conflicts of interest to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Peabody, J., Ziesmann, M.T. & Gillman, L.M. Comparing the stress response using heart rate variability during real and simulated crises: a pilot study. Adv in Health Sci Educ 29, 465–475 (2024). https://doi.org/10.1007/s10459-023-10246-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-023-10246-7