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Cognitive Load and Stress in Simulation

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Comprehensive Healthcare Simulation: Pediatrics

Part of the book series: Comprehensive Healthcare Simulation ((CHS))

Abstract

Simulation-based education (SBE) has all the requisite elements for a stressful experience: being novel, unpredictable, imparting a sense of lack of control, and potentially threatening the participant’s ego. Indeed, SBE has been shown to evoke a physiological stress response in learners, which can be measured objectively using physiological or biological means, or subjectively using self-report questionnaires. The interaction between stress and cognitive load on performance and learning in the simulation environment is complex and not yet fully elucidated. At an appropriate level of cognitive load and moderate level of stress, simulation challenges and engages the learner, contributing to improved performance and learning outcomes. On the other hand, excessive stress can contribute to cognitive overload, attentional narrowing and distractibility, all of which are associated with impaired performance. Despite this detrimental effect of stress, learning can still be reinforced at high-stress levels through the enhancement on memory consolidation.

In the simulation arena, stress results not only from the scenario difficulty but also from emotions, noise, team dynamics, the presence of observers, and the subjective perception of being appraised. The learners’ perception of their abilities to meet the presented challenge will dictate their stress response and this in turn is likely influenced by prior experience in simulation, clinical expertise, perceived task difficulty, team factors, as well as their personality traits and coping styles. Several studies have reported that SBE could provide higher stress levels in trainees than those they may experience during real-life clinical situations. Simulation educators have traditionally embraced the potential benefits of adding realistic stress to simulation training. However, they should be equally cognizant of the potentially negative effects of stress on performance and consider strategies to minimize unnecessary stress.

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Authors and Affiliations

  1. Department of Paediatric Anaesthesia, KK Women’s and Children’s Hospital, Duke-NUS Graduate Medical School, Yong Loo Lin School of Medicine, 100 Bukit Timah Road, 229899, Singapore, Singapore

    Choon Looi Bong MBChB, FRCA

  2. Department of Medicine, Division of Respirology, Cumming School of Medicine, Alberta Health Services, 7007 14St SW, T2V 1P9, Calgary, AB, Canada

    Kristin Fraser MD

  3. Simulation Laboratory, Department of Emergency Medicine, University of Poitiers, University Hospital, 6 rue de la Miletrie, 86000, Poitiers, France

    Denis Oriot MD, PhD

Authors
  1. Choon Looi Bong MBChB, FRCA
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  2. Kristin Fraser MD
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  3. Denis Oriot MD, PhD
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Correspondence to Choon Looi Bong MBChB, FRCA .

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Editors and Affiliations

  1. KidSIM(TM) Pediatric Simulation Program, Alberta Children's Hospital, CALGARY, Alberta, Canada

    Vincent J. Grant

  2. KidSIM-ASPIRE Simulation Research Prgm, Alberta Children's Hospital, CALGARY, Alberta, Canada

    Adam Cheng

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Bong, C., Fraser, K., Oriot, D. (2016). Cognitive Load and Stress in Simulation. In: Grant, V., Cheng, A. (eds) Comprehensive Healthcare Simulation: Pediatrics. Comprehensive Healthcare Simulation. Springer, Cham. https://doi.org/10.1007/978-3-319-24187-6_1

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