Stress response in the daily lives of simulation repeaters. A randomized controlled trial assessing stress evolution over one year of repetitive immersive simulations

PLoS One. 2019 Jul 25;14(7):e0220111. doi: 10.1371/journal.pone.0220111. eCollection 2019.

Abstract

Background: Simulations in healthcare reproduce clinical situations in stressful conditions. Repeated stress exposure might influence the learning process in simulation as well as real-life.

Objectives: 1) To record heart rate and heart rate variability evolution during one-day simulation over one year; 2) To analyze the effect of repetitive high-fidelity simulations on the risk of post-traumatic stress disorder.

Study design: Single-center, investigator-initiated RCT. 48 participants were randomized in 12 multidisciplinary teams of French Emergency Medical Services to manage infant shock in high-fidelity simulations. In the experimental group, 6 multidisciplinary teams were exposed to 9 different simulation sessions over 1 year. In the control group, 6 multidisciplinary teams participated in only 3 simulation sessions, in common with those of the experimental group (initial, intermediate after 6 months, and finally after 1 year). Heart rate (HR) and heart rate variability (HRV) were analyzed on a 24-hour Holter from the day prior to simulation until the end of simulation. Questionnaires of Impact of Event Scale-Revised at 7 days and Post-traumatic Check-List Scale at 1 month were used to detect possible post-traumatic stress disorder in participants. p<0.05 was considered significant.

Results: Stress increased during each simulation in the two groups. After analysis on the 24-hour period, there was no significant difference between the two groups during the initial simulation session in terms of heart rate and heart rate variability. In the 24-hour period of the intermediate and final simulation sessions, the level of stress was higher in the control group during the diurnal (p = 0.04) and nocturnal periods (p = 0.01). No participant developed post-traumatic stress disorder after the 72 simulation sessions.

Conclusions: Despite the stress generated by simulation, the more the sessions were repeated, the less were their repercussions on the daily lives of participants, reflected by a lower sympathetic activity. Moreover, repetition of simulations did not lead to post-traumatic stress disorder.

Trial registration: ClinicalTrials.gov NCT02424890.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living* / psychology
  • Adult
  • Circadian Rhythm / physiology
  • Critical Care / psychology
  • Disease Progression
  • Emergency Medical Services*
  • Female
  • Heart Rate / physiology*
  • Humans
  • Male
  • Periodicity
  • Recurrence
  • Risk Factors
  • Simulation Training*
  • Stress Disorders, Post-Traumatic / etiology
  • Stress Disorders, Post-Traumatic / pathology
  • Stress Disorders, Post-Traumatic / physiopathology
  • Stress, Psychological / etiology
  • Stress, Psychological / pathology*
  • Stress, Psychological / physiopathology*

Associated data

  • ClinicalTrials.gov/NCT02424890

Grants and funding

DA Ghazali was the recipient of a grant from the French Emergency Medicine Society (SFMU). The commercial company Laerdal (Tanke Svilandsgt 30. Stavanger, 4002. Norway) provided the SFMU with the amount of the grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.