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首页> 外文期刊>BMC Medical Education >Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot study
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Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot study

机译：在模拟的关键临床遭遇期间，居民的心率，焦虑和表现：一项初步研究

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Background High-fidelity patient simulation has been praised for its ability to recreate lifelike training conditions. The degree to which high fidelity simulation elicits acute emotional and physiologic stress among participants – and the influence of acute stress on clinical performance in the simulation setting – remain areas of active exploration. We examined the relationship between residents’ self-reported anxiety and a proxy of physiologic stress (heart rate) as well as their clinical performance in a simulation exam using a validated assessment of non-technical skills, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Methods This was a prospective observational cohort study of emergency medicine residents at a single academic center. Participants managed a simulated clinical encounter. Anxiety was assessed using a pre- and post-simulation survey, and continuous cardiac monitoring was performed on each participant during the scenario. Performance in the simulation scenario was graded by faculty raters using a critical actions checklist and the Ottawa GRS instrument. Results Data collection occurred during the 2011 academic year. Of 40 eligible residents, 34 were included in the analysis. The median baseline heart rate for participants was 70 beats per minute (IQR: 62 – 78). During the simulation, the median maximum heart rate was 140 beats per minute (IQR: 137 – 151). The median minimum heart rate during simulation was 81 beats per minute (IQR: 72 – 92), and mean heart rate was 117 beats per minute (95% CI: 111 – 123). Pre- and post-simulation anxiety scores were equal (mean 3.3, IQR: 3 to 4). The minimum and maximum Overall Ottawa GRS scores were 2.33 and 6.67, respectively. The median Overall score was 5.63 (IQR: 5.0 to 6.0). Of the candidate predictors of Overall performance in a multivariate logistic regression model, only PGY status showed statistical significance (P?=?0.02). Conclusions Simulation is associated with physiologic stress, and heart rate elevation alone correlates poorly with both perceived stress and performance. Non-technical performance in the simulation setting may be more closely tied to one’s level of clinical experience than to perceived or actual stress.
机译：背景技术高保真患者模拟具有重现逼真的训练条件的能力，因此受到赞誉。高保真度模拟在参与者中引起急性情绪和生理压力的程度以及模拟环境中急性压力对临床表现的影响仍然是积极探索的领域。我们使用非技术技能的经过验证的评估，《渥太华危机资源管理全球评级量表》（《渥太华危机资源管理全球评级量表》（渥太华GRS）。方法这是在单个学术中心对急诊医学居民进行的前瞻性观察队列研究。参与者管理了一个模拟的临床遭遇。使用模拟前和模拟后评估来评估焦虑，并在情景中对每个参与者进行连续的心脏监测。教师评估人员使用关键行动清单和渥太华GRS仪器对模拟方案中的绩效进行了评分。结果数据收集发生在2011学年。在40名合格居民中，有34名被纳入分析。参与者的平均基线心率是每分钟70次（IQR：62 – 78）。在模拟过程中，最大最大心率中位数为每分钟140次（IQR：137 – 151）。模拟过程中的最低心率中位数为每分钟81次（IQR：72 – 92），平均心率为每分钟117次（95％CI：111 – 123）。模拟前和模拟后的焦虑评分相等（平均值3.3，IQR：3至4）。渥太华GRS的最低和最高总分分别为2.33和6.67。中位数总分为5.63（IQR：5.0至6.0）。在多元逻辑回归模型中，总体绩效的候选预测指标中，只有PGY状态显示出统计学显着性（P≤0.02）。结论模拟与生理压力有关，仅心率的升高与感知压力和表现都没有很好的相关性。在模拟环境中，非技术性能可能与临床经验水平紧密相关，而不是与感知或实际压力相关。

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