2018, Bensouda et al.(3030 Bensouda B, Mandel R, Mejri A, Lachapelle J, St-Hilaire M, Ali N. Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial. BMC Med Educ. 2018;18(1):230. https://doi.org/10.1186/s12909-018-1338-4 https://doi.org/10.1186/s12909-018-1338-...
) Canada |
IG: 1 observer during simulation CG: 5 observers during simulation |
IG: 24 CG: 25 |
Obtain evidence that interns are adversely affected by the presence of a large audience during neonatal endotracheal intubation. |
Heart rate |
Medicine |
The presence of the external public did not negatively affect the period of the simulated intubation, but the presence of observers not belonging to the scenario was stressful. |
2010, Bong et al.(2424 Bong CL, Lightdale JR, Fredette ME, Weinstock P. Effects of simulation versus traditional tutorial-based training on physiologic stress levels among clinicians: a pilot study. Simul Healthc. 2010;5(5):272-8. https://doi.org/10.1097/SIH.0b013e3181e98b29 https://doi.org/10.1097/SIH.0b013e3181e9...
) United States |
IG: training based on high fidelity simulation (HFS) CG: interactive educational training session |
IG: 13 CG: 14 |
Measure and compare physical and biochemical markers of stress in participants undergoing simulation with those undergoing teaching sessions/tutorials. |
Salivary cortisol, heart rate |
Medicine and Nursing |
Regardless of the role of participants in the simulation, all showed high levels of physiological stress. |
2018, Boostel et al.(3434 Boostel R, Felix JVC, Bortolato-Major C, Pedrolo E, Vayego SA, Mantovani MF. Stress of nursing students in clinical simulation: a randomized clinical trial. Rev Bras Enferm. 2018;71(3):967-74. https://doi.org/10.1590/0034-7167-2017-0187 https://doi.org/10.1590/0034-7167-2017-0...
) Brazil |
IG: class followed by simulation CG: class followed by laboratory practice |
IG: 27 CG: 25 |
Evaluate the perception of students' stressors before and after the clinical simulation or the conventional practical class in the laboratory. |
Questionary |
Nursing |
The simulation increased the perception of stressors related to the lack of competence and the interpersonal relationship when acting in front of the patient, multidisciplinary team, and colleagues compared to the conventional practical class in the laboratory. |
2016, Demaria et al.(3535 DeMaria S, Silverman ER, Lapidus KA, Williams CH, Spivack J, Levine A, et al. The impact of simulated patient death on medical students' stress response and learning of ACLS. Med Teach. 2016;38(7):730-7. https://doi.org/10.3109/0142159X.2016.1150986 https://doi.org/10.3109/0142159X.2016.11...
) United States |
IG: simulation group with death CG: simulation group with survival |
IG: 13 CG: 14 |
Describe the physiological and biochemical stress response in students during the simulation of a patient death compared to a group whose patient is programmed to survive. |
Salivary cortisol, DHEA hormone and heart rate |
Medicine |
Students experienced stress during high fidelity simulation; there was not a negative response of a scenario with death compared to a survival scenario. |
2012, Finan et al.(3636 Finan E, Bismilla Z, Whyte HE, Leblanc V, McNamara PJ. High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training. J Perinatol. 2012;32(4):287-92. https://doi.org/10.1038/jp.2011.96 https://doi.org/10.1038/jp.2011.96...
) Canada |
IG: HFS simulation CG: low fidelity simulation (LFS) |
IG: 8 CG: 8 |
Compare the effects of HFS versus LFS on stress measurements in a group of neonatology interns. |
Survey and salivary cortisol |
Medicine |
The use of HFS and LFS technology increased subjective and objective stress measures. HFS did not offer additional benefits in terms of stress modification. |
2015, Flinn et al.(3737 Flinn JT, Miller A, Pyatka N, Brewer J, Schneider T, Cao CG. The effect of stress on learning in surgical skill acquisition. Med Teach. 2016;38(9):897-903. https://doi.org/10.3109/0142159X.2015.1114597 https://doi.org/10.3109/0142159X.2015.11...
) United States |
CG: control group OG: observed group EG: encouraged group CGi: criticized group |
CG: 10 OG: 10 EG: 10 CGi: 10 |
Compare the effects of the LFS simulator versus HFS technology on performance levels, objective and subjective measures of stress in neonatology interns. |
MBP, heart rate, skin conductance, basal cortisol and Anxiety Inventory |
Medicine |
The criticized group had higher levels of stress compared to the control group. The presence of an expert evaluator produced higher levels of stress for participants. |
2019, Ghazali et al.(2929 Ghazali DA, Breque C, Sosner P, Lesbordes M, Chavagnat JJ, Ragot S, et al. 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;14(7):e0220111. https://doi.org/10.1371/journal.pone.0220111 https://doi.org/10.1371/journal.pone.022...
) France |
IG: 9 simulations for 1 year CG: 3 simulations for 1 year |
IG: 24 CG: 24 |
Analyze physiological stress according to the frequency of repetition of simulations. |
Heart rate variability |
Medicine, nursing, paramedic, ambulance driver |
Stress is recurrent in repeated high-fidelity simulation sessions in life-threatening events and decreases over 24 hours. |
2009, Girzadas et al.(3333 Girzadas DV Jr, Delis S, Bose S, Hall J, Rzechula K, Kulstad EB. Measures of stress and learning seem to be equally affected among all roles in a simulation scenario. Simul Healthc. 2009 Fall;4(3):149-54. https://doi.org/10.1097/SIH.0b013e3181abe9f2 https://doi.org/10.1097/SIH.0b013e3181ab...
) United States |
IG: team leader in simulation CG: member in simulation |
38 |
Measure heart rates and stress and learning perceived by participants in two simulation scenarios, in addition to evaluating their responses to questions at the end of the experiment. |
Heart rate, survey |
Students and medical residents |
The participants' heart rate increased from the pre-procedure to the critical intervention. Self-reported learning values increased with self-reported stress levels. |
2020, Hardenberg, Rana, Tori(11 Hardenberg J, Rana I, Tori K. Evaluating impact of repeated exposure to high fidelity simulation: skills acquisition and stress levels in postgraduate critical care nursing students. Clin Simul Nurs. 2020;48:96-102. https://doi.org/10.1016/j.ecns.2020.06.002 https://doi.org/10.1016/j.ecns.2020.06.0...
) Australia |
IG: repeated simulation sessions CG: a single simulation session |
IG: 7 CG: 7 |
Investigate whether repeated exposure to a challenging clinical scenario leads to a reduction in stress levels. |
Heart rate |
Nursing |
Repeated simulation exposure did not reduce stress levels measured by heart rate. |
2013, Hunziker et al.(3838 Hunziker S, Pagani S, Fasler K, Tschan F, Semmer NK, Marsch S. Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial. BMC Emerg Med. 2013;13:8. https://doi.org/10.1186/1471-227X-13-8 https://doi.org/10.1186/1471-227X-13-8...
) Switzerland |
IG: with previous instructions on how to deal with stress CG: no previous instructions on how to deal with stress |
IG: 62 CG: 62 |
Describe stress patterns during a simulation and investigate perceived stress and its association with coping and performance strategy. |
Survey |
Medicine |
A brief stress coping strategy moderately decreased perceived stress without significantly affecting performance in a CPR scenario. |
2015, Ignacio et al.(4141 Ignacio J, Dolmans D, Scherpbier A, Rethans JJ, Chan S, Liaw SY. Comparison of standardized patients with high-fidelity simulators for managing stress and improving performance in clinical deterioration: a mixed methods study. Nurse Educ Today. 2015;35(12):1161-8. https://doi.org/10.1016/j.nedt.2015.05.009 https://doi.org/10.1016/j.nedt.2015.05.0...
)Singapore |
IG: use of standardized patient in the simulation CG: use of mannequin in the simulation |
IG: 29 CG: 28 |
Compare the effects of using a standardized patient and high-fidelity mannequin on students' stress levels and performance. |
Salivary alpha-amylase and focus group |
Nursing |
Performance and stress during training did not differ with or without a standardized patient. However, in the focus group, we noticed that using standardized patients in the simulation had advantages over the mannequin. |
2017, Lizotte et al.(2727 Lizotte MH, Janvier A, Latraverse V, Lachance C, Walker CD, Barrington KJ, et al. The impact of neonatal simulations on trainees' stress and performance: a parallel-group randomized trial. Pediatr Crit Care Med. 2017;18(5):434-41. https://doi.org/10.1097/PCC.0000000000001119 https://doi.org/10.1097/PCC.000000000000...
) Canada |
IG: simulation with death CG: simulation with survival |
IG: 21 CG: 21 |
Evaluate the impact of simulations on stress and performance both during a simulation with survivors and in simulated death. |
Survey, salivary cortisol |
Medicine |
The simulation caused stress without interfering with performance. Having a "dead" mannequin during the simulation did not increase objective stress or interfere with performance. |
2013, Meunier et al.(2828 Meunier J, Merckaert I, Libert Y, Delvaux N, Etienne AM, Liénard A, et al. The effect of communication skills training on residents' physiological arousal in a breaking bad news simulated task. Patient Educ Couns. 2013;93(1):40-7. https://doi.org/10.1016/j.pec.2013.04.020 https://doi.org/10.1016/j.pec.2013.04.02...
) Belgium |
IG: with previous training on communication CG: no previous training on communication |
IG: 50 CG: 48 |
Evaluate the effect of communication training on physiological arousal during an adverse communication simulation. |
Heart rate, salivary cortisol and survey |
Medicine |
Communication skills training affects physiological arousal in a simulated adverse communication task. |
2013, Pottier et al.(39) France |
IG: high stress scenario CG: low stress scenario |
IG: 21 CG:20 |
Assess the impact of subjective and physiological stress on student decision-making and communication skills in an outpatient setting. |
Scales, cognitive evaluation, Anxiety Inventory, salivary cortisol |
Medicine |
The simulated high-stress outpatient consultation is a negative impact situation for students, leading to failures in clinical reasoning and diagnostic errors. |
2010, Prabhu et al.(4040 Prabhu A, Smith W, Yurko Y, Acker C, Stefanidis D. Increased stress levels may explain the incomplete transfer of simulator-acquired skill to the operating room. Surgery. 2010;147(5):640-5. https://doi.org/10.1016/j.surg.2010.01.007 https://doi.org/10.1016/j.surg.2010.01.0...
) United States |
IG: previous suture training CG: no previous suture training |
IG: 13 CG: 07 |
Examine the trainees' stress level during the transition from the simulator to the operating room and its impact on performance. |
Survey, heart rate, and heart rate variability |
Medicine |
The improper transition from the simulator to the operating room involving the acquired skills may be a consequence of increased stress and anxiety. Heart rate was a better measure of stress compared to heart rate variability. |
2017, Sorensen et al.(3232 Sorensen JL, van der Vleuten C, Rosthoj S, Ostergaard D, LeBlanc V, Johansen M, et al. Simulation-based multiprofessional obstetric anaesthesia training conducted in situ versus off-site leads to similar individual and team outcomes: a randomised educational trial. BMJ Open. 2015;5(10):e008344. https://doi.org/10.1136/bmjopen-2015-008344 https://doi.org/10.1136/bmjopen-2015-008...
) Denmark |
IG: in situ simulation CG: clinic simulation |
IG: 48 CG: 49 |
Investigate the effect of simulation in situ versus clinical simulation on knowledge, safety, stress, motivation, perception of simulation, team performance, and organizational impact among multidisciplinary teams of obstetric anesthesia. |
Survey, salivary cortisol |
Medicine and nursing |
There was no finding that education based on simulation conducted in situ compared to clinical simulation led to different results evaluated in stress. |
2018, Timberlake, Stefanidis and Gardner(4242 Timberlake MD, Stefanidis D, Gardner AK. Examining the impact of surgical coaching on trainee physiologic response and basic skill acquisition. Surg Endosc. 2018;32(10):4183-90. https://doi.org/10.1007/s00464-018-6163-7 https://doi.org/10.1007/s00464-018-6163-...
) United States |
IG: laparoscopic suture training with video and instructor practice CG: laparoscopic suture training with video and practice without an instructor |
IG: 12 CG: 12 |
Examine the impact of a specific teaching technique on skill acquisition and physiological stress. |
Heart rate, heart rate variability, respiratory rate |
Medicine |
Students who receive surgical training exhibit greater performance gains compared to those who do it self-directed. Improvements in skill acquisition correlated with increases in heart rate variability. |
2016, Waterland et al.(3131 Waterland P, Khan FS, Ismaili E, Cheruvu C. Environmental noise as an operative stressor during simulated laparoscopic surgery. Surg Laparosc Endosc Percutan Tech. 2016;26(2):133-6. https://doi.org/10.1097/SLE.0000000000000250 https://doi.org/10.1097/SLE.000000000000...
) England |
IG: simulation with 80 dB noises. CG: simulation in silence |
IG: 35 CG: 35 |
Determine the effect of environmental noise on the psychological and physiological response to stress in students during simulated laparoscopic surgery. |
Anxiety Inventory, heart rate |
Medicine |
Environmental noises generated an increase in the participants' stress response in simulated laparoscopic surgery environments. |