S. Alken1, J. Luursema1, C. Fluit1, H. Van Goor1 1Radboud University Medical Center,Nijmegen, N/A, Netherlands
Introduction:
High levels of stress can cause cognitive overload, compromise technical and non-technical abilities of surgeons and can potentially compromise teaching climate and efficiency. This study aims to investigate how stress is perceived by trainees and faculty during a simulation team training, and how subjective stress is related to objective stress data.
Methods:
Data was collected during the Definitive Surgical Trauma Care (DSTC) course, a highly realistic hands-on trauma surgery team training performed on live porcine models. 7 surgical teams participated, each team existing of 1 faculty coaching 2 trainees.
Subjective stress was measured by the State Trait Anxiety Index (STAI; 6= lowest level of stress; 24= highest level of stress) and on a Visual Analogue Scale (VAS; 0= lowest level of stress; 100= highest level of stress). Objective stress was measured by saliva cortisol level, heart rate and heart rate variability. Saliva samples, STAI and VAS scores were collected 2 times at baseline and 4 times during the simulation training. Heart rate and heart rate variability was registered every 4 and 300 seconds respectively with the Health Patch™ (Vital Connect Inc, Campbell, USA) worn by all participants.
Results:
Trainees reported a significant increase of mean subjective stress during training compared to baseline (STAI: 12.44 vs. 9.65, +2.79, Wilcoxon SR Test, P = .005; VAS: 39.06 vs. 20.33, + 18.73, Wilcoxon SR Test, P= .007), whereas faculty did not (STAI: 9.87 vs. 9.21, +0.66, Wilcoxon SR Test, P = .180; VAS: 25.00 vs. 18.57, +6.43, Wilcoxon SR Test, P= .138).
Between the faculty and trainees within the same team, in-training VAS and STAI scores did not correlate (Pearson’s r ranging from -.580 to .765). Strong correlations were found between the in-training cortisol levels of faculty and trainees in 5 of 7 teams (Pearson’s r ranging from .929 to .979). Analysis of cortisol samples and Health Patch™ data is currently done.
Conclusion:
Perceived stress differed between faculty and trainees during a highly realistic damage control surgery team training, whereas objective stress as measured by cortisol did not. Possibly, stress remains unnoticed or neglected by faculty.