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Impact of stress on resident performance in simulated trauma scenarios

Harvey, Adrian MD, MEd; Bandiera, Glen MD, MEd; Nathens, Avery B. MD, PhD; LeBlanc, Vicki R. PhD

The Journal of Trauma and Acute Care Surgery: February 2012 - Volume 72 - Issue 2 - p 497–503
doi: 10.1097/TA.0b013e31821f84be
Original Articles

Background: Training and practice in medicine are inherently stressful. The effects of stress on performance in clinical situations are poorly understood. The purpose of this study was to examine the stress responses and clinical performance of residents during low and high stress (HS) simulated trauma resuscitations.

Methods: Thirteen emergency medicine and general surgery residents were evaluated in HS and low stress (LS) trauma resuscitation simulations. Subjective and physiologic (heart rate, salivary cortisol) responses were measured at baseline and in response to the scenarios. Performance was assessed with global rating and checklist scores of technical performance, time to record critical information, and the Anesthesia Non-Technical Skills tool. Postscenario recall was assessed with the completion of a standardized trauma history form.

Results: Postscenario subjective stress and cortisol levels were higher in the HS scenario compared with the LS scenario (p < 0.05). Checklist performance scores and postscenario recall were significantly lower in the HS compared with the LS condition (p < 0.05).

Conclusion: In trainees, some aspects of performance and immediate recall appear to be impaired in complex clinical scenarios in which they exhibit elevated subjective and physiologic stress responses. The findings of this study highlight a potential threat to patient safety and demand further investigation. Future studies should strive to further elucidate the effects of stress on specific components of performance and investigate ways to reduce its negative impact.

Toronto, Canada

From the Wilson Centre (A.H., G.B., V.R.L.); Departments of Surgery (A.H., A.B.N.) and Medicine (G.B., V.R.L.), University of Toronto; and Trauma Department (G.B., A.B.N.), St. Michael's Hospital, Toronto, Ontario, Canada.

Submitted: February 1, 2011, Revised: April 8, 2011, Accepted: April 13, 2011.

Presented at the annual meetings of the Association of Medical Education in Europe and of the Association of American Medical Schools.

Address for reprints: Vicki R. LeBlanc, PhD, Wilson Centre, 200 Elizabeth St, 1ES-565, Toronto, ON M5G 2C4, Canada; email:

© 2012 Lippincott Williams & Wilkins, Inc.