Measuring simulation stress

Fort Worth, TX

12/4/2009

By: Marisa Reynolds, Schieffer School of Journalism

Eyes open. Slowly breathing. Lying still.

This is not a human being, but a human patient simulator, what most medical practitioners use to explore various clinical situations. According to Meti.com, these human patient simulators mimic real human beings, and have the ability to provide respiratory gas exchange, anesthesia delivery and patient monitoring with a real physiological clinical monitor. These realistic characteristics help students learn skills, gain experience and develop competencies that will help them in their careers, without the risk of harming a real person.

For years, simulation has been used as a learning tool for many medical training programs. Instructors have used it as a test tool, because they are able to control monitors and put students in various clinical situations.

The skills learned through simulation then carry over into the operating room, where the students are given the opportunity to practice on a human being under the supervision of their professor.

Dennis Cheek and Terri Jones, both certified registered nurse anesthesiologists and doctors of nursing practice at TCU, decided to study the levels of stress students undergo in the classroom compared to the operating room in order to validate the use of this simulation teaching tool.

“There is nothing in literature about testing technical effects relating to experience,” Dr. Cheek said. Certified registered nursing students Damiun Bassendeh, Sarah Goss and Bethany Weeks also participated in this study, testing patients and helping with the write-up of the Institutional Review Board Protocol, for the group that determines the risk of the study using human participants.

“There is always improvement in learning, and this is one way we could validate the reasoning behind using simulation,” Dr. Jones said.

Drs. Cheek and Jones encouraged all TCU graduate students to participate in the study and 21 agreed to help. They were each asked to place a dime-sized cortical sponge that is used to measure stress levels under their tongue for three days when they thought they were experiencing a minimal level of stress. This acted as the study’s control group. Students were then asked to repeat this process in the classroom and later in the operating room. The students’ stress levels were monitored electronically through the cortisol sponge.

Both Dr. Cheek and Dr. Jones hope that this study increases knowledge in the clinical field.

“I would like to see simulation more life-like, so it’s not as stressful when [students] get in the operating room,” Dr. Cheek said. According to sciencedirect.com, increased cortisol levels affect your memory performance.

“We hope to show that increased cortisol levels also lead to improved memory and learning of critical events,” Dr. Jones said.

The first stage of the project ended in October 2009.

“Research always leads to additional questions,” Dr. Cheek said. They hope to submit their findings of their first study to the American Nurse Association and eventually be published in the association’s journal.

Surprisingly, the results contradicted both faculty members’ hypothesis: stress levels turned out to be higher in the classroom than in the operating room.

“Students felt more comfortable in the operating room because they knew that their professor would not allow for error, whereas in the classroom, they were all on their own,” Dr. Cheek said.

Drs. Cheek and Jones hope to continue their research in the spring. They are unsure about their next research project, but they will probably repeat the study or compare the group with experienced nurse anesthetists.