Education  |   July 2020
Stress Management Training Improves Overall Performance during Critical Simulated Situations: A Prospective Randomized Controlled Trial
Author Notes
  • From the Departments of Anesthesia and Intensive Care, Hospices Civils of Lyon, Lyon, France (F.S., G.P., D.C., J.-J.L., T.R., M.L.); Departments of Anesthesia and Intensive Care, Grenoble Alpes University Hospital, Grenoble, France (J.-N.E.); Institute of Biomedical Research, Armies’ Health Service, Bretigny sur Orge, France (D.C., M.T., F.C.); Desgenettes Hospital, Armies’ Health Service, Lyon, France (M.B.); Seventh Medical Center of the Armies of Lyon, 76th Medical Antenna of Varces, Varces, France (A.G.-L.); Claude Bernard Lyon 1 University, high fidelity medical simulation center (CLESS; Centre Lyonnais d’Enseignement par Simulation en Santé), SAMSEI, Lyon, France (D.C., J.-J.L., T.R., M.L.); Health Data Department, Hospices Civils of Lyon, Lyon, France (A.D.); Claude Bernard Lyon 1 University, Health Services and Performance Research Lab (EA 7425 HESPER), Lyon, France (A.D., J.-J.L., M.L.); EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Pi3), Claude Bernard Lyon 1 University-Biomérieux-Hospices Civils of Lyon, Lyon, France (T.R.); and Val-de-Grâce School, Paris, France (M.T., F.C.).
  • The first results of this study were presented at the 2017, 2018, and 2019 annual meetings of the French Society of Anesthesiology and Critical Care Medicine (SFAR; Paris, France) on September 23, 2017, September 29, 2018, and September 20, 2019, respectively, in Paris, France.
    The first results of this study were presented at the 2017, 2018, and 2019 annual meetings of the French Society of Anesthesiology and Critical Care Medicine (SFAR; Paris, France) on September 23, 2017, September 29, 2018, and September 20, 2019, respectively, in Paris, France.×
  • Submitted for publication September 11, 2019. Accepted for publication February 28, 2020. Published online first on April 16, 2020. Published online first on April 16, 2020.
    Submitted for publication September 11, 2019. Accepted for publication February 28, 2020. Published online first on April 16, 2020. Published online first on April 16, 2020.×
  • Address correspondence to Dr Lilot: Département d’anesthésie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France. marclilot@hotmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Central and Peripheral Nervous Systems / Critical Care / Education / CPD / Respiratory System
Education   |   July 2020
Stress Management Training Improves Overall Performance during Critical Simulated Situations: A Prospective Randomized Controlled Trial
Anesthesiology 7 2020, Vol.133, 198-211. doi:https://doi.org/10.1097/ALN.0000000000003287
Anesthesiology 7 2020, Vol.133, 198-211. doi:https://doi.org/10.1097/ALN.0000000000003287
Abstract

Background: High-fidelity simulation improves participant learning through immersive participation in a stressful situation. Stress management training might help participants to improve performance. The hypothesis of this work was that Tactics to Optimize the Potential, a stress management program, could improve resident performance during simulation.

Methods: Residents participating in high-fidelity simulation were randomized into two parallel arms (Tactics to Optimize the Potential or control) and actively participated in one scenario. Only residents from the Tactics to Optimize the Potential group received specific training a few weeks before simulation and a 5-min reactivation just before beginning the scenario. The primary endpoint was the overall performance during simulation measured as a composite score (from 0 to 100) combining a specific clinical score with two nontechnical scores (the Ottawa Global Rating Scale and the Team Emergency Assessment Measure scores) rated for each resident by four blinded independent investigators. Secondary endpoints included stress level, as assessed by the Visual Analogue Scale during simulation.

Results: Of the 134 residents randomized, 128 were included in the analysis. The overall performance (mean ± SD) was higher in the Tactics to Optimize the Potential group (59 ± 10) as compared with controls ([54 ± 10], difference, 5 [95% CI, 1 to 9]; P = 0.010; effect size, 0.50 [95% CI, 0.16 to 0.91]). After specific preparation, the median Visual Analogue Scale was 17% lower in the Tactics to Optimize the Potential group (52 [42 to 64]) than in the control group (63 [50 to 73]; difference, −10 [95% CI, −16 to −3]; P = 0.005; effect size, 0.44 [95% CI, 0.26 to 0.59].

Conclusions: Residents coping with simulated critical situations who have been trained with Tactics to Optimize the Potential showed better overall performance and a decrease in stress level during high-fidelity simulation. The benefits of this stress management training may be explored in actual clinical settings, where a 5-min Tactics to Optimize the Potential reactivation is feasible prior to delivering a specific intervention.

Editor’s Perspective:

What We Already Know about This Topic:

  • Stress may be associated with impaired performance on cognitive tasks

  • Stress management training may lead to a reduced response to stress

What This Article Tells Us That Is New:

  • Stress management training may improve performance among trainees subjected to a stressful simulated clinical environment