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Ahn BT, Maurice-Ventouris M, Bilgic E, Yang A, Lau CHH, Peters H, Li K, Chang-Ou D, Harley JM. A scoping review of emotions and related constructs in simulation-based education research articles. Adv Simul (Lond) 2023; 8:22. [PMID: 37717029 PMCID: PMC10505334 DOI: 10.1186/s41077-023-00258-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/17/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND While acknowledgement of emotions' importance in simulation-based education is emerging, there are concerns regarding how education researchers understand the concept of emotions for them to deliberately incorporate emotionally charged scenarios into simulation-based education. This concern is highlighted especially in the context of medical education often lacking strong theoretical integration. To map out how current simulation-based education literature conceptualises emotion, we conducted a scoping review on how emotions and closely related constructs (e.g. stress, and emotional intelligence) are conceptualised in simulation-based education articles that feature medical students, residents, and fellows. METHODS The scoping review was based on articles published in the last decade identified through database searches (EMBASE and Medline) and hand-searched articles. Data extraction included the constructs featured in the articles, their definitions, instruments used, and the types of emotions captured. Only empirical articles were included (e.g. no review or opinion articles). Data were charted via descriptive analyses. RESULTS A total of 141 articles were reviewed. Stress was featured in 88 of the articles, while emotions and emotional intelligence were highlighted in 45 and 34 articles respectively. Conceptualisations of emotions lacked integration of theory. Measurements of emotions mostly relied on self-reports while stress was often measured via physiological and self-report measurements. Negative emotions such as anxiety were sometimes seen as interchangeable with the term stress. No inferences were made about specific emotions of participants from their emotional intelligence. CONCLUSIONS Our scoping review illustrates that learners in simulation-based education are most often anxious and fearful. However, this is partially due to medical education prioritising measuring negative emotions. Further theoretical integration when examining emotions and stress may help broaden the scope towards other kinds of emotions and better conceptualisations of their impact. We call for simulation education researchers to reflect on how they understand emotions, and whether their understanding may neglect any specific aspect of affective experiences their simulation participants may have.
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Affiliation(s)
| | | | - Elif Bilgic
- Department of Surgery, McGill University, Montreal, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
- McMaster Education Research Innovation and Theory (MERIT) program, Hamilton, Canada
| | - Alison Yang
- Department of Surgery, McGill University, Montreal, Canada
| | | | - Hannah Peters
- Department of Surgery, McGill University, Montreal, Canada
| | - Kexin Li
- Department of Surgery, McGill University, Montreal, Canada
| | | | - Jason M Harley
- Department of Surgery, McGill University, Montreal, Canada.
- Research Institute of the McGill University Health Centre, Montreal, Canada.
- Institute for Health Sciences Education, McGill University, Montreal, Canada.
- Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada.
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First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study. J Clin Med 2022; 11:jcm11020435. [PMID: 35054129 PMCID: PMC8780943 DOI: 10.3390/jcm11020435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3–4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants’ neurologic affiliation was associated with performance of fewer checks (regression coefficient −0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.
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Vincent A, Semmer NK, Becker C, Beck K, Tschan F, Bobst C, Schuetz P, Marsch S, Hunziker S. Does stress influence the performance of cardiopulmonary resuscitation? A narrative review of the literature. J Crit Care 2020; 63:223-230. [PMID: 33046274 DOI: 10.1016/j.jcrc.2020.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
Cardiopulmonary resuscitation represents a major physical and psychological challenge for all involved health care workers because survival of the patients is closely related to the timely and accurate actions of rescuers. Consequently, rescuers may experience high levels of acute mental stress. Stress, in turn, may influence attentional resources and distractibility, which may affect the quality of resuscitation. This narrative review summarizes the current state of research concerning the influence of stress on resuscitation performance. Peer-reviewed studies retrieved in scientific databases were eligible. We found that rescuers experience high levels of stress and some associations of higher levels of stress with lower resuscitation performance. Finally, few interventional studies assessed whether interventions aiming at reducing levels of stress may have a beneficial effect on resuscitation performance, but results are variable. Although the mechanisms linking stress to performance of emergency teams are still not fully understood, factors such as individual experience and self-confidence of rescuers, gender composition and hierarchy within resuscitation teams may play an important role. This review provides a targeted overview of how stress can be defined and measured, how it may influence emergency situations such as a cardiopulmonary resuscitation, and which interventions have the potential to reduce overwhelming stress.
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Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Franziska Tschan
- Department of Psychology, University of Neuchâtel, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Cora Bobst
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Philipp Schuetz
- University Department of Medicine, Kantonsspital Aarau, Haus 7, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland.
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Association of self-esteem, personality, stress and gender with performance of a resuscitation team: A simulation-based study. PLoS One 2020; 15:e0233155. [PMID: 32407382 PMCID: PMC7224528 DOI: 10.1371/journal.pone.0233155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/29/2020] [Indexed: 01/09/2023] Open
Abstract
Background Gender composition, stress and leadership of a resuscitation team influence CPR performance. Whether psychological variables such as self-esteem, motivation and personality traits are associated with resuscitation performance, stress levels and gender of rescuers during a cardiac arrest scenario remains uncertain. Methods We included 108 medical students in this prospective, observational simulator study. We videotaped the resuscitation performance and assessed self-esteem, perceived stress-overload and personality traits using validated questionnaires. In addition, we analysed leadership utterances and ECG data of all participants during the simulation. The primary endpoint was cardiopulmonary resuscitation performance, defined as hands-on time within the first 180 sec. Secondary outcomes included first meaningful measure of resuscitation, leadership statements of group leaders and physiological stress parameters of rescuers. Results Adjusted for group size and leadership designation, mean self-esteem of students was significantly associated with hands-on time (adjusted regression coefficient 7.94 (95%CI 2.61 to 13.27), p<0.01). The personality trait conscientiousness was positively associated with hands-on time (adjusted regression coefficient 38.4, [95%CI 7.41 to 69.38, p = 0.02]). However, after additional adjustment for self-esteem, this association was no longer significant. Further, agreeableness of team leaders was significantly associated with longer hands-on time (adjusted regression coefficient 20.87 [95%CI 3.81 to 37.94], p = 0.02). Openness to experience was negatively associated with heart rate reactivity (-5.92 (95%CI -10 to -1.85), p<0.01). Male students showed significantly higher (mean, [±SD]) self-esteem levels (24.6 [±3.8] vs. 22.0 [±4.4], p<0.01), expressed significantly more leadership statements (7.9 [±7.8] vs. 4.6 [±3.8], p<0.01) and initiated first resuscitation measures more often (n, [%]) compared to female students (16, [23] vs. 7, [12], p = 0.01). Conclusion This simulator study found that self-esteem of resuscitation teams and agreeableness of team leaders of inexperienced students was associated with cardiopulmonary resuscitation performance. Whether enhancing these factors during resuscitation trainings serve for better performance remains to be studied.
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Sutter R, Tisljar K, Opić P, De Marchis GM, Bassetti S, Bingisser R, Hunziker S, Marsch S. Emergency management of status epilepticus in a high-fidelity simulation: A prospective study. Neurology 2019; 93:838-848. [PMID: 31594860 DOI: 10.1212/wnl.0000000000008461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To quantify the quality of physicians' emergency first response to status epilepticus (SE) and to identify risk factors for nonadherence to treatment guidelines in a standardized simulated scenario. METHODS In this prospective trial, 58 physicians (of different background) of the University Hospital Basel, a Swiss academic medical care center, were confronted with a simulated SE. Primary outcomes were time to (1) airway protection, (2) supplementary oxygen, and (3) administration of antiseizure drugs (ASDs). RESULTS All physicians recognized ongoing seizures. Airways were checked by 54% and protected by 16% within a median of 3.9 minutes. Supplementary oxygen was administered by 76% with a median of 2.8 minutes. First-line ASDs were administered by 98% (benzodiazepines 97% within a median of 2.9 minutes), and second-line ASDs by 57% within 8.1 minutes. Regarding secondary outcomes, the median time to monitor blood pressure and heart rate was 1.8 (interquartile range [IQR] 1.3-2.6) and 2.0 (IQR 1.4-2.7) minutes, respectively. Neurologic affiliation of physicians was associated with inadequate assessments of vital signs (odds ratio [OR] = 0.2; 95% CI 0.04-0.93) and most frequent administration of second-line ASDs (OR = 5.0; 95% CI 1.01-25.3). Knowing treatment guidelines and subjective certainty regarding SE diagnosis were associated with frequent administration of second-line ASDs (OR = 10.4; 95% CI 1.2-88.1). CONCLUSIONS Nonadherence to SE treatment guidelines is frequent. The lack of airway assessment and protection in the simulated clinical scenario of SE may increase mortality and promote treatment refractoriness related to aspiration pneumonia. Guideline-based clinical training is urgently needed to increase the quality of SE management. REGISTRATION ISRCTN registry (ID ISRCTN60369617; www.isrctn.com/ISRCTN60369617).
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Affiliation(s)
- Raoul Sutter
- From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland.
| | - Kai Tisljar
- From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Petra Opić
- From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Gian Marco De Marchis
- From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Stefano Bassetti
- From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Roland Bingisser
- From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Sabina Hunziker
- From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Stephan Marsch
- From the Clinic for Intensive Care Medicine (R.S., K.T., P.O., S.M.), University Hospital Basel; Department of Neurology (R.S., G.M.D.M.), University Hospital Basel; Medical Faculty (R.S., G.M.D.M., S.B., R.B., S.H., S.M.), University of Basel; Division of Internal Medicine (P.O., S.B.), University Hospital Basel; Department of Emergency Medicine (R.B.), University Hospital Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
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Hunziker S, O'Connell KJ, Ranniger C, Su L, Hochstrasser S, Becker C, Naef D, Carter E, Stockwell D, Burd RS, Marsch S. Effects of designated leadership and team-size on cardiopulmonary resuscitation: The Basel-Washington SIMulation (BaWaSim) trial. J Crit Care 2018; 48:72-77. [PMID: 30172964 DOI: 10.1016/j.jcrc.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE During cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied. METHODS This randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance. RESULTS We included 90 teams with a total of 408 students. No difference in mean (±SD) hands-on time (seconds) were observed between emergent leadership (106 ± 30) compared to designated leadership (103 ± 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 ± 30) and larger teams (106 ± 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams. CONCLUSIONS Within this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.
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Affiliation(s)
- Sabina Hunziker
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland.
| | | | - Claudia Ranniger
- Clinical Learning and Simulation Skills (CLASS) Center, The George Washington University, Washington, DC, United States
| | - Lillian Su
- Children's National Medical Center, Washington, DC, United States
| | - Seraina Hochstrasser
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland
| | - Christoph Becker
- Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Daryl Naef
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland
| | - Elizabeth Carter
- Children's National Medical Center, Washington, DC, United States
| | - David Stockwell
- Patient Safety and the Pediatric Intensive Care Unit, Children's National Medical Center, Washington, DC, United States
| | - Randall S Burd
- Children's National Medical Center, Department of Surgery, Washington, DC, United States
| | - Stephan Marsch
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland
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