Evaluation of Stress Levels of Trainee Cardiac Surgery Residents during Training Interventions Using Physiological Stress Parameters

The influence of virtual reality simulation on surgical residents' heart rate during an assessment of arthroscopic technical skills: A prospective, paired observational study

HYPOTHESIS

To demonstrate that a virtual reality (VR) simulation training program reduces heart rate variability during an assessment of surgical trainees' technical skills in arthroscopy.

STUDY DESIGN

Prospective observational matched study.

MATERIALS & METHODS

Thirty-six orthopaedic surgery residents, new to arthroscopy, received standard training in arthroscopic knee surgery, supplemented by additional monthly training for 6months on a VR simulator for 16 of them. At inclusion, the 2 groups (VR and NON-VR) answered a questionnaire and performed a meniscectomy on a VR simulator. After 6months of training, two independent trainers blinded to the inclusion arms evaluated the technical skills of the two groups during meniscectomies on a model and on an anatomical subject. Heart rate variability (HRV) was measured using a wireless heart rate monitor during baseline, VR training, and assessment.

RESULTS

After removing incomplete data, the analysis focused on 10 VR residents matched at inclusion with 10 NON-VR residents. The VR group had a significantly lower heart rate at the final assessment (p=0.02) and lower overall HRV (p=0.05). The low/high frequency ratio (LF/HF) was not significantly different between the groups (1.84 vs 2.05, p=0.66) but the before-after training comparison showed a greater decrease in this ratio in the VR group compared to the NON-VR group -0.76 (-41%) vs -0.08 (-4%).

CONCLUSION

This study demonstrates a significant difference in heart rate variability between trained residents versus untrained residents during the final assessment of their technical skills at 6months. It appears that improving stress management should be an integral part of training programs in arthroscopic surgery.

CLINICAL INTEREST

VR simulators in arthroscopy could improve non-technical skills such as heart rate variability, from the perspective of accountability.

LEVEL OF EVIDENCE

III.

Occupational stress and burnout among intensive care unit nurses during the pandemic: A prospective longitudinal study of nurses in COVID and non-COVID units

Background

Intensive care unit (ICU) nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses' workload and further exacerbated their stress and burnout. This work investigates occupational stress and burnout experienced by ICU nurses working with COVID and non-COVID patients.

Method

A prospective longitudinal mixed-methods study was conducted with a cohort of ICU nurses working in medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-h shifts. Data on occupational stress and burnout prevalence were collected using validated questionnaires. Physiological indices of stress were collected using wrist-worn wearable technologies. Participants elaborated on the causes of stress experienced each shift by completing open-ended questions. Data were analyzed using statistical and qualitative methods.

Results

Participants caring for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p < 0.001) in comparison to non-COVID unit participants. No differences in stress levels were found when the same participants worked with COVID and non-COVID patients at different shifts (p = 0.58) at the COVID unit. The cohorts expressed similar contributors to stress, based in communication tasks, patient acuity, clinical procedures, admission processes, proning, labs, and assisting coworkers.

Conclusion

Nurses in COVID units, irrespective of whether they care for a COVID patient, experience occupational stress and burnout.

Activation of the stress response among the cardiac surgical residents: comparison of teaching procedures and other (daily) medical activities

BACKGROUND

The aim of this Pilot study was to investigate the cardiac surgical residents' workload during different surgical teaching interventions and to compare their stress levels with other working time spent in the intensive care unit or normal ward.

METHODS

The objective stress was assessed using two cardiac surgical residents' heart rate variability (HRV) both during surgical activities (32 selected teaching operations (coronary artery bypass graft n = 26 and transcatheter aortic valve implantation n = 6), and during non-surgical periods. Heart rate, time and frequency domains as well as non-linear parameters were analyzed using the Wilcoxon test.

RESULTS

The parasympathetic activity was significantly reduced during the surgical phase, compared to the non-surgical phase: Mean RR (675.7 ms vs. 777.3 ms), RMSSD (23.1 ms vs. 34.0 ms) and pNN50 (4.7% vs. 10.6%). This indicates that the residents had a higher stress level during surgical activities in comparison to the non-surgical times. The evaluation of the Stress Index during the operations and outside the operating room (8.07 vs. 10.6) and the parasympathetic nervous system index (- 1.75 to - 0.91) as well as the sympathetic nervous system index (1.84 vs. 0.65) confirm the higher stress level during surgery. This can be seen too used the FFT Analysis with higher intraoperative LF/HF ratio (6.7 vs. 3.8).

CONCLUSION

HRV proved to be a good, objective method of identifying stress among physicians both in and outside the operating room. Our results show that residents are exposed to high psychological workloads during surgical activities, especially as the operating surgeon.