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P36 Setting hearts racing: going beyond self reported stress in simulation

Background The University of Bristol’s Swindon academy has previously recognised that undergraduate students can find simulation stressful.1 There is emerging evidence that emotional and physiological stress during learning can improve a student’s task performance and memory formation.2,3,4Heart rate (HR) and Heart rate variability (HRV) are easily obtainable measurements that appear to be linked with mental stress.5,6 Studies looking at hostage taking scenario simulation in police officers have been able to create a graphical representation of physiological stress during the simulation.8 The implications of this may be that by adapting simulations scenarios to create carefully tailored stressful moments it may be possible to improve a student’s self-awareness, task performance and memory retention. In this study we aim to develop and test a low-cost simple method to allow measurement of a student’s physiological and perceived mental stress during an on call simulation. Methods 30 final year medical students on their preparation for practice placements will undergo an on-call simulation. All students will wear a non-invasive heart rate monitor (Wahoo TIKR ©) throughout the simulation. Data from this monitor will be collected and interpreted by a commercially available smart phone application (Sweetbeats©). The heart rate (beats per minute) and HRV measurement’s (RMSSD, LF, HF and LF:HF) will be recorded prior to the day of the simulation to get a baseline measurement. The students will then wear the monitors throughout the simulation. The students perceived maximal stressor during the simulation will also be recorded by a questionnaire upon leaving the simulation suite. All simulations will also be video recorded. Results The video recording of the scenario will allow us to playback significant events in the simulation and tie them to the corresponding physiological data from the heart rate monitors. Data will be presented in graphical form with the X axis being time and the Y axis being one of HR or HRV. Key learning events of the simulation will be labelled on the graph, along with events corresponding to significant changes in HR, HRV (anything above a 10% change from baseline) and the moments students perceived to be most stressful. The data from all 30 students will then be used to create an average ‘stress profile’ of the simulation (a graph of time vs Stress with key event plotted and labelled. Conclusion This project aims to see if using low cost, readily available technology makes it possible to identify specific mental and physiological stressors during simulation. A ‘stress profile’ of the simulation could help to identify key stressors for students undertaking the simulation and in the future allow the simulation to be tailored to maximise a student’s learning. References . Banks C, Barr J, Goddard T, Majumdar D. De-stressing the stressful simulation. Poster at ASME conference 2016. . Ell SW, Cosley B, McCoy S. When bad stress goes good: Increased threat reactivity improved category learning performance. Psychon Bull rev 2010;18:96–102. . DeMaria S, Bryson EO, Mooney TJ, Silverstein JH, Reich DI, Bodian CB, Levine AI. Adding emotional stress to training in simulated cardiopulmonary arrest enhances participant performance. Medical Education 2010;44:1006–1015. . Kromann CB, Jensen MI, Ringsted C. Stress and learning. Medical Education 2010;44:950–952. . Matthews S, jelinek H, Vafaeiafraz S, McLachlan CS. Heart rate stability and decreased parasympathetic heart rate variability in healthy young adults during perceived stress 2012. . Taelman J, Vandeput S, Spaepen A, Van Huffel S. Influence of mental stress on heart rate and heart rate variability. ECIFMBE, IFMBE Proceedings 2009;22:1366–1369. . Reetta O, Matti V, Tiina L, Mika T, Pasi K, Jari V, Minna S, Clas-Håkan N. Perceived mental stress and reactions in heart rate variability: A pilot study among employees of an electronics company. International Journal of Occupational Safety and Ergonomics 2008;14(3):275–283. doi:10.1080/10803548.2008.11076767 . McCraty R, Atkinson M. Resilience training programme reduces physiological and psychological stress in police officers. Global advances in health and medicine 2012;1(5).