Understanding the Antecedents and Effects of Acute Stress in Complex Medical Settings

• In Event: Emotions in Medical Education: Causes and Effects

Abstract

Rationale. Medical education and practice are domains that contain significant stressors for individuals. During training, stressors include clinical or licensing exams and conflicts between clinical and education responsibilities. During clinical practice, common stressors include treating rapidly deteriorating patients, sleep deprivation, and inadequate personal time (Dyrbye et al., 2005, 2006). These stressors have documented effects on individuals’ mental and physical health (Rutledge et al., 2009; Zuardi et al., 2011).

Despite the documented link between job stress and mental health, there is relatively little research on the impact of stress on learning and clinical performance in the health professions (Schull, et. al, 2001). If stress, in addition to its impact on wellbeing, impairs medical decision-making, motor skills, or learning, this could have a significant negative impact on patient management. As a result, patient care and safety could be jeopardized. Understanding the extent to which stress affects clinical performance will allow us to effectively target technological and educational interventions to improving clinical performance in acutely stressful situations.

Method. This presentation will provide of an overview of a program of research in which simulation modalities were used to recreate the stressors of medical education and practice. Using experimental designs to compare low stress to high stress conditions, we measured the effects of subjective (state anxiety) and physiological (salivary cortisol) stress on clinical performance.

Results. Across four studies (N = 106 participants), paramedics, emergency medicine residents, and medical students took part in low and high stress simulated clinical scenarios. The results of these studies consistently reveal that clinical performance, memory, and clinical reasoning are impaired in stressful conditions, when compared to low stress conditions (Harvey et al., 2012; LeBlanc et al., 2005, 2012; Pottier et al., 2013). For example, in a study with 41 final-year medical students (Pottier et al., 2013), we observed negative correlations between several stress indicators and the ability to generate evidence for alternative diagnostic hypotheses (r values= -.028 to -.32, all p’s< .05). Using these results, and findings from several other studies, this presentation will provide an analysis of emerging trends from a program of research that is working to understand the antecedents and effects of acute stress and anxiety on clinical performance in complex medical settings.

Significance. Together, these studies reveal that acute stress can have important negative effects on several components of clinical practice. As such, this work underlines the importance of delivering training aimed at the recognition and regulation of emotional responses to acute stressors as complements to traditional approaches that target the acquisition of skills and knowledge (Regehr et al., 2014).

Author

• Vicki R LeBlanc