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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2015 | Review

Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients

Authors: Bernd Valentin, Oliver Grottke, Max Skorning, Sebastian Bergrath, Harold Fischermann, Daniel Rörtgen, Marie-Therese Mennig, Christina Fitzner, Michael P Müller, Clemens Kirschbaum, Rolf Rossaint, Stefan K Beckers

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2015

Abstract

Background

In emergency medicine, the benefits of high-fidelity simulation (SIM) are widely accepted and standardized patients (SP) are known to mimic real patients accurately. However, only limited data are available concerning physicians’ stress markers within these training environments.

The aim of this pilot study was to investigate repetitive stress among healthcare professionals in simulated pre-hospital emergency scenarios using either SIM or SPs.

Methods

Teams with one emergency medical services (EMS) physician and two paramedics completed three SIM scenarios and two SP scenarios consecutively. To evaluate stress, salivary cortisol and alpha-amylase were measured in saliva samples taken before, during and after the scenarios.

Results

A total of 14 EMS physicians (29% female; mean age: 36.8 ± 5.0 years; mean duration of EMS-experience: 9.1 ± 5.8 years) and 27 paramedics (11% female; age: 30.9 ± 6.9 years; EMS experience: 8.1 ± 6.0 years) completed the study. Alpha-amylase and cortisol levels did not differ significantly between the two professions. Cortisol values showed a gradual and statistically significant reduction over time but little change was observed in response to each scenario. In contrast, alpha-amylase activity increased significantly in response to every SIM and SP scenario, but there was no clear trend towards an overall increase or decrease over time.

Conclusion

Increases in salivary alpha-amylase activity suggest that both SIM and SP training produce stress among emergency healthcare professionals. Corresponding increases in salivary cortisol levels were not observed. Among physicians in the emergency setting, it appears that alpha-amylase provides a more sensitive measure of stress levels than cortisol.

Breuer G, Riss R, Schroder T, Monk S, Schuttler J. The intensive care simulator: a new teaching-concept to train severe sepsis management. Dtsch Med Wochenschr. 2004;129(48):2586–9.CrossRefPubMed

Chopra V, Gesink BJ, de Jong J, Bovill JG, Spierdijk J, Brand R. Does training on an anaesthesia simulator lead to improvement in performance? Br J Anaesth. 1994;73(3):293–7.CrossRefPubMed

Lighthall GK, Barr J, Howard SK, Gellar E, Sowb Y, Bertacini E, et al. Use of a fully simulated intensive care unit environment for critical event management training for internal medicine residents. Crit Care Med. 2003;31(10):2437–43.CrossRefPubMed

Mueller MP, Heller AR, Koch T. A new simulator-based psychological training on crisis management. MedEduc. 2005;39:1155.

Timmermann A, Eich C, Russo SG, Barwing J, Hirn A, Rode H, et al. Teaching and simulation: methods, demands, evaluation and visions. Anaesthesist. 2007;56(1):53–62.CrossRefPubMed

Abrahamson S, Denson JS, Wolf RM. Effectiveness of a simulator in training anesthesiology residents. J Med Educ. 1969;44(6):515–9.PubMed

Alkov RA, Borowsky MS, Williamson DW, Yacavone DW. The effect of trans-cockpit authority gradient on Navy/Marine helicopter mishaps. Aviat Space Environ Med. 1992;63(8):659–61.PubMed

Denson JS, Abrahamson S. A computer-controlled patient simulator. JAMA. 1969;208(3):504–8.CrossRefPubMed

Hendrickse AD, Ellis AM, Morris RW. Use of simulation technology in Australian defence force resuscitation training. JRArmy Med Corps. 2001;147:173–8.CrossRef

10.

Orlansky J. Human factors in aircraft design. Med News LettAviat. 1948;9:1–4.

11.

Keitel A, Ringleb M, Schwartges I, Weik U, Picker O, Stockhorst U, et al. Endocrine and psychological stress responses in a simulated emergency situation. Psychoneuroendocrinology. 2011;36(1):98–108.CrossRefPubMed

12.

Müller MP, Hansel M, Fichtner A, Hardt F, Weber S, Kirschbaum C, et al. Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study. Resuscitation. 2009;80(8):919–24.CrossRefPubMed

13.

Sanders AF. Towards a model of stress and human performance. Acta Psychol. 1983;53:61–97. Amst.CrossRef

14.

Quilici AP, Pogetti RS, Fontes B, Zantut LF, Chaves ET, Birolini D. Is the advanced trauma life support simulation exam more stressful for the surgeon than emergency department trauma care? Clinics. 2005;60:287–92. Sao Paulo.CrossRefPubMed

15.

Gallacher DV, Petersen OH. Stimulus-secretion coupling in mammalian salivary glands. Int Rev Physiol. 1983;28:1–52.PubMed

16.

Takai N, Yamaguchi M, Aragaki T, Eto K, Uchihashi K, Nishikawa Y. Effect of psychological stress on the salivary cortisol and amylase levels in healthy young adults. Arch Oral Biol. 2004;49(12):963–8.CrossRefPubMed

17.

Kirschbaum C, Hellhammer DH. Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology. 1994;19(4):313–33.CrossRefPubMed

18.

Rörtgen D, Bergrath S, Rossaint R, Beckers SK, Fischermann H, Na I, et al. Comparison of physician staffed emergency teams with paramedic teams assisted by telemedicine – a randomized, controlled simulation study. Resuscitation. 2013;84(1):85–92.CrossRefPubMed

19.

Skorning M, Bergrath S, Rörtgen D, Beckers SK, Brokmann JC, Gillmann B, et al. Teleconsultation in pre-hospital emergency medical services: real-time telemedical support in a prospective controlled simulation study. Resuscitation. 2012;83(5):626–32.CrossRefPubMed

20.

Skorning M, Bergrath S, Rörtgen D, Brokmann JC, Beckers SK, Protogerakis M, et al. E-health in emergency medicine - the research project Med-on-@ix. Anaesthesist. 2009;58(3):285–92.CrossRefPubMed

21.

Rohleder N, Wolf JM, Maldonado EF, Kirschbaum C. The psychosocial stress-induced increase in salivary alpha-amylase is independent of saliva flow rate. Psychophysiology. 2006;43(6):645–52.CrossRefPubMed

22.

Bligh J, Bleakley A. Distributing menus to hungry learners: can learning by simulation become simulation of learning? Med Teach. 2006;28(7):606–13.CrossRefPubMed

23.

DeMaria Jr S, Bryson EO, Mooney TJ, Silverstein JH, Reich DL, Bodian C, et al. Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance. Med Educ. 2010;44:1006–15.CrossRefPubMed

24.

Hassan I, Weyers P, Maschuw K, Dick B, Gerdes B, Rothmund M, et al. Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance. Br J Surg. 2006;93(12):1554–9.CrossRefPubMed

25.

Moorthy K, Munz Y, Dosis A, Bann S, Darzi A. The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc. 2003;17(9):1481–4.CrossRefPubMed

26.

Gordis E, Granger D, Susman E, Trickett P. Asymmetry between salivary cortisol and α-amylase reactivity to stress: Relation to aggressive behavior in adolescents. Psychoneuroendocrinology. 2006;31(8):976–87.CrossRefPubMed

27.

van Stegeren AH, Roozendaal B, Kindt M, Wolf OT, Joëls M. Interacting noradrenergic and corticosteroid systems shift human brain activation patterns during encoding. Neurobiol Learn Mem. 2010;93(1):56–65.CrossRefPubMed

28.

Callahan CA, Hojat M, Gonnella JS. Volunteer bias in medical education research: an empirical study of over three decades of longitudinal data. Med Educ. 2007;41(8):746–53.CrossRefPubMed

Title: Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients
Authors: Bernd Valentin
Oliver Grottke
Max Skorning
Sebastian Bergrath
Harold Fischermann
Daniel Rörtgen
Marie-Therese Mennig
Christina Fitzner
Michael P Müller
Clemens Kirschbaum
Rolf Rossaint
Stefan K Beckers
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2015
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-015-0110-6

At a glance: The STEP trials

Springer Medicine

Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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