Melissa Joseph, MD

Yale Center for Medical Simulation

“Task Stress State and Physiologic Response during Medical Simulation”

Simulation Academy Novice Research Grant



Our goal is to further understand the effects of the acute stressors that Emergency Medicine (EM) Physicians encounter both clinically and in the simulation laboratory. Utilizing both the Dundee Stress State Questionnaire (DSSQ) as well as a wearable biometric shirt to obtain Heart Rate Variability (HRV), this proposal will aim to delineate stress states and physiologic response in EM residents to various stressors during medical simulation cases. Furthermore, we aim to explore changes in decision-making that may occur as a result of these stress states as measured by the Balloon Analog Risk Task (BART).

Specific Aim 1: To characterize and compare the stress state change, as measured by the DSSQ, induced in Emergency Medicine residents by simulation scenarios with varied stressors: medical difficulty, equipment failure, teamwork challenge (difficult nurse), and emotional stressor (emotional family member) Hypothesis: Different stressors will induce varied stress states and stress state change in EM residents. Specifically, medical difficulty will be associated with Task Engagement, emotional stressor from a family member will be associated with Worry, and equipment failure and teamwork challenges will be associated with Distress.

Specific Aim 2: To compare stress state change, as measured by the DSSQ, in EM residents with changes in HRV, an established autonomic nervous system marker associated with development of burnout and PTSD, using a biometric (Hexoskin) smart shirt. Hypothesis: Different stress states will induce a varied response in HRV in EM residents, with Distress causing a relative decrease in HRV as compared to Worry and Task Engagement.

Specific Aim 3: To evaluate the effect of acute stress on risk-taking behavior to. Residents will participate in the Balloon Analog Risk Task (BART), a measure of risk tolerance, following each of the stressful scenarios. This will allow us to compare what effect, if any, acute stress has on risk tolerance in the simulated clinical experience. Hypothesis: Residents will demonstrate increased risk-taking behavior following high stress simulation scenarios.

Emergency Medicine (EM) Physicians suffer disproportionately from burnout and PTSD and associated unique, acute stressors within the clinical environment are thought to play a large role. With further understanding of physician stress states and their physiologic effects, we can not only better identify stressors that are more closely associated with development of clinical burnout, but also work to design effective interventions to lower the stress response during these difficult situations and work to prevent burnout and PTSD development. From a sim perspective, this work will also help us to understand of participant stress state during use of confederates such as nurses, difficult family members, or distractors.

Research Results

Dr. Joseph is still completing the project.