The impact of simulated patient death on medical students’ stress response and learning of ACLS

Abstract

Introduction: There is considerable controversy as to whether the simulator should die during high-fidelity simulation (HFS). We sought to describe the physiologic and biochemical stress response induced by simulated patient death as well as the impact on long-term retention of Advanced Cardiovascular Life Support (ACLS) knowledge and skills.

Methods: Twenty-six subjects received an American Heart Association (AHA) ACLS provider course. Following the course, subjects participated in HFS and were randomized to simulated death or survival. Heart rate and salivary cortisol (SC) and dihydroepiandrosterone (DHEA) were collected at this time. Subjects returned six months later for a follow-up simulation in which ACLS knowledge and skills were tested.

Results: For all participants, there was an increase in heart rate during simulation compared with baseline heart rate (+ 32 beats/minute), p < 0.0001. Similarly, SC and DHEA were higher compared with baseline levels (+ 0.115 μg/dL, p <0.01 and + 97 pg/mL, p < 0.001, respectively). However, the only statistically significant difference between groups was an increase in heart rate response at the end of the simulation compared with baseline in the death group (+ 29.2 beats/minute versus + 18.5 beats/minute), p < 0.05. There was no difference on long-term knowledge or skills.

Conclusions: Learners experience stress during high-fidelity simulation; however, there does not appear to be a readily detectable difference or negative response to a simulated patient death compared with simulated survival.

Acknowledgements

We wish to thank David L. Reich, Miguel A. Yaport, Susan Uysal and Brian Iacoviello.

All research was performed at the Icahn School of Medicine at Mount Sinai in New York, NY, USA.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

This investigation was funding internally by departmental sources.

Notes on contributors

Samuel DeMaria, MD, is an Associate Professor of Anesthesiology at the Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Eric R. Silverman, MD, is a Board Certified Anesthesiologist at the Albany Medical Center, Albany, NY, USA.

Kyle A. B. Lapidus, BA, is an Adjunct Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Christian H. Williams, MD, is a Resident in Psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY, USA.

John Spivack, PhD, is an Assistant Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Adam Levine, MD, is a Professor of Anesthesiology at the Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Andrew Goldberg, MD, is an Assistant Professor of Anesthesiology at the Icahn School of Medicine at Mount Sinai, New York, NY, USA.