Effect of a behavioral intervention on anxiety and perceived performance of non-technical skills during surgical simulations.
BACKGROUND
Surgical trainees experience intrinsic stress and anxiety during high-acuity clinical situations which can negatively impact performance. Emerging data suggests that education in mindfulness-based coping techniques may improve performance. We evaluated the effects of a stress recovery intervention on novice trainees' perceived level of anxiety during an intentionally stressful simulation.


METHODS
Participants were recruited from surgical intern classes over three consecutive years. All participants completed a simulation intentionally designed to evoke a stress response. Participants then completed a stress recovery intervention or received no additional training. All participants then completed a second novel simulation.


RESULTS
Intervention participants had significantly higher self-reported ability to manage stress (intervention 2.4 to 3.6, p < 0.01; control 2.8 to 3.3, p = 0.06), and stop, think, and observe (intervention 2.5 to 3.7, p < 0.01; control 2.6 to 3.3, p = 0.08) during the second simulation. Both groups also had significantly lower levels of state anxiety during the second simulation as compared to the first (intervention 45.1 vs 59.3, p < 0.01; control 49.3 vs 57.4, p < 0.05). During the second simulation, trainees in both groups reported improvements in perceived abilities to: recognize stress (intervention 2.7 to 4.1, p < 0.01; control 2.9 to 3.6, p < 0.05), communicate with and lead their team (intervention 2.4 to 3.3, p < 0.05; control 2.3 to 3.3, p < 0.01), and to prioritize, plan, and prepare (intervention 2.1 to 3.1, p < 0.05; control 2.1 to 3.0, p < 0.01).


CONCLUSION
Our research shows that a brief intervention was associated with a significant increase in trainee ability to both recognize internal stress and engage in proactive coping mechanisms. This research also shows that while repeated stress-inducing simulations may themselves decrease perceived anxiety levels in novice surgical trainees, training in coping strategies may potentiate this effect.
['Merriman|Lisa|L|', 'Williams-Karnesky|Rebecca L|RL|', 'Pepin|Renee|R|', 'Brooks|Annette|A|', 'Wernly|Jorge|J|', 'Jones|Zoë O|ZO|', 'Russell|John C|JC|']
D000223:Adaptation, Psychological D001007:Anxiety D002983:Clinical Competence D006801:Humans D007396:Internship and Residency D064866:Mindfulness D012649:Self Concept D000066908:Simulation Training D013514:Surgical Procedures, Operative
Anxiety Simulation Stress recovery Mindfulness Surgical education