Impact of stress on the efficacy of management of life-threatening conditions provided by anesthesiology residents and medical students

Background and Goal of Study: 
This is an innovative simulation-based study focused on stress level evaluation in medical providers. The aim of the study was to measure the relation between stress and effectiveness of management in life-threatening conditions. The study group comprises young anesthesiology residents (AR) and medical students (MS) – medical providers particularly prone to elevated stress levels. We expected that increased stress level may cause increased error frequency in delivering appropriate treatment and decision making time.
Materials and Methods: 
26 subjects from Medical University of Warsaw were examined: 10 AR and 16 MS. The subjects were involved in two independent simulation stations – airway obstruction in unconscious patient and in-hospital cardiac arrest. All subjects who had taken part in the study were qualified in advance life support. We measured time needed to solve the problem and errors made in algorithms. The stress level was measured by galvanic skin response and blinking rate using eye-tracking technology. The gaze duration of fixation was evaluated (eye-tracking technology). T-student test was used for statistical analysis.  
Results and Discussion: 
Group with higher level of stress (higher galvanic response, higher blinking rate) had increased error frequency in both simulations. AR presented higher levels of stress in both simulations than MS. The time needed to establish airway patency was shorter in MS group (mean: 20,05 s in MS vs 35,06 s in AR, p=0.01), probably because AR needed more time for checking for safety, general assessment and breathing evaluation. There was no significant difference between groups in the time needed to recognize and defibrillate ventricular fibrillation, although the interruptions in cardiopulmonary resuscitation were longer in MS group (mean: 19,3 s in MS vs 10,7 s in AR p=0,04). AR had focused their eyesight on the most important information, whereas MS had more often but shorter gazes.
Conclusion(s): 
Higher stress levels could lead to higher errors rate in simulated life-threatening situations. Unexpectedly medical students were less stressed during simulation of than young anesthesiology residents. 
This is a pilot study, further surveys on bigger group of subjects are planned to establish the association of stress level and error frequency. 
Acknowledgements (optional): 
The authors would like to thank Institute of Sensory Analysis for making galvanic skin response method and eye-tracking available.