Physiological and self-assessed psychological stress induced by a high fidelity simulation course among third year anesthesia and critical care residents: An observational study.
Identifieur interne : 000B20 ( Main/Corpus ); précédent : 000B19; suivant : 000B21Physiological and self-assessed psychological stress induced by a high fidelity simulation course among third year anesthesia and critical care residents: An observational study.
Auteurs : Thomas Geeraerts ; Philippe Roulleau ; Gaëlle Cheisson ; Fouad Marhar ; Karl Aidan ; Karim Lallali ; Morgan Leguen ; David Schnell ; Fabien Trabold ; Philippe Fauquet-Alekhine ; Jacques Duranteau ; Dan BenhamouSource :
- Anaesthesia, critical care & pain medicine [ 2352-5568 ] ; 2017.
English descriptors
- KwdEn :
- Adult (MeSH), Amylases (analysis), Amylases (metabolism), Anesthesiology (education), Clinical Competence (MeSH), Critical Care (MeSH), Female (MeSH), High Fidelity Simulation Training (methods), Humans (MeSH), Internship and Residency (statistics & numerical data), Male (MeSH), Saliva (enzymology), Self-Assessment (MeSH), Stress, Physiological (MeSH), Stress, Psychological (etiology), Stress, Psychological (psychology).
- MESH :
- chemical , analysis : Amylases.
- chemical , metabolism : Amylases.
- education : Anesthesiology.
- enzymology : Saliva.
- etiology : Stress, Psychological.
- methods : High Fidelity Simulation Training.
- psychology : Stress, Psychological.
- statistics & numerical data : Internship and Residency.
- Adult, Clinical Competence, Critical Care, Female, Humans, Male, Self-Assessment, Stress, Physiological.
Abstract
INTRODUCTION
The use of high fidelity simulators in Medicine can improve knowledge, behaviour and practice but may be associated with significant stress. Our objective was to measure physiological and psychological self-assessed intensity of stress before and after a planned simulation training session among third year anaesthesia and critical care residents.
METHODS
A convenience sample of 27 residents participating in a simulation training course was studied. Stress was evaluated by self-assessment using a numerical scale and by salivary amylase concentration before and after the session. Technical and non-technical (using the Aberdeen Anaesthetists' Non Technical Skills scale) performances were assessed through videotapes analysis.
RESULTS
The median stress score was 5 (2-8) before and 7 (2-10) after the simulation session (P<0.001). For 48% of residents studied, the stress score after the session was superior or equal to 8/10. Salivary amylase concentration increased significantly after the session compared to before the session, respectively (1,250,440±1,216,667 vs. 727,260±603,787IU/L, P=0.008). There was no significant correlation between stress parameters and non-technical performance.
DISCUSSION
Simulation-induced stress, as measured by self-assessment and biological parameter, is high before the session and increases significantly during the course. While this stress did not seem to impact performance negatively, it should be taken into account.
DOI: 10.1016/j.accpm.2017.06.002
PubMed: 28648752
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Electronic address: geeraerts.t@chu-toulouse.fr.</nlm:affiliation></affiliation></author><author><name sortKey="Roulleau, Philippe" sort="Roulleau, Philippe" uniqKey="Roulleau P" first="Philippe" last="Roulleau">Philippe Roulleau</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Cheisson, Gaelle" sort="Cheisson, Gaelle" uniqKey="Cheisson G" first="Gaëlle" last="Cheisson">Gaëlle Cheisson</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Marhar, Fouad" sort="Marhar, Fouad" uniqKey="Marhar F" first="Fouad" last="Marhar">Fouad Marhar</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, Institut Toulousain de Simulation en Santé (ItSims), CHU de Toulouse, Université Paul-Sabatier, 31059 Toulouse, France.</nlm:affiliation></affiliation></author><author><name sortKey="Aidan, Karl" sort="Aidan, Karl" uniqKey="Aidan K" first="Karl" last="Aidan">Karl Aidan</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Lallali, Karim" sort="Lallali, Karim" uniqKey="Lallali K" first="Karim" last="Lallali">Karim Lallali</name><affiliation><nlm:affiliation>Service de biochimie, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Leguen, Morgan" sort="Leguen, Morgan" uniqKey="Leguen M" first="Morgan" last="Leguen">Morgan Leguen</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Foch, université Paris Île-de-France Ouest, 92150 Suresnes, France.</nlm:affiliation></affiliation></author><author><name sortKey="Schnell, David" sort="Schnell, David" uniqKey="Schnell D" first="David" last="Schnell">David Schnell</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Trabold, Fabien" sort="Trabold, Fabien" uniqKey="Trabold F" first="Fabien" last="Trabold">Fabien Trabold</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Fauquet Alekhine, Philippe" sort="Fauquet Alekhine, Philippe" uniqKey="Fauquet Alekhine P" first="Philippe" last="Fauquet-Alekhine">Philippe Fauquet-Alekhine</name><affiliation><nlm:affiliation>Laboratoire de Recherche pour les Sciences de l'Énergie, 86200 Montagret, France.</nlm:affiliation></affiliation></author><author><name sortKey="Duranteau, Jacques" sort="Duranteau, Jacques" uniqKey="Duranteau J" first="Jacques" last="Duranteau">Jacques Duranteau</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Benhamou, Dan" sort="Benhamou, Dan" uniqKey="Benhamou D" first="Dan" last="Benhamou">Dan Benhamou</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:28648752</idno><idno type="pmid">28648752</idno><idno type="doi">10.1016/j.accpm.2017.06.002</idno><idno type="wicri:Area/Main/Corpus">000B20</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000B20</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Physiological and self-assessed psychological stress induced by a high fidelity simulation course among third year anesthesia and critical care residents: An observational study.</title><author><name sortKey="Geeraerts, Thomas" sort="Geeraerts, Thomas" uniqKey="Geeraerts T" first="Thomas" last="Geeraerts">Thomas Geeraerts</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, Institut Toulousain de Simulation en Santé (ItSims), CHU de Toulouse, Université Paul-Sabatier, 31059 Toulouse, France. Electronic address: geeraerts.t@chu-toulouse.fr.</nlm:affiliation></affiliation></author><author><name sortKey="Roulleau, Philippe" sort="Roulleau, Philippe" uniqKey="Roulleau P" first="Philippe" last="Roulleau">Philippe Roulleau</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Cheisson, Gaelle" sort="Cheisson, Gaelle" uniqKey="Cheisson G" first="Gaëlle" last="Cheisson">Gaëlle Cheisson</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Marhar, Fouad" sort="Marhar, Fouad" uniqKey="Marhar F" first="Fouad" last="Marhar">Fouad Marhar</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, Institut Toulousain de Simulation en Santé (ItSims), CHU de Toulouse, Université Paul-Sabatier, 31059 Toulouse, France.</nlm:affiliation></affiliation></author><author><name sortKey="Aidan, Karl" sort="Aidan, Karl" uniqKey="Aidan K" first="Karl" last="Aidan">Karl Aidan</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Lallali, Karim" sort="Lallali, Karim" uniqKey="Lallali K" first="Karim" last="Lallali">Karim Lallali</name><affiliation><nlm:affiliation>Service de biochimie, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Leguen, Morgan" sort="Leguen, Morgan" uniqKey="Leguen M" first="Morgan" last="Leguen">Morgan Leguen</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Foch, université Paris Île-de-France Ouest, 92150 Suresnes, France.</nlm:affiliation></affiliation></author><author><name sortKey="Schnell, David" sort="Schnell, David" uniqKey="Schnell D" first="David" last="Schnell">David Schnell</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Trabold, Fabien" sort="Trabold, Fabien" uniqKey="Trabold F" first="Fabien" last="Trabold">Fabien Trabold</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Fauquet Alekhine, Philippe" sort="Fauquet Alekhine, Philippe" uniqKey="Fauquet Alekhine P" first="Philippe" last="Fauquet-Alekhine">Philippe Fauquet-Alekhine</name><affiliation><nlm:affiliation>Laboratoire de Recherche pour les Sciences de l'Énergie, 86200 Montagret, France.</nlm:affiliation></affiliation></author><author><name sortKey="Duranteau, Jacques" sort="Duranteau, Jacques" uniqKey="Duranteau J" first="Jacques" last="Duranteau">Jacques Duranteau</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author><author><name sortKey="Benhamou, Dan" sort="Benhamou, Dan" uniqKey="Benhamou D" first="Dan" last="Benhamou">Dan Benhamou</name><affiliation><nlm:affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Anaesthesia, critical care & pain medicine</title><idno type="eISSN">2352-5568</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Amylases (analysis)</term><term>Amylases (metabolism)</term><term>Anesthesiology (education)</term><term>Clinical Competence (MeSH)</term><term>Critical Care (MeSH)</term><term>Female (MeSH)</term><term>High Fidelity Simulation Training (methods)</term><term>Humans (MeSH)</term><term>Internship and Residency (statistics & numerical data)</term><term>Male (MeSH)</term><term>Saliva (enzymology)</term><term>Self-Assessment (MeSH)</term><term>Stress, Physiological (MeSH)</term><term>Stress, Psychological (etiology)</term><term>Stress, Psychological (psychology)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="analysis" xml:lang="en"><term>Amylases</term></keywords><keywords scheme="MESH" type="chemical" qualifier="metabolism" xml:lang="en"><term>Amylases</term></keywords><keywords scheme="MESH" qualifier="education" xml:lang="en"><term>Anesthesiology</term></keywords><keywords scheme="MESH" qualifier="enzymology" xml:lang="en"><term>Saliva</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Stress, Psychological</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>High Fidelity Simulation Training</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Stress, Psychological</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Internship and Residency</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Clinical Competence</term><term>Critical Care</term><term>Female</term><term>Humans</term><term>Male</term><term>Self-Assessment</term><term>Stress, Physiological</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>INTRODUCTION</b></p><p>The use of high fidelity simulators in Medicine can improve knowledge, behaviour and practice but may be associated with significant stress. Our objective was to measure physiological and psychological self-assessed intensity of stress before and after a planned simulation training session among third year anaesthesia and critical care residents.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>A convenience sample of 27 residents participating in a simulation training course was studied. Stress was evaluated by self-assessment using a numerical scale and by salivary amylase concentration before and after the session. Technical and non-technical (using the Aberdeen Anaesthetists' Non Technical Skills scale) performances were assessed through videotapes analysis.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>The median stress score was 5 (2-8) before and 7 (2-10) after the simulation session (P<0.001). For 48% of residents studied, the stress score after the session was superior or equal to 8/10. Salivary amylase concentration increased significantly after the session compared to before the session, respectively (1,250,440±1,216,667 vs. 727,260±603,787IU/L, P=0.008). There was no significant correlation between stress parameters and non-technical performance.</p></div><div type="abstract" xml:lang="en"><p><b>DISCUSSION</b></p><p>Simulation-induced stress, as measured by self-assessment and biological parameter, is high before the session and increases significantly during the course. While this stress did not seem to impact performance negatively, it should be taken into account.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">28648752</PMID><DateCompleted><Year>2018</Year><Month>07</Month><Day>27</Day></DateCompleted><DateRevised><Year>2018</Year><Month>07</Month><Day>27</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2352-5568</ISSN><JournalIssue CitedMedium="Internet"><Volume>36</Volume><Issue>6</Issue><PubDate><Year>2017</Year><Month>Dec</Month></PubDate></JournalIssue><Title>Anaesthesia, critical care & pain medicine</Title><ISOAbbreviation>Anaesth Crit Care Pain Med</ISOAbbreviation></Journal><ArticleTitle>Physiological and self-assessed psychological stress induced by a high fidelity simulation course among third year anesthesia and critical care residents: An observational study.</ArticleTitle><Pagination><MedlinePgn>403-406</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S2352-5568(16)30112-6</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.accpm.2017.06.002</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">The use of high fidelity simulators in Medicine can improve knowledge, behaviour and practice but may be associated with significant stress. Our objective was to measure physiological and psychological self-assessed intensity of stress before and after a planned simulation training session among third year anaesthesia and critical care residents.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">A convenience sample of 27 residents participating in a simulation training course was studied. Stress was evaluated by self-assessment using a numerical scale and by salivary amylase concentration before and after the session. Technical and non-technical (using the Aberdeen Anaesthetists' Non Technical Skills scale) performances were assessed through videotapes analysis.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">The median stress score was 5 (2-8) before and 7 (2-10) after the simulation session (P<0.001). For 48% of residents studied, the stress score after the session was superior or equal to 8/10. Salivary amylase concentration increased significantly after the session compared to before the session, respectively (1,250,440±1,216,667 vs. 727,260±603,787IU/L, P=0.008). There was no significant correlation between stress parameters and non-technical performance.</AbstractText><AbstractText Label="DISCUSSION" NlmCategory="CONCLUSIONS">Simulation-induced stress, as measured by self-assessment and biological parameter, is high before the session and increases significantly during the course. While this stress did not seem to impact performance negatively, it should be taken into account.</AbstractText><CopyrightInformation>Published by Elsevier Masson SAS.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Geeraerts</LastName><ForeName>Thomas</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, Institut Toulousain de Simulation en Santé (ItSims), CHU de Toulouse, Université Paul-Sabatier, 31059 Toulouse, France. Electronic address: geeraerts.t@chu-toulouse.fr.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Roulleau</LastName><ForeName>Philippe</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cheisson</LastName><ForeName>Gaëlle</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Marhar</LastName><ForeName>Fouad</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, Institut Toulousain de Simulation en Santé (ItSims), CHU de Toulouse, Université Paul-Sabatier, 31059 Toulouse, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Aidan</LastName><ForeName>Karl</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lallali</LastName><ForeName>Karim</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Service de biochimie, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Leguen</LastName><ForeName>Morgan</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, hôpital Foch, université Paris Île-de-France Ouest, 92150 Suresnes, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schnell</LastName><ForeName>David</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Trabold</LastName><ForeName>Fabien</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fauquet-Alekhine</LastName><ForeName>Philippe</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Laboratoire de Recherche pour les Sciences de l'Énergie, 86200 Montagret, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Duranteau</LastName><ForeName>Jacques</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Benhamou</LastName><ForeName>Dan</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Département d'anesthésie-réanimation, hôpital Bicêtre, université Paris-Sud, AP-HP, 94275 Le Kremlin-Bicêtre, France.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>06</Month><Day>23</Day></ArticleDate></Article><MedlineJournalInfo><Country>France</Country><MedlineTA>Anaesth Crit Care Pain Med</MedlineTA><NlmUniqueID>101652401</NlmUniqueID><ISSNLinking>2352-5568</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>EC 3.2.1.-</RegistryNumber><NameOfSubstance UI="D000681">Amylases</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000681" MajorTopicYN="N">Amylases</DescriptorName><QualifierName UI="Q000032" MajorTopicYN="N">analysis</QualifierName><QualifierName UI="Q000378" MajorTopicYN="N">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000776" MajorTopicYN="N">Anesthesiology</DescriptorName><QualifierName UI="Q000193" MajorTopicYN="Y">education</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002983" MajorTopicYN="N">Clinical Competence</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003422" MajorTopicYN="Y">Critical Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000070856" MajorTopicYN="N">High Fidelity Simulation Training</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007396" MajorTopicYN="N">Internship and Residency</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012463" MajorTopicYN="N">Saliva</DescriptorName><QualifierName UI="Q000201" MajorTopicYN="N">enzymology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012647" MajorTopicYN="Y">Self-Assessment</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013312" MajorTopicYN="Y">Stress, Physiological</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013315" MajorTopicYN="N">Stress, Psychological</DescriptorName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Anaesthesia</Keyword><Keyword MajorTopicYN="N">Crisis management</Keyword><Keyword MajorTopicYN="N">Performance</Keyword><Keyword MajorTopicYN="N">Simulation</Keyword><Keyword MajorTopicYN="N">Stress</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year><Month>08</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>06</Month><Day>06</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>06</Month><Day>10</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>6</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a AutomedicationFrancoV1
| This area was generated with Dilib version V0.6.38. |  |