O3278: Self-regulating Physiologic Response and Intensity in Navigating Time-sensitive Situations

Background: Neonatal resuscitation is a high-stress, time-pressured task that requires intense focus and decision-making under pressure. This study employed methods of performance enhancement technology utilized in other high-risk industries and competitive athletics to healthcare professionals responsible for resuscitating neonates at the time of birth. We hypothesized that after training, subjects will be better able to regulate their stress response and will improve overall skill performance. The technology and methods utilized in this study have the potential to demonstrate novel, important knowledge for medical simulation and the events these simulations replicate.

Methods: 10 healthcare professionals tasked with neonatal resuscitation completed a 2-phase protocol of neonatal resuscitation simulations and a training module addressing stress regulation. The first 5 simulations increased in time-sensitivity, and the next 5 simulations increased in level of audio distraction. Audio distraction level was measured utilizing the National Institute for Occupational Safety & Health (NIOSH) Sound Level Meter App, a sound level calibrator, and an MicWⓇ omnidirectional measurement microphone. The subject wore a heart rate monitor (PolarⓇ chest strap), measuring heart rate and heart rate variability (HRV), a measure of sympathetic and parasympathetic response through analyzing variation in the beat-to-beat interval. Performance was analyzed using post hoc scoring of video footage that compiled views of the subject, the HRV reading, the simulation manikin’s vitals, and the room sound level (Figure 1).

Results: Analysis of performance differences between phase A and phase B demonstrated that after training in physiologic self-regulation, subjects exhibited higher HRV and lower sympathetic nervous system (SNS) response response during the simulated neonatal resuscitation scenarios. The overall pre-training median HRV was a decrease of -2.09% relative to the subject’s control, representing increased stress response, while the post-training median HRV demonstrated an improvement, with a 2.59% increase relative to the subject’s control, although this result was not statistically significant (p=0.226). Some individual trials, however, such as trial 2.3 —the 3 audio distractor condition, demonstrated statistically significant improvements (p=0.016). This result suggests that significant self-regulation of stress response may be possible for only moderate to high (not very high) levels of stressors.

Conclusion: These results demonstrate that healthcare professionals possess the ability to learn to control their physiological response to simulated clinical scenarios characterized by time pressure and multiple auditory distractors. This finding could represent a shift in how healthcare professionals involved in neonatal resuscitation train to improve their abilities. The use of HRV in this simulation study provides unique insight into the stress level of the simulation participant, allowing for evaluation of stress response, an important factor in physician performance. Precise measurement of audio distractors contributes to research on the impact of sound in the physician environment, potentially driving change in the best clinical working environments.