Audition Rotations: Factors Affecting Quality and Program Perception

Background: Emergency Medicine residents are often tasked to make rapid, high stakes decisions with limited information and resources.Understandably, this work can be inherently stressful.While residents get considerable training in patient management, formalized stress management is not a standard curricular requirement.Objectives: We aimed to utilize a simulated case to load cumulative stress in order to assess response and performance under stress.Methods: We created a low fidelity stress inoculation simulation which introduced sequential stressors common to working in a high-acuity emergency department.18 residents were given 10 minutes to complete a series of patient encounters of advancing complexity.Simulated clinical interruptions were introduced, forcing learners to make rapid decisions.Proficiency was measured via completion of 19 critical actions.Resident heart rates (HR) were also monitored throughout the case.Following the simulation, a survey was conducted utilizing the National Aeronautics and Space Administration Task Load Index on a 10 point Likert-type scale.Results: All participants noted prior experience in stressful clinical situations, but only one learner reported any prior stress management training.All participants felt satisfied with the simulated case, would be worthwhile to continue and would be helpful in the future.Post-intervention data noted a direct relationship between HR variation and perceived stress.We observed no correlation between level of stress reported and number of critical actions completed.Realism of the experience was rated 9.37.Ability to recognize cognitive overload was rated 8.84. Conclusion:While we observed no correlation between stress experienced and clinical performance, stress inoculation training resulted in a heightened awareness of cognitive overload.Future curricula should consider integration of simulated stress inoculation to identify and mitigate stressors.