What is the clinical evidence from this study?

Study design: Observational. Population: Physician performance under stress during airway management (n=25). Intervention: Heart rate variability (HRV). Primary outcome: Association between pre-task HRV (Log RMSSD) and general performance score (adjusted r = -0.85, 95% CI -0.97, -0.46, p=<0.01).

What does this research mean for the field?

Heart rate variability is associated with physician performance during simulated airway management, with lower pre-task heart rate variability and higher baseline resting heart rate variability correlating with superior performance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To examine the relationship between heart rate variability and physician clinical performance during high-fidelity airway management simulations across differing physiological measurement time points.

September 17, 2026European Archives of Oto-Rhino-LaryngologyOpen Access

Lower pre-simulation and higher baseline HRV are strongly linked to better airway management performance.

Q: What are the key findings of this study?

Lower pre-simulation heart rate variability was associated with better performance (adjusted r = -0.85), whereas higher baseline heart rate variability was associated with better performance (adjusted r = 0.73) during airway management simulations.

Q: What does this research mean for the field?

Heart rate variability is associated with physician performance during simulated airway management, with lower pre-task heart rate variability and higher baseline resting heart rate variability correlating with superior performance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the relationship between heart rate variability and physician clinical performance during high-fidelity airway management simulations across differing physiological measurement time points.

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Why the study?

Is heart rate variability associated with physician performance during airway management simulations?

Population

25 physicians participating in two high-fidelity airway simulation courses, mean age 35.9 ± 4.7 years, 17…

Design

Cross-sectional, Blinded supervisors rated performance

Key result

Lower pre-simulation heart rate variability was associated with better performance (adjusted r = -0.85), whereas higher baseline heart rate variability was associated with better performance (adjusted r = 0.73) during airway management simulations.

Authors

NCNarin N. Carmel-Neiderman YKYosef Kula RLRachel Lebovits

Discussion

Member takes

Overview

HRV timing affects performance associations in airway simulations; leaves open its utility for clinician assessment or training.

Key Points

To examine the relationship between heart rate variability and physician clinical performance during high-fidelity airway management simulations across differing physiological measurement time points.
Enrolled 25 physicians (17 males, 8 females; mean age 35.9 ± 4.7 years) comprising otolaryngologists and anesthesiologists participating in high-fidelity airway simulation courses.
Measured heart rate variability via a finger-mounted optical sensor (recorded as RMSSD) either immediately before simulation (pre-task cohort, n = 11) or several days prior (baseline cohort, n = 14).
Evaluated performance using standardized 10-point Likert scales scored by blinded supervisors, calculating unadjusted and adjusted partial Pearson correlations controlling for age, clinical experience, and self-reported stress.
In the pre-task cohort (n = 11), lower heart rate variability correlated with higher performance scores (unadjusted log RMSSD r = -0.73, 95% CI [-0.927, -0.244]; adjusted r = -0.85, 95% CI [-0.97, -0.46]).
In the baseline cohort (n = 14), higher resting heart rate variability correlated with higher performance scores (unadjusted log RMSSD r = 0.53, 95% CI [0.055, 0.845]; adjusted r = 0.73, 95% CI [0.198, 0.933]).
Self-reported stress exhibited no statistically meaningful association with either heart rate variability measurements or simulation performance ratings.

Study Design

Type

Observational (n=25)

Blinding

Supervisors blinded to HRV measurements

Multicenter

Structured PICO

Is heart rate variability associated with physician performance during airway management simulations?

Population

25 otolaryngologists and anesthesiologists (mean age 35.9 years, 32% female) participating in high-fidelity airway management simulations.

Exposure

Heart-rate variability (HRV) measurement via finger-mounted optical sensor (expressed as RMSSD) recorded either immediately before simulation (pre-task) or several days prior (baseline).

Outcome

Physician performance rated by blinded supervisors on standardized 10-point Likert scales.surrogate

Main Result

Effect estimate: adjusted r = -0.85 (95% CI -0.97, -0.46)

p-value: p=<0.01

Heart rate variability is associated with physician performance during simulated airway management, though the direction of association depends on the timing of HRV measurement.

Limitations

Small sample size (n = 25, split into two cohorts)
Between-cohort design prevents separation of measurement timing effects from differences in clinical experience and cohort characteristics
HRV was derived from short recordings using a finger-based photoplethysmography sensor
Simulation scenarios differed between cohorts and were not formally validated for equivalence
Inter-rater reliability could not be formally assessed as individual rater scores were not retained after averaging
Small sample size
Wide confidence intervals

Cite This Study

Carmel-Neiderman et al. (2026) conducted an observational in Physician performance under stress during airway management (n=25). Heart rate variability (HRV) was evaluated on Association between pre-task HRV (Log RMSSD) and general performance score (adjusted r = -0.85, 95% CI -0.97, -0.46, p=<0.01). Lower pre-simulation heart rate variability was associated with better performance (adjusted r = -0.85), whereas higher baseline heart rate variability was associated with better performance (adjusted r = 0.73) during airway management simulations.

synapsesocial.com/papers/6aabb8135f706d05830e7909 https://doi.org/10.1007/s00405-026-10603-3

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September 17, 2026European Archives of Oto-Rhino-LaryngologyOpen Access

Lower pre-simulation and higher baseline HRV are strongly linked to better airway management performance.

View Full Paper

Ask AI

Bookmark

Why the study?

Is heart rate variability associated with physician performance during airway management simulations?

Population

25 physicians participating in two high-fidelity airway simulation courses, mean age 35.9 ± 4.7 years, 17…

Design

Cross-sectional, Blinded supervisors rated performance

Key result

Authors

NCNarin N. Carmel-Neiderman YKYosef Kula RLRachel Lebovits

Discussion

Member takes

Overview

HRV timing affects performance associations in airway simulations; leaves open its utility for clinician assessment or training.

Key Points

To examine the relationship between heart rate variability and physician clinical performance during high-fidelity airway management simulations across differing physiological measurement time points.
Enrolled 25 physicians (17 males, 8 females; mean age 35.9 ± 4.7 years) comprising otolaryngologists and anesthesiologists participating in high-fidelity airway simulation courses.
Measured heart rate variability via a finger-mounted optical sensor (recorded as RMSSD) either immediately before simulation (pre-task cohort, n = 11) or several days prior (baseline cohort, n = 14).
Evaluated performance using standardized 10-point Likert scales scored by blinded supervisors, calculating unadjusted and adjusted partial Pearson correlations controlling for age, clinical experience, and self-reported stress.
In the pre-task cohort (n = 11), lower heart rate variability correlated with higher performance scores (unadjusted log RMSSD r = -0.73, 95% CI [-0.927, -0.244]; adjusted r = -0.85, 95% CI [-0.97, -0.46]).
In the baseline cohort (n = 14), higher resting heart rate variability correlated with higher performance scores (unadjusted log RMSSD r = 0.53, 95% CI [0.055, 0.845]; adjusted r = 0.73, 95% CI [0.198, 0.933]).
Self-reported stress exhibited no statistically meaningful association with either heart rate variability measurements or simulation performance ratings.

Study Design

Type

Observational (n=25)

Blinding

Supervisors blinded to HRV measurements

Multicenter

Structured PICO

Is heart rate variability associated with physician performance during airway management simulations?

Population

25 otolaryngologists and anesthesiologists (mean age 35.9 years, 32% female) participating in high-fidelity airway management simulations.

Exposure

Heart-rate variability (HRV) measurement via finger-mounted optical sensor (expressed as RMSSD) recorded either immediately before simulation (pre-task) or several days prior (baseline).

Outcome

Physician performance rated by blinded supervisors on standardized 10-point Likert scales.surrogate

Main Result

Effect estimate: adjusted r = -0.85 (95% CI -0.97, -0.46)

p-value: p=<0.01

Heart rate variability is associated with physician performance during simulated airway management, though the direction of association depends on the timing of HRV measurement.

Limitations

Small sample size (n = 25, split into two cohorts)
Between-cohort design prevents separation of measurement timing effects from differences in clinical experience and cohort characteristics
HRV was derived from short recordings using a finger-based photoplethysmography sensor
Simulation scenarios differed between cohorts and were not formally validated for equivalence
Inter-rater reliability could not be formally assessed as individual rater scores were not retained after averaging
Small sample size
Wide confidence intervals

Cite This Study

synapsesocial.com/papers/6aabb8135f706d05830e7909 https://doi.org/10.1007/s00405-026-10603-3

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