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Withington AR1, Chalmers KJ1, Cavaleri R1, Blackstock FC1
1Western Sydney University, Physiotherapy, Campbelltown, Australia
Background: Simulation based education (SBE) is considered to be an important educational medium that is increasingly being implemented within the scope of physiotherapy education. However, recent evidence suggests that SBE may be a more stressful experience than learning with patients in a clinical environment. Different levels of anxiety and/or stress experienced in different learning situations may influence attainment of learning objectives and performance of clinical skills. However, the impact of anxiety on learning in SBE has not yet been examined. All learning experiences, SBE included, should induce an appropriate amount of anxiety and/or stress to maximize learning and subsequent improvement in practice.
Purpose: The aim of this study was to explore levels of perceived anxiety and physiological stress response during an SBE experience, and their association with performance of the learnt skill.
Methods: A pilot randomized trial was conducted with participants completing their 4th year of a Bachelor of Physiotherapy in Sydney, Australia. Participants were randomized into one of three SBE scenarios of different cognitive intensities that aimed to stimulate low, medium, or high stress, and subsequent anxiety, while learning the skill of airway suctioning on a mannequin (Laerdal MegaCode Kelly). Performance of the skill of airway suctioning was rated before and after the SBE. Anxiety experienced was measured using the State Trait Anxiety Inventory (STAI), heart rate (HR), salivary cortisol, and a visual analogue scale (VAS) of perceived anxiety. Differences in skill performance were compared between groups using an ANOVA, and performance was correlated with anxiety experienced using a Spearman's Rho. Significance was set at p 0.05.
Results: Of a total student cohort of 47, 30 students were recruited, and 27 completed the study. The low stress group performed the skill with greater accuracy than the medium stress group in the 'preparation for suctioning' assessment criterion (out of 5) (mean 4.40(95%CI 3.9-4.9) vs 3.61(95%CI 3.0-4.2) respectively, F(1)=5.395, p=0.033), and the high group in the 'preparation for suctioning' (mean 4.40(95%CI 3.9-4.9) vs 3.56(95%CI 2.8-4.4) respectively, F(1)=4.697, p=0.046) and 'total score' criteria (out of 20) (mean 16.30(95%CI 14.6-18.0) vs. 14.13(95%CI 12.7-15.5), F(1)=4.807, p=0.043). Higher perceived anxiety VAS scores were significantly correlated with poorer performance of the skill of airway suctioning (r=-0.441, p=0.021). There was also a statistically significant, moderate correlation between VAS and HR change (r=0.425, p=0.027).
Conclusion(s): Students experience psychological and physiological stress and anxiety during SBE, and this level of stress correlates with their subsequent performance of the skill learned in the SBE experience. That is, students who experience lower levels of stress during SBE perform better than those who experience medium or high levels of stress.
Implications: The assumption that simulation is a “safe learning environment” may not be accurate. A fully powered randomized controlled trial is required to further explore the relationship between SBE cognitive intensity, anxiety and learning, and methods to adjust cognitive intensity for optimal level of stress to improve efficiency and efficacy of SBE as a pedagogical method.
Keywords: Simulation, Anxiety, Learning
Funding acknowledgements: No specific funding was provided, all funding was contributed by the Western Sydney University research resources
Purpose: The aim of this study was to explore levels of perceived anxiety and physiological stress response during an SBE experience, and their association with performance of the learnt skill.
Methods: A pilot randomized trial was conducted with participants completing their 4th year of a Bachelor of Physiotherapy in Sydney, Australia. Participants were randomized into one of three SBE scenarios of different cognitive intensities that aimed to stimulate low, medium, or high stress, and subsequent anxiety, while learning the skill of airway suctioning on a mannequin (Laerdal MegaCode Kelly). Performance of the skill of airway suctioning was rated before and after the SBE. Anxiety experienced was measured using the State Trait Anxiety Inventory (STAI), heart rate (HR), salivary cortisol, and a visual analogue scale (VAS) of perceived anxiety. Differences in skill performance were compared between groups using an ANOVA, and performance was correlated with anxiety experienced using a Spearman's Rho. Significance was set at p 0.05.
Results: Of a total student cohort of 47, 30 students were recruited, and 27 completed the study. The low stress group performed the skill with greater accuracy than the medium stress group in the 'preparation for suctioning' assessment criterion (out of 5) (mean 4.40(95%CI 3.9-4.9) vs 3.61(95%CI 3.0-4.2) respectively, F(1)=5.395, p=0.033), and the high group in the 'preparation for suctioning' (mean 4.40(95%CI 3.9-4.9) vs 3.56(95%CI 2.8-4.4) respectively, F(1)=4.697, p=0.046) and 'total score' criteria (out of 20) (mean 16.30(95%CI 14.6-18.0) vs. 14.13(95%CI 12.7-15.5), F(1)=4.807, p=0.043). Higher perceived anxiety VAS scores were significantly correlated with poorer performance of the skill of airway suctioning (r=-0.441, p=0.021). There was also a statistically significant, moderate correlation between VAS and HR change (r=0.425, p=0.027).
Conclusion(s): Students experience psychological and physiological stress and anxiety during SBE, and this level of stress correlates with their subsequent performance of the skill learned in the SBE experience. That is, students who experience lower levels of stress during SBE perform better than those who experience medium or high levels of stress.
Implications: The assumption that simulation is a “safe learning environment” may not be accurate. A fully powered randomized controlled trial is required to further explore the relationship between SBE cognitive intensity, anxiety and learning, and methods to adjust cognitive intensity for optimal level of stress to improve efficiency and efficacy of SBE as a pedagogical method.
Keywords: Simulation, Anxiety, Learning
Funding acknowledgements: No specific funding was provided, all funding was contributed by the Western Sydney University research resources
Topic: Education; Education
Ethics approval required: Yes
Institution: Western Sydney University
Ethics committee: Western Sydney University Human Ethics Committee
Ethics number: H12616
All authors, affiliations and abstracts have been published as submitted.
