Timing of Coping Instruction Presentation for Real-time Acute Stress Management: Potential Implications for Improved Surgical Performance

Stress in surgical educational environments: a systematic review

BACKGROUND

The effects of stress on surgical residents and how stress management training can prepare residents to effectively manage stressful situations is a relevant topic. This systematic review aimed to analyze the literature regarding (1) the current stress monitoring tools and their use in surgical environments, (2) the current methods in surgical stress management training, and (3) how stress affects surgical performance.

METHODS

A search strategy was implemented to retrieve relevant articles from Web of Science, Scopus, and PubMed. The 787 initially retrieved articles were reviewed for further evaluation according to the inclusion/exclusion criteria (Prospero registration number CRD42021252682).

RESULTS

Sixty-one articles were included in the review. The stress monitoring methods found in the articles showed heart rate analysis as the most used monitoring tool for physiological parameters while the STAI-6 scale was preferred for psychological parameters. The stress management methods found in the articles were mental-, simulation- and feedback-based training, with the mental-based training showing clear positive effects on participants. The studies analyzing the effects of stress on surgical performance showed both negative and positive effects on technical and non-technical performance.

CONCLUSIONS

The impact of stress responses presents an important factor in surgical environments, affecting residents' training and performance. This study identified the main methods used for monitoring stress parameters in surgical educational environments. The applied surgical stress management training methods were diverse and demonstrated positive effects on surgeons' stress levels and performance. There were negative and positive effects of stress on surgical performance, although a collective pattern on their effects was not clear.

Results of exploratory investigation into adherence to auditory coping instructions during an acutely stressful task

Healthcare providers often perform under significant stress, during which their performance must be optimal, but is known to suffer. Stress management interventions in this context can provide cognitive support to rescue performance. This exploratory study sought to evaluate the effect of stress intervention components on stress and performance while clinicians engaged in two versions of a computer-based task, differing in overall level of demand: one high-stress and one low-stress. Participants (N = 45) were assigned to one of five groups (N = 9 per group), where they each completed both versions of the task, under different conditions of cognitive support. Group 1 received no intervention; Group 2 received biofeedback; and Group 3 received biofeedback and explicit coping instructions. Group 4 received emotional intelligence training, and Group 5 received emotional intelligence training and biofeedback. We hypothesized that Group 3 participants would present the lowest self-reported and physiological measures of stress, and the highest performance. Results reveal that the high-stress task induced significantly higher self-reported and physiological stress/anxiety, and lower task performance. No significant main effects of experimental condition or interaction effects were detected, indicating that intervention components had minimal effect on stress and performance. However, ultra-short term physiological analysis, analyzing <5 min of HRV data, revealed significantly decreased stress (SDNN, the standard deviation of normal-to-normal peaks) following auditory coping instructions. Exploratory study results suggest that although cognitive intervention components had minimal effect on stress and performance, physiological stress may be significantly reduced immediately following adherence to a coping instruction intervention. Future work is needed.Lay summaryThis exploratory study evaluated the potential benefit of providing healthcare practitioners with various stress management components during an acutely stressful task. Our results support the positive effect of following behavioral coping instructions on immediate physiological measures of stress.