Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study

Resuscitation. 2009 Aug;80(8):919-24. doi: 10.1016/j.resuscitation.2009.04.027. Epub 2009 May 21.


Background: Simulator training is well established to improve technical and non-technical skills in critical situations. Few data exist about stress experienced during simulator training. This study aims to evaluate performance and stress in intensivists before and after two different simulator-based training approaches.

Methods: Thirty-two intensivists took part in one of six 1-day simulator courses. The courses were randomised to either crew resource management (CRM) training, which contains psychological teaching and simulator scenarios, or classic simulator training (MED). Before and after the course each participant took part in a 10-min test scenario. Before (T1) and after (T2) the scenario, and then again 15 min later (T3), saliva samples were taken, and amylase and cortisol were measured. Non-technical skills were evaluated using the Anaesthetist's Non-Technical Skills (ANTS) assessment tool. Clinical performance of the participants in the test scenarios was rated using a checklist.

Results: Twenty-nine participants completed the course (17-CRM, 12-MED). ANTS scores as well as clinical performances were significantly better in the post-intervention scenario, with no differences between the groups. Both cortisol concentration and amylase activity showed a significant increase during the test scenarios. In the post-intervention scenario, the increase in amylase but not cortisol was significantly smaller. There were no differences between the CRM and MED group.

Conclusions: High fidelity patient simulation produces significant stress. After a 1-day simulator training, stress response measured by salivary alpha-amylase was reduced. Clinical performance and non-technical skills improved after 1 day of simulator training. Neither stress nor performance differed between the groups.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Competence*
  • Education, Medical, Continuing / methods*
  • Female
  • Humans
  • Male
  • Manikins*
  • Pilot Projects
  • Reproducibility of Results
  • Resuscitation / education*
  • Resuscitation / psychology
  • Saliva / enzymology
  • Stress, Psychological / enzymology
  • Stress, Psychological / prevention & control*
  • Teaching / methods
  • alpha-Amylases / metabolism


  • alpha-Amylases