Oral Themed Presentation


Investigating biometric and psychologic measures of residents via a wearable performance tracking device

Tuesday, May 15
11:00 - 12:30
Location: Jupiter 1&2

Background: : Little is known about the physiology of providers delivering care. Sophisticated monitoring facilitates greater care of our patients while pushing technological innovation. Biometrics is the science of using distinctive, measurable characteristics to label and describe individuals. It provides a new medium capable of exploring one's physiology.1,2 Through quantitative measurement of vitals, we can better understand how providers process stress, make critical decisions and perform complex tasks.

Research Question: : To explore physiologic changes that occur to providers during simulated patient care scenarios. To explore patterns of high performers. To correlate psychologic and physiologic stress patterns. To determine if a cognitive aid can mitigate physiological or psychological stress measures.

Methodology: : Multiple levels of pediatric residents wore the Hexoskin™ biometric smart shirt during a simulation exercise. Heart rate (HR), respiratory rate (RR), heart rate variability (HRV) and cadence were continuously recorded via a 4ms resolution 256 Hz ECG, 8ms resolution breathing sensor, and 64Hz accelerometer. Baseline measures were performed in participants. Participants were scored on performance. Statistical analysis was performed using paired t test on mean HR, max HR, and HRV as measured by SD1/SD2 ratios. Psychologic analysis was completed using the NASA TLX inventory. The Pedistat™ app was used as a cognitive aid (CA) during roughly half of the simulations.

Results: : 22 residents participated, 8 PGY1, 8 PGY2 and 6 PGY3. Participants experienced a rise in mean and max HR (+8.4%, p=.005; +13.1%, p<.001) with PGY3 residents experiencing the greatest rise (+12.9%; +18.9%). HRV decreased (-10.9%, p=.35) for all participants. Performance score did not correlate with changes in vitals (mean HR r(20)=.09, p=.67; max HR r(20)=.01, p=.96; SD1/SD2 r(20)=.001, p=.85). There was positive correlation between self-evaluation and actual performance, r(20)=.79, p<.001. Changes in vitals did not correlate with psychological scores. CA participants had less change in HR (7.2% vs 9.3%, p=.71), max HR (10.2% vs 15.5%, p=.34) and HRV (8.91% vs 12.5%, p=.81) suggesting less stress but not meeting significance. CA participants had higher performance scores (19/26 vs 17/26, p=.12), felt less frustrated (10/20 vs 14/20, p=.07) and believed the scenario was more brief (13/20 vs 15/20, p=.07).

Discussion/Conclusions: : All participants experienced increases in mean HR, max HR, and decreased HRV suggesting the experience was stressful. Despite belief that those who remained calmer would perform better, no correlation existed. Those who used a CA performed higher with less overall changes in their vitals. Psychological correlation with vitals was not present. This study was likely underpowered to determine true significance as many measures approached significance including cognitive appraisals of stress amongst groups. Continued research is needed to determine implications in real and simulated environments.

Robert M. Parker, DO

Pediatric Critical Care Fellow
Nemours/A.I. duPont Hospital for Children
Wilmington, Delaware

Dr. Rob Parker is a pediatric critical care fellow at Nemours/A. I. duPont Hospital for Children in Wilmington, Delaware, USA. He completed medical school at the University of New England College of Osteopathic Medicine and a residency in Pediatrics at Barbara Bush Children’s Hospital at Maine Medical Center in Portland, Maine, USA. His research interests include provider biometrics, and how providers experience stress in both real and simulated scenarios. He has created the International Medical Biometrics Collaborative in an effort to better understand these concepts, and further explore how we can improve patient care while limiting burnout. He will be continuing this research as an attending in Pediatric Critical Care at Baystate Medical Center this fall. This is his third IPSSW having previously presented in 2015 and 2017.


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Nicholas B. Slamon, MD

Clinical Associate Professor of Pediatrics, Pediatric Critical Care Fellowship Program Director
Nemours/A.I. duPont Hospital for Children
Wilmington, Delaware


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Catherine Allan, MD

Associate Program Director - Simulator Program
Boston Children's Hospital
Boston, Massachusetts

Catherine Allan, MD is the Associate Program Director of the Simulator Program and Medical Director of the Cardiac Intensive Care Unit at Boston Children’s Hospital. Over the last 10 years she has helped to develop a robust, interdisciplinary program in ECMO Simulation at Boston Children’s Hospital. Dr. Allan has translated this model to other insitutions on both a National and International level to help these programs build new clinical ECMO Programs. She has published on the use of ECMO Simulation Skills Training and on clinical outcomes following ECMO support in the congenital heart disease population and has presented on ECMO simulation at multiple National and International Meetings.


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