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Participants’ perception of in situ simulation related anxiety: a multi-disciplinary study

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

Background: : Simulation related anxiety is prevalent amongst all healthcare professions. In excess, this stress can impact learning and performance through cognitive overload1. The Simulated Inter-Professional Team Training (SPRinT) programme runs regular 2-hourly high-fidelity in situ simulation courses to front line inter-professional teams focusing on crisis resource management. Scenarios derive from real events and utilise real medications and equipment. Raising awareness of participant anxiety may help simulation faculty to adapt their approach, ensuring participants’ anxiety is recognised and managed to support learning.

Research Question: : We aimed to identify anxiety levels as perceived by participants of SPRinT courses both pre and post simulation. We also considered the influence of repeat attendance on anxiety as well as profession. We hypothesized that anxiety levels would significantly decrease following completion of a simulation; furthermore that repeat attendance would be reflected in anxiety scores by lowering them.


Methodology: : Prospective pre and post-course anonymous surveys of SPRinT simulation participants were collected from May until October 2017 using the adapted short-form State Trait Anxiety Inventory (STAI)2. STAI utilities level of agreement with emotive descriptors to identify overall anxiety levels consciously perceived by the individual. Anxiety scores were calculated pre and post simulation, with significant anxiety suggested as scores above 39. Demographic data collected included, number of previous SPRinT courses attended and profession. The results were found to be non-normally distributed therefore were analysed in accordance; considering median scores and interquartile range. Descriptive data was measured using frequency (%).

Results: : Over 6 SPRinT courses, 43 questionnaires were collected. Demographic data showed that the majority of SPRinT course participants were from the nursing and medical professions, working across the paediatric intensive care unit and ward. Among the participants, there were varying numbers of previous courses attended. When comparing pre and post simulation median anxiety scores, results showed a significant decrease from 41.7 to 33.3, as hypothesized. It was also highlighted however that a small number of individuals experienced significant anxiety levels even post course. When considering the influence of repeat course attendance of anxiety scores, it was not shown to have any significance either pre or post simulation. When measuring anxiety levels against profession, doctors/nurses, it was again found to have no significance.


Discussion/Conclusions: : Although results showed a clear reduction in perceived anxiety levels following simulation, it is important to consider that some participants do experience significant anxiety therefore may need additional support. More data needs to be collected in order to further analyse anxiety levels and consider whether a cut off for significant anxiety is reflective of our population and within healthcare simulation. Additional data and analysis may also show a significance of repeat attendance as originally hypothesized. Salivary cortisol could be collected and measured to provide physiological markers of anxiety alongside perceived levels. In order to look at how to support participants, retrospective interviews would provide information to guide faculty in this. Furthermore this would offer insight into maintaining a psychologically safe environment within healthcare simulation.





Sami Collins, RSCN

Deputy Sister, Deputy SPRinT Nurse
Royal Brompton & Harefield NHS Foundation Trust

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Cecilia Korb, MD, MSc

PICU Clinical Fellow, SPRinT Faculty
Royal Brompton & Harefield NHS Foundation Trust

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Send Email for Lydia Lofton

Helena Sampaio, RSCN

PICU Senior Staff Nurse & Advanced Nurse Practitioner Trainee, SPRinT Faculty
Royal Brompton & Harefield NHS Foundation Trust

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Craig Knott, MBBS, BA Hons (Oxon), MRCPCH

Clinical Fellow - PICU & SPRinT
Royal Brompton & Harefield NHS Foundation Trust

Dr Knott graduated from his medical degree at Wadham College, University of Oxford, and University College London in 2005. He subsequently completed his training in General Paediatrics in London, England in 2015. He maintained an interest in Intensive Care Medicine during this training, and is now undertaking further training in intensive care including having undertaken a Fellowship at the Hospital for Sick Children in Toronto in 2016.
Dr. Knott joined the Royal Brompton's SPRinT simulation team in 2017, and has undertaken both the SPRinT Introductory Facilitators course and the Advanced Facilitators Course. Dr. Knott is developing his research interests in Simulation with the team including use of the innovative open chest model, team performance improvement through in-situ simulation, and quality CPR.

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Mary Lane, MB ChB, FRCA, MA Med Ed (ML)

Consultant Paediatric and Congenital Cardiac Anaesthetist, Director SPRinT Programme
Royal Brompton & Harefield NHS Foundation Trust

Dr Mary Lane MBChB, FRCA, MA Med Ed
Consultant Paediatric & Congenital Cardiac Anaesthetist, Royal Brompton Hospital
Director SPRinT Programme

Dr Lane joined the SPRinT programme in 2009, developing and leading the expansion of the Mobile
SPRinT programme. She served as associate director in 2011 before becoming a Director in 2012. As
a director, she has helped lead the development of SPRinT into an internationally recognised and
national award winning programme.
Mary has a keen interest in medical education and human factor training, in particular using simulation with a focus
on adult learning techniques to enhance and consolidate learning. She is a graduate of the Harvard/Children’s Hospital
Boston Simulation Instructor Course (2010/11) and London Deanery Simulation Facilitation Training (2009). In 2015
she completed her Masters in Medical Education, awarded with distinction from the University of Bedfordshire.
Dr Lane is Chair of the Education Committee of the Association of Paediatric Anaesthetists since 2013 and a
council member of the Patient Safety Section of the Royal Society of Medicine since 2016. As Chair of Royal
Brompton’s Experts in Simulation Committee since 2015, she has overseen the implementation of several quality
improvement initiatives to promote safe in-situ simulation simulation.

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Margarita Burmester, MRCP FRCPCH FFICM MAcadMEd

Lead Consultant Paediatric Intensive Care Unit, Founder & Director SPRinT Programme
Royal Brompton & Harefield NHS Foundation Trust

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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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