Oral Themed Presentation
Background: : Studies of acoustic analysis suggest that, compared to a personal baseline, mean
fundamental frequency and formant frequencies of voice vary within an individual’s
communication during stressful events. We will review this hypothesis within the
pediatric otolaryngology (ORL) simulation environment to assess whether this
technique may be used as a tool to assess participants’ stress response and cognitive
Research Question: : Is there a change in fundamental frequency and formant frequency of voice during stressful events in simulation.
Methodology: : ORL simulation scenarios were performed to teach the participants teamwork and refine
clinical skills. Each was performed in an actual operating room (OR) environment (in
situ) with a multidisciplinary team consisting of ORL surgeons, OR nurses and
anesthesiologist. A total of twenty simulations were completed. Ten were led by an ORL
attending and ten were led by an ORL fellow. Each scenario was videotaped.
The vocal communication of each of the twenty individual leaders was analyzed using a
long-term pitch analysis PRAAT software (autocorrelation method) to obtain mean
fundamental frequency (F0). First four formant frequencies (F1, F2, F3 and F4) for each
subject were also be calculated. In reviewing the videotape of individual scenarios, each leader’s voice was analyzed during a non-stressful environment (WHO sign-out procedure) and compared with their voice during a stressful portion of the scenario (responding to deteriorating oxygen saturations in the mannequin).
Results: : There was a statistically significant increase in the mean fundamental frequency of
speech in the ORL Fellow (lead surgeon) participating in pediatric ORL simulation
between ‘stress’ and non-stress environments. This change was not found within the
Discussion/Conclusions: : Medical simulation often produces a degree of stress. Stress may serve as an adjunct
(challenge stress) or hindrance (threat stress) to the learning process. In order to study
and optimize stress during simulation, attempts, have been made to assess the degree of
simulation induced stress using physiological parameters such as heart rate, heart rate
variability and galvanic skin responses. This pilot study suggests voice analysis of
participants may serve as a simple, non-invasive, non-intrusive means of evaluating and
titrating the response during simulation.