Simulation and stress: acceptable to students and not confidence-busting.

Background: Newly qualified doctors frequently feel unprepared for clinical practice. 'Performing under stress' has been cited as a particular barrier in this transitional period. Conventional views on training using simulation state that it must take place in a controlled environment to benefit learning; however, we attempted to create a high realism 'high-stress' simulated scenario to try and prepare students for stressful situations in future practice.

Methodology: Simulation stations were designed for final-year students. High realism was incorporated, as were factors designed to generate increased stress for students. Examples of this were that tutors did not prompt students during simulations, all bloods had to be taken to a 'lab', incomplete or incorrect requests were rejected and results were received in real time. All requests for senior help had to be made properly by telephone to a 'registrar'.Students completed a questionnaire rating knowledge and confidence of various session outcomes before and after the session, and rated the overall session out of 10. They also provided free-text comments. Before and after scores were compared with a Mann-Whitney U-test.

Results:   Forty students completed the session. Overall, the session was evaluated highly by students (with a mean score of 9.6 out of 10). There was no significant difference between the pre- and post-session scores. The free-text comments reflected the utility of the enhanced realism and stress.

Discussion: From the students' comments we appear to have successfully created the 'stress' we set out to achieve. We were concerned that incorporating significant stress may have a negative impact on learning; however, students did not report a decrease in confidence following the session.