Article Text

Relationship between acute stress and clinical performance in medical students: a pilot simulation study
  1. Stephanie J Russ1,
  2. Ian Morrison1,
  3. Cheryl Bell2,
  4. Jeremy Charles Morse1,
  5. Rhoda Katharine Mackenzie1,
  6. Marie K Johnston2
  1. 1Institute for Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
  2. 2Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Stephanie J Russ, Institute for Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK; stephanie.russ{at}


Background Acute stress has been linked to impaired clinical performance in healthcare settings. However, few studies have measured experienced stress and performance simultaneously using robust measures in controlled experimental conditions, which limits the strength of their findings.

Aim In the current study we examined the relationship between acute stress and clinical performance in second-year medical students undertaking a simulated ECG scenario. To explore this relationship in greater depth we manipulated two variables (clinical urgency and cognitive load), and also examined the impact of trait anxiety and task self-efficacy.

Methods Second-year medical students were asked to conduct a 12-lead ECG on a simulated patient. Students were randomly assigned to one of four experimental conditions according to clinical urgency (high/low) and cognitive load (high/low), which were manipulated during a handover prior to the ECG. As part of the scenario they were asked to describe the ECG trace to a senior doctor over the phone and to conduct a drug calculation. They then received a performance debrief. Psychological stress and physiological stress were captured (via self-report and heart rate, respectively) and various aspects of performance were observed, including technical competence, quality of communication, work rate and compliance with patient safety checks. Trait anxiety and task self-efficacy were also captured via self-report.

Results Fifty students participated. While there was little impact of experimental condition on stress or performance, there was a significant relationship between stress and performance for the group as a whole. Technical competence was poorer for those reporting higher levels of psychological stress prior to and following the procedure. Neither trait anxiety nor task self-efficacy mediated this relationship.

Conclusions This study has provided evidence for a link between acute stress and impaired technical performance in medical students completing a simulated clinical scenario using real-time measures. The implications for patient safety and medical education are discussed.

  • stress
  • simulation-based education
  • patient safety

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  • Contributors All authors were involved in formulation of the research concept, research questions and study design. SJR, IM, CB, JCM and RKM were involved in data collection. SJR and RKM undertook data analysis. SJR and MKJ drafted the manuscript and all authors were involved in critically reviewing it. All authors have approved the manuscript for submission.

  • Funding This study ran as part of the MBChB curriculum at the University of Aberdeen and no additional funding was required.

  • Competing interests SJR has recently become a member of the editorial board for BMJ Simulation & Technology Enhanced Learning. All other authors declare no competing interests.

  • Patient consent Obtained.

  • Ethics approval University of Aberdeen College Ethics Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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