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Biosensors, Biomarkers and Biometrics: a Bootcamp Perspective
  1. Osian P James1,2,
  2. David B T Robinson1,
  3. Luke Hopkins1,4,
  4. Chris Bowman1,
  5. Arfon G M T Powell5,
  6. Chris Brown1,3,
  7. Damian M Bailey6,
  8. Richard J Egan1,4,
  9. Wyn G Lewis1,7
  10. On behalf of Welsh Surgical Research Initiative
    1. 1 School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
    2. 2 Department of Surgery, Royal Gwent Hospital, Newport, UK
    3. 3 Department of Surgery, Cwm Taf Morgannwg University Health Board, Abercynon, UK
    4. 4 Department of Surgery, Morriston Hospital, Swansea, UK
    5. 5 Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
    6. 6 University of South Wales Faculty of Life Sciences and Education, Pontypridd, UK
    7. 7 Department of Surgery, University Hospital of Wales, Cardiff, UK
    1. Correspondence to Osian Penri James, Health Education and Improvement Wales’ School of Surgery, Cefn Coed, Nantgarw CF15 7QQ, UK; osianpjames{at}


    Introduction Competitive physical performance is routinely monitored by wearable technology (biosensors), yet professional healthcare is not, despite high prevalence of trainee stress and burnout, notwithstanding the corresponding risk to patient safety. This study aimed to document the physiological stress response of UK Core Surgical Trainees (CSTs) during simulation training.

    Methods CSTs (n=20, 10 male) were fitted with Vital Scout Wellness Monitors (VivaLNK, Campbell, California, USA) for an intensive 3-day training bootcamp. In addition to physiological parameters, CST demographics, event diaries and Maslach Burnout Inventory scores were recorded prospectively during exposure to three scenarios: interactive lectures, clinical skills simulation and non-technical (communication) training.

    Results Baseline heart rate (BHR, 60 bpm (range 39–81 bpm)) and baseline respiratory rate (14/min (11–18/min)) varied considerably and did not correlate (rho 0.076, p=0.772). BHR was associated with weekly exercise performed (66 bpm (<1 hour) vs 43 bpm (>5 hour), rho −0.663, p=0.004). Trainee response (standardised median heart rate vs BHR) revealed heart rate was related proportionately to lectures (71 bpm, p<0.001), non-technical skills training (79 bpm, p<0.001) and clinical skills simulation (88 bpm, p<0.001). Respiratory rate responded similarly (p<0.001 in each case). Heart rate during clinical skills simulation was associated with emotional exhaustion (rho 0.493, p=0.044), but maximum heart rate was unrelated to CSTs’ perceived peak stressors.

    Discussion Stress response, as derived from positive sympathetic heart rate drive varied over two-fold, with a direct implication on oxygen uptake and energy expenditure, and highlighting the daily physical demands placed upon clinicians.

    • Surgical Education
    • Simulation Training
    • Training
    • Non-Technical Skills
    • Stress

    Statistics from


    • Twitter Osian P James @osianp and Welsh Surgical Research Initiative @ResearchWelsh

    • Collaborators On behalf of Welsh Surgical Research Initiative, Joshua Aston, Emma Barlow, Charlotte Bee, Danielle Britton, Alice Campion, Martin Clarkson, Victoria Evans, Raja Jambulingam, Zayd Jawad, Sam Jeffreys, Arun Krishna, Jet Lee, Zoe Li, Anna Lygas, Eshan Mazumdar, Matthew McKenna, Clara Miller, Simon Morris, Francesca Solari, Jennifer Wallace.

    • Contributors OPJ, DBTR, LH, CB, AGMTP, CB, DMB, RJE and WGL made significant contributions to the conception and design of this work, drafting of the manuscript, approved the final version for publication and are accountable for each aspect of this study. OPJ, DBTR, LH and AGMTP were responsible for data acquisition and analysis. WL retains overall responsibility as senior author of the manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. OPJ is supported by a Joint Surgical Research Fellowship from the Royal College of Surgeons of England and Health Education and Improvement Wales. DMB is supported by a Royal Society Wolfson Research Fellowship (#WM170007), Royal Society International Exchanges Award (IES\R2\192137) and Japan Society for the Promotion of Science Research Fellowship (#JSPS/OF317).

    • Competing interests None declared.

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

    • Data availability statement Data are available upon reasonable request.

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