Causes of stress and their change with repeated sessions as perceived by undergraduate medical students during high-fidelity trauma simulation

It is known that simulation training is associated with stress for the trainees, at all levels of trainee experience. We explored the factors which were perceived by the trainees to cause them the maximum stress related to their simulation experience and their temporal changes over three simulation sessions. Ninety-seven final year medical students were administered a Likert-type questionnaire on perceived stressors after trauma simulation training. These stressors were classified as intrapsychic (relating to internal feelings); interpersonal (relating to interaction with others) and interactive (related to interaction with the simulated patient). Non-parametric tests were used for statistical analysis. Death of the simulated patient scored highest of all stressors. When the median scores for intrapsychic, interpersonal or interactive items were plotted session-wise, three distinct types of graphs were obtained. Eight of 13 items had a decrease in perceived stress scores from the first to the second session. Only 'death of the simulated patient' showed a significant increase in the score from the second to the third session. Undergraduate medical trainees experienced stress due to various factors during their first simulation session, which reduced with repeated sessions. However, perceived stress related to simulated death of a patient continued to remain high even after two repetitions. We suggest that simulation training programmes for undergraduate medical students should have at least one repeat session to reduce the stress and that facilitators should consider keeping the simulated patient alive throughout the training sessions.