Effects of Brief Mental Skills Training on Emergency Medicine Residents' Stress Response During a Simulated Resuscitation: A Prospective Randomized Trial.

BACKGROUND: Acute stress impairs physician decision-making and clinical performance in resuscitations. Mental skills training, a component of the multistep, cognitive-behavioral technique of stress inoculation, modulates stress response in high-performance fields. OBJECTIVE: We assessed the effects of mental skills training on emergency medicine (EM) residents' stress response in simulated resuscitations as well as residents' perceptions of this intervention. METHODS: In this prospective, educational intervention trial, postgraduate year-2 EM residents in seven Chicago-area programs were randomly assigned to receive either stress inoculation training or not. One month prior to assessment, the intervention group received didactic training on the "Breathe, Talk, See, Focus" mental performance tool. A standardized, case-based simulation was used for assessment. We measured subjective stress response using the six-item short form of the Spielberger State-Trait Anxiety Inventory (STAI-6). Objective stress response was measured through heart rate (HR) and heart rate variability (HRV) monitoring. We measured subjects' perceptions of the training via survey. RESULTS: Of 92 eligible residents, 61 participated (25 intervention; 36 control). There were no significant differences in mean pre-/post-case STAI-6 scores (-1.7 intervention, 0.4 control; p = 0.38) or mean HRV (-3.8 milliseconds [ms] intervention, -3.8 ms control; p = 0.58). Post-assessment surveys indicated that residents found this training relevant and important. CONCLUSION: There was no difference in subjective or objective stress measures of EM resident stress response after a didactic, mental performance training session, although residents did value the training. More extensive or longitudinal stress inoculation curricula may provide benefit.

Perinatal perimortem and postmortem examination: obligations and considerations for perinatal, neonatal, and pediatric clinicians.

Clinicians are called upon to participate in a variety of clinical scenarios in which babies will die. A number of factors have caused the most appropriate method of evaluating cause(s) of death, namely autopsy, to fall to record low numbers during the past decade. Because of obligations unique to the stillborn fetus, dead or dying infant or child, and family and siblings, it is important for clinicians to understand the importance and utility of postmortem examination. Postmortem examination is of multidisciplinary importance to determine the cause of death and contributing and related diagnoses. This article summarizes some of what is known about postmortem examination and provides a list of guidelines available on the Internet and in the medical literature for the systematic assessment of perinatal death and the provision of appropriate testing. Clinicians are encouraged to use their leadership roles to improve rates of postmortem examination and to participate in research and education to improve its occurrence.