Association of Personality Traits With the Efficacy of Stress Management Interventions for Medical Students Taking Objective Structured Clinical Examinations.

PURPOSE: Personality traits are associated with psychophysiological stress, but few studies focus on medical students. This study aimed to better understand the association of personality traits with the efficacy of stress management interventions for medical students. METHOD: A randomized controlled trial was conducted with fourth-year students who took the objective structured clinical examination at Bernard University Lyon 1 in December 2021. Students were randomized in cardiac biofeedback, mindfulness, and control groups. Each intervention was implemented for 6 minutes before the examination. Physiological stress levels were collected during the intervention. Psychological stress levels were rated by students at baseline and after the intervention. Personality traits were assessed via the Big-Five Inventory. Interactions between personality traits and the efficacy of the interventions were analyzed using multivariable linear regression models. RESULTS: Four hundred eighty-one students participated. Higher baseline psychological stress levels were associated with higher neuroticism and agreeableness (ß = 10.27, 95% confidence interval (CI) [7.40, 13.13], P < .001 and ß = 3.42, 95% CI [0.98, 5.85], P = .006, respectively) and lower openness (ß = -4.95, 95% CI [-7.40, -2.49], P < .001). As compared to the control intervention, both stress management interventions led to lower levels of psychological (P < .001 for both) and physiological stress levels (biofeedback: P < .001 and mindfulness: P = .009). Biofeedback efficacy varied by extraversion score for psychological (ß = -5.66, 95% CI [-10.83, -0.50], P = .03) and physiological stress reduction (ß = -0.002, 95% CI [-0.003, -0.00004], P = .045). Mindfulness efficacy varied by agreeableness score for psychological stress reduction (ß = -7.87, 95% CI [-13.05, -2.68], P = .003). CONCLUSIONS: Students with a high score in extraversion may benefit more from biofeedback interventions, while students with high scores in agreeableness may benefit more from mindfulness interventions.

Influence of the embedded participant on learners' performance during high-fidelity simulation sessions in healthcare.

BACKGROUND: The embedded participant (EP) plays a key role during a full scale/high-fidelity simulation (HFS) session. He/she is expected to guide the learner towards the achievement of the educational objectives of the scenario. However, his/her influence on learners' performance stands undetermined and this effect remains briefly addressed in the literature. This study primarily aims to assess whether the EP could have an influence on the performance of the learner during a HFS scenario. The secondary aim was to establish an inventory of the EP practices in France. METHODS: This retrospective study was conducted in Lyon Claude Bernard University Health Simulation Centre (France). Anaesthesia and critical care residents in postgraduate years 1 to 5 who were scheduled for their HFS sessions during the 2016 to 2021 academic years were included. Two investigators independently evaluated the resident performance regarding both technical and non-technical skills from video recordings. In addition, a nationwide survey was sent out by email through the networks of the Francophone Healthcare Simulation Society (SoFraSimS, Société Francophone de Simulation en Santé) to collect information on EP practices in French-speaking Simulation centres. RESULTS: From a total of 344 HFS videos analysed, a cohort of 19 experienced EPs was identified. The EPs had an influence on the technical and non-technical performances of the learners. The 147 responses to the survey showed that predefined rules of EP good practice existed in only 36% of the simulation centres and 65% of respondents believed that specific EP training would be justified. CONCLUSION: The EP can exert an influence on the performance of the learners during HFS. For acting as an EP, a great variability of practices and a lack of training are reported by professionals working in simulation centres. These results suggest that more attention must be paid to EP training and attitudes during simulation, especially if summative simulations are extensively developed.

The impact of shift work on pain recognition, a robust ability among intensive care nurses.

BACKGROUND: Pain empathy is essential for high-quality of care. The cognitive ability to identify and understand the pain in others remains underexplored in the context of hospital shift work. This study aimed to observe the early subliminal ability to detect pain in other faces and to investigate pain intensity evaluations during day and night shifts. METHODS: Twenty-one nurses (31 ± 7 years, 20 women) from cardio-paediatric intensive care participated in this study. Eighteen nurses completed all testing in the morning and evening hours, before and after the 12-hour day and night shift. In the first test, the nurses had to decide if facial stimuli presented subliminally showed pain or not. During the second test, they consciously determined the intensity of the painful faces on a numerical scale. Sleep, sleepiness and empathy were also measured. RESULTS: Recognition accuracy and pain sensitivity remained stable over time, only sensitivity increased following the work shift (F(1,15) = 7.10, p = 0.018). Intensity ratings remained stable. Sleepiness at the end of the night shift was negatively correlated with accuracy (ρ = -0.51, p = 0.018) and positively correlated with prior night shifts (ρ = -0.50, p = 0.022). CONCLUSION: The judgement of facial pain expressions seems robust across shift types, only individual factors such as sleepiness interfere with pain recognition. Pain sensitivity may be enhanced during working hours. SIGNIFICANCE STATEMENT: Some professions need to know how to assess pain 24/7 and a lack of sleep can disrupt the cognitive processes necessary for this assessment. Night shifts provoke a bias in pain management, and sleep deprivation, a decrease in pain evaluation. By conducting a repeated measure study in the field that applied a different paradigm (subliminal recognition of facial cues) we add evidence to the understanding of pain recognition and the impact of sleep deprivation on the early processing of pain in others.

Personality traits affect anticipatory stress vulnerability and coping effectiveness in occupational critical care situations.

The present study aimed at investigating the influence of personality on both anticipatory stress vulnerability and the effectiveness of coping strategies in an occupational stressful context. Following assessment of individual personality traits (Big Five Inventory), 147 volunteers were exposed to the anticipation of a stressful event. Anxiety and cardiac reactivity were assessed as markers of vulnerability to anticipatory stress. Participants were then randomly assigned to three groups and subjected to a 5-min intervention: relaxation breathing, relaxation breathing combined with cardiac biofeedback, and control. The effectiveness of coping interventions was determined through the cardiac coherence score achieved during the intervention. Higher neuroticism was associated with higher anticipatory stress vulnerability, whereas higher conscientiousness and extraversion were related to lower anticipatory stress vulnerability. Relaxation breathing and biofeedback coping interventions contributed to improve the cardiac coherence in all participants, albeit with greater effectiveness in individuals presenting higher score of openness to experience. The present findings demonstrated that personality traits are related to both anticipatory stress vulnerability and effectiveness of coping interventions. These results bring new insights into practical guidelines for stress prevention by considering personality traits. Specific practical applications for health professionals, who are likely to manage stressful situations daily, are discussed.

Effects of relaxing breathing paired with cardiac biofeedback on performance and relaxation during critical simulated situations: a prospective randomized controlled trial.

BACKGROUND: Active participation in high-fidelity simulation remains stressful for residents. Increased stress levels elicited during such simulation impacts performance. We tested whether relaxing breathing, paired or not with cardiac biofeedback, could lead to enhanced performance of residents during simulation. METHODS: This randomized pilot study involved the fifth-year anesthesiology and critical care residents who participated in high-fidelity at Lyon medical simulation center in 2019. Residents were randomized into three parallel interventions: relaxing breathing, relaxing breathing paired with cardiac biofeedback, and control. Each intervention was applied for five minutes immediately after the scenario briefing. The primary endpoint was the overall performance during the simulation rated by two blinded independent investigators. The secondary endpoints included component scores of overall performance and changes in psychological states. RESULTS: Thirty-four residents were included. Compared to the control group, residents in the relaxing breathing (+ 7%, 98.3% CI: 0.3 to 13.7, P = 0.013) and relaxing breathing paired with cardiac biofeedback (+ 8%, 98.3% CI: 0.82 to 14.81, P = 0.009) groups had a higher overall performance score. Following the interventions, compared to the control group, stress level was lower when participants had performed relaxing breathing alone (P = 0.029) or paired with biofeedback (P = 0.035). The internal relaxation level was higher in both the relaxing breathing alone (P = 0.016) and paired with biofeedback groups (P = 0.035). CONCLUSIONS: Performing five minutes of relaxing breathing before the scenario resulted in better overall simulation performance. These preliminary findings suggest that short breathing interventions are effective in improving performance during simulation. TRIAL REGISTRATION: The study protocol was retrospectively registered on clinicaltrials.gov ( NCT04141124 , 28/10/2019).

Combining proactive transcranial stimulation and cardiac biofeedback to substantially manage harmful stress effects.

BACKGROUND: Previous studies have identified the dorsolateral prefrontal cortex (dlPFC) as a core region in cognitive emotional regulation. Transcranial direct current stimulations of the dlPFC (tDCS) and heart-rate variability biofeedback (BFB) are known to regulate emotional processes. However, the effect of these interventions applied either alone or concomitantly during an anticipatory stress remains unexplored. OBJECTIVE: The study investigated the effect of anodal tDCS and BFB, alone or combined, on psychophysiological stress responses and cognitive functioning. METHODS: Following a stress anticipation induction, 80 participants were randomized into four groups and subjected to a 15-min intervention: neutral video viewing (ctrl), left dlPFC anodal tDCS (tdcs), heart-rate variability biofeedback (bfb), or a combined treatment (bfb + tdcs). Participants were then immediately confronted with the stressor, which was followed by an assessment of executive functions. Psychophysiological stress responses were assessed throughout the experiment (heart rate, heart-rate variability, salivary cortisol). RESULTS: The tdcs did not modulate stress responses. Compared with both ctrl and tdcs interventions, bfb reduced physiological stress and improved executive functions after the stressor. The main finding revealed that bfb + tdcs was the most effective intervention, yielding greater reduction in psychological and physiological stress responses than bfb. CONCLUSIONS: Combining preventive tDCS with BFB is a relevant interventional approach to reduce psychophysiological stress responses, hence offering a new and non-invasive treatment of stress-related disorders. Biofeedback may be particularly useful for preparing for an important stressful event when performance is decisive.

Implementing biofeedback as a proactive coping strategy: Psychological and physiological effects on anticipatory stress.

Anticipating a stressful situation involves psychophysiological reactions before the occurrence of the overt stress event. The current challenge in the stress domain is to characterize anticipatory stress reactions and how to effectively modulate them. The present study aimed to characterize the anticipation period and evaluate the benefits of a heart-rate variability biofeedback (BFB) intervention designed to manage anticipatory stress. Healthy participants were exposed to an anticipation stress period (15 min) during which they either practised BFB (stress + bfb, n = 15) or watched a neutral video (stress + video, n = 14). Anticipatory stress was effectively induced by the Trier Social Anticipatory Stress (TSAS) protocol, specifically designed for this study. Control participants, without anticipation stress, practised BFB for an equivalent time (ctrl + bfb, n = 15). Subsequently, all participants performed a set of cognitive tasks assessing executive functions. Heart-rate variability (cardiac coherence, standard deviation of the R-R intervals, root mean square of successive difference measure) and the evolution of the perceived psychological state were measured during the anticipation period. Self-reported judgements of how the intervention influenced stress and performance were further assessed. The main result showed that BFB is a relevant proactive stress-coping method. Compared with the stress + video group, participants who practised BFB attained higher cardiac coherence scores. Post-intervention self-reported measures revealed that BFB contributed to reduce psychological stress and increase perceived levels of performance. Together, these findings provide practical guidelines for examining the stress anticipation period by means of the TSAS protocol.

Acute stress affects implicit but not explicit motor imagery: A pilot study.

Motor imagery (MI) is the capacity to mentally perform one or a set of movements without concomitant overt action. MI training has been show to enhance the subsequent motor performance. While the benefits of MI to manage stress have been extensively documented, the reverse impact of stress on MI received far less attention. The present study thus aimed to evaluate whether acute stress might influence MI abilities. Thirty participants were assigned either to a stress or a control group. The Socially Evaluated Cold Pressor Test (SECPT) was used to induce stress, with heart rate, electrodermal activity, salivary cortisol, and self-report perceived levels of stress being monitored during the experiment. Stress induction was followed by both implicit (laterality judgment) and explicit (sequential pointing) MI tasks. Main results showed a deleterious impact of stress on implicit MI, while explicit MI was not altered. These exploratory findings provide a deeper understanding of stress effects on cognition, and practically support that under stressful conditions, as during a sport competition or rehabilitation contexts, explicit MI should be prioritized.

Early stimulation of the left posterior parietal cortex promotes representation change in problem solving.

When you suddenly understand how to solve a problem through an original and efficient strategy, you experience the so-called "Eureka" effect. The appearance of insight usually occurs after setting the problem aside for a brief period of time (i.e. incubation), thereby promoting unconscious and novel associations on problem-related representations leading to a new and efficient solving strategy. The left posterior parietal cortex (lPPC) has been showed to support insight in problem solving, when this region is activated during the initial representations of the task. The PPC is further activated during the next incubation period when the mind starts to wander. The aim of this study was to investigate whether stimulating the lPPC, either during the initial training on the problem or the incubation period, might enhance representation change in problem solving. To address this question, participants performed the Number Reduction Task (NRT, convergent problem-solving), while excitatory or sham (placebo) transcranial direct current stimulation (tDCS) was applied over the lPPC. The stimulation was delivered either during the initial problem representation or during the subsequent incubation period. Impressively, almost all participants (94%) with excitatory tDCS during the initial training gained representational change in problem solving, compared to only 39% in the incubation period and 33% in the sham groups. We conclude that the lPPC plays a role during the initial problem representation, which may be considerably strengthened by means of short brain stimulation.

Putative sex-specific human pheromones do not affect gender perception, attractiveness ratings or unfaithfulness judgements of opposite sex faces.

Debate continues over the existence of human sex pheromones. Two substances, androstadienone (AND) and estratetraenol (EST), were recently reported to signal male and female gender, respectively, potentially qualifying them as human sex pheromones. If AND and EST truly signal gender, then they should affect reproductively relevant behaviours such as mate perception. To test this hypothesis, heterosexual, Caucasian human participants completed two computer-based tasks twice, on two consecutive days, exposed to a control scent on one day and a putative pheromone (AND or EST) on the other. In the first task, 46 participants (24 male, 22 female) indicated the gender (male or female) of five gender-neutral facial morphs. Exposure to AND or EST had no effect on gender perception. In the second task, 94 participants (43 male, 51 female) rated photographs of opposite-sex faces for attractiveness and probable sexual unfaithfulness. Exposure to the putative pheromones had no effect on either attractiveness or unfaithfulness ratings. These results are consistent with those of other experimental studies and reviews that suggest AND and EST are unlikely to be human pheromones. The double-blind nature of the current study lends increased support to this conclusion. If human sex pheromones affect our judgements of gender, attractiveness or unfaithfulness from faces, they are unlikely to be AND or EST.