The impact of simulated patient death on medical students' stress response and learning of ACLS.

INTRODUCTION: There is considerable controversy as to whether the simulator should die during high-fidelity simulation (HFS). We sought to describe the physiologic and biochemical stress response induced by simulated patient death as well as the impact on long-term retention of Advanced Cardiovascular Life Support (ACLS) knowledge and skills. METHODS: Twenty-six subjects received an American Heart Association (AHA) ACLS provider course. Following the course, subjects participated in HFS and were randomized to simulated death or survival. Heart rate and salivary cortisol (SC) and dihydroepiandrosterone (DHEA) were collected at this time. Subjects returned six months later for a follow-up simulation in which ACLS knowledge and skills were tested. RESULTS: For all participants, there was an increase in heart rate during simulation compared with baseline heart rate (+ 32 beats/minute), p < 0.0001. Similarly, SC and DHEA were higher compared with baseline levels (+ 0.115 µg/dL, p <0.01 and + 97 pg/mL, p < 0.001, respectively). However, the only statistically significant difference between groups was an increase in heart rate response at the end of the simulation compared with baseline in the death group (+ 29.2 beats/minute versus + 18.5 beats/minute), p < 0.05. There was no difference on long-term knowledge or skills. CONCLUSIONS: Learners experience stress during high-fidelity simulation; however, there does not appear to be a readily detectable difference or negative response to a simulated patient death compared with simulated survival.

Emotional disclosure and victim blaming.

Victim blaming occurs when people are unfairly held responsible for their misfortunes. According to just world theory, witnessing another's victimization threatens just world beliefs, which arouses distress. Victim blaming redeems just world beliefs, thereby reducing distress. However, negative emotions can also be resolved through emotional disclosure, suggesting that disclosure can prevent victim blaming. Two experiments confirmed this prediction. In Study 1 participants viewed a woman being victimized or a woman in a nonvictimizing conflict. Participants then disclosed or suppressed the emotions aroused by these scenes and 1 week later evaluated the woman they had viewed. Disclosure reduced blaming of the victim but did not affect blaming of the nonvictim. Further, the more distress participants disclosed, the less they blamed the victim. Study 2 replicated the primary results of Study 1 and also showed that (a) disclosure exclusively reduces blaming of victims; it does not moderate judgments of victimizers, and (b) the effects of disclosure on blaming applies across genders. These 2 studies confirm that victim blaming is a form of emotion management (per just world theory), and that emotional disclosure prevents blaming by supplying an alternative mode of emotion management. This research also suggests that emotional disclosure moderates social perception, in general.