S (T) I M U L A T E: an examination of stress and performance in medical simulation

The initial narrative review collates existing literature, highlighting the equivocal nature of stress in terms of enhancing or impairing performance, depending on individual differences and the stressors involved. A subsequent systematic review further narrows the focus, identifying the role of stress in medical simulations, and presenting several existing gaps in the research domain. The feasibility study conducted as part of this thesis confirms the viability of a multimodal stress assessment approach in simulated environments.

By integrating various markers, the study offers a comprehensive view of how stress manifests and affects performance under different levels of complexity. The pilot study, which builds on these findings, demonstrates significant physiological and psychological stress responses during high-complexity simulations, but reveals a more nuanced relationship between these stress markers and clinical performance. The development of a novel multimodal tool, known as the StressFlux Index, is introduced as a potential solution for real-time stress assessment.

This tool combines a selection of non-invasive physiological markers to provide immediate feedback, paving the way for more personalized educational interventions. The findings of this thesis draw attention to the need for further research to refine the StressFlux Index, and to fully understand the role of stress in simulation-based healthcare education.