P3.240: Relationship Between HRV and Performance of Pediatric Residents During Simulation

Background: Both physiological and perceived stress impact the daily lives of medical providers. While chronic stress is known to harm mental and physical health, research suggests that discrete episodes of acute stress may enhance performance. The balance between managing stress through preparation and reduction techniques and leveraging it to improve outcomes remains unclear. Previous studies have shown a negative correlation between physiological stress and non-technical skills, but were limited in scope and did not fully explore the spectrum of stress’s effects. Research also suggests that while stress increases during medical emergencies, more experienced providers experience lower stress levels, indicating stress can be helpful in acute situations but decreases with experience. Heart rate variability (HRV) has been studied as a marker for physiological stress in real and simulated medical emergencies. This study aims to contribute to the understanding of stress's impact on clinical performance, exploring the balance between its benefits and harms.

Methods: This prospective cross-sectional study involved attaching wearable devices to participants during a half-day simulation involving eight different scenarios. Baseline data was collected during the pre-brief session and continuous data was recorded throughout all simulations. Performance was evaluated using a pre-embedded global rating scale (Likert format 1-5). Changes in HRV (delta HRV) were calculated as the difference between HRV during cases and baseline HRV. Mixed effects models were used, with performance scores as the response, delta HRV as the predictor, and case type as a 3-level factor (apnea, ventricular tachycardia, seizure), and random intercepts per participant. Two models for each response were fitted: one with delta HRV for linear associations and one using restricted cubic splines to assess non-linear relationships.

Results: Data was collected from 16 participants across 3 simulations, totaling 48 cases. Performance scores were highest in the apnea simulation, followed by ventricular tachycardia, and lowest in the seizure scenario (p < 0.001). There was no significant relationship, linear or otherwise, between delta HRV and performance scores (p>0.23).

Conclusion: This study explored the relationship between HRV, as a marker of stress, and clinical performance. The results indicate no significant association between changes in HRV and performance scores, suggesting that HRV alone may not reliably predict performance in simulated medical emergencies. Limitations, including the small sample size, limited granularity of performance ratings, and inability to control for prior experience, may have impacted the findings. The lack of a strong association underscores the complexity of the relationship between stress and performance in medical emergencies. While some acute stress may be beneficial, factors such as experience, emergency type, and individual stress tolerance must also be considered. Future research is needed to further explore these dynamics and inform the development of educational curricula that help medical providers balance stress and performance effectively.