Threshold-anxiety in medical students performing a prehospital high-fidelity clinical simulation: Randomized clinical trial

Background

The aim of this study was to determine the delta anxiety index (pre- and post-simulation) of medical students performing prehospital critical care high-fidelity clinical simulations (sepsis, myocardial infarction, polytrauma and anaphylactic shock) case-by-case. The secondary outcome was to identify clinical scenarios resulting in extreme anxiety levels (> 25 % post-simulation vs. pre-simulation delta anxiety).

Methods

A randomized (four prehospital critical care cases), blind, simulation-based clinical trial was performed at the Advanced Clinical Simulation Center of the Medical School of Valladolid University (Spain) with the participation of volunteer last-year medical students (6th year) from September 20, 2022, to April 15, 2024. The STAI questionnaire, epidemiological data and lifestyle habits were assessed. The principal outcome was the delta anxiety level (pre- and post-simulation) on the state subscale of the STAI.

Results

A total of 342 participants met the inclusion criteria. The median age was 23 years (IQR: 23–24; range: 22–41), and 67.8 % were female (213 cases). Scenario-by-scenario analysis revealed no significant differences by sex, age, prior simulation training, or role in the simulated scenario (leader or assistant). The polytrauma scenario yielded the worst post-simulation evaluation on the state subscale of the STAI, with a median of 54 points (IQR: 46–66) (p < 0.001).

Conclusion

Polytrauma and anaphylactic shock scenarios are more likely to induce extreme anxiety levels in final-year medical students during high-fidelity clinical simulations. Educators must be aware of these potential anxiety levels and carefully design the scenarios, providing adequate preparation and facilitating effective debriefing to optimize learning and mitigate the negative effects of excessive anxiety.