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Cited by 23Simulation-Based Education in HealthcareCardiac Arrest and ResuscitationSurgical Simulation and Training

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

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Schlatter, Sophie T., Thérond, Corentin C., Guillot, Aymeric, Louisy, Simon P., Duclos, Antoine, Lehot, Jean-Jacques, Rimmelé, Thomas, Debarnot, Ursula S. +1 more·2022·BMC Medical Education
DOI 10.1186/s12909-022-03420-9PMC PMC9164463
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Abstract

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).

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  • One intervention was effective despite not incorporating human-guided training, multiple sessions, or long-term practice.

    “One intervention was effective despite not incorporating human-guided training, multiple sessions, or long-term practice [79].”

    From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [79]

    The Discussion and Conclusion report improved simulation performance after a single five-minute breathing intervention, supporting the claim that this intervention did not require multiple sessions or a prolonged practice protocol. But the Methods (Design) say the investigator performed each intervention and stayed to verify it, and that all participants had previously received formal training in stress-management tactics. The paper therefore does not establish effectiveness without human involvement or prior training. (LLM, conf=0.88)

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  • Schlatter et al.'s effective intervention [79] lacked human guidance but used a 6 bpm practice among 5th-year medical residents guided via screen cursor with an investigator present to ensure adherence.

    “While Schlatter and colleagues’ effective intervention [79] lacked human guidance, their 6 bpm practice among 5th-year medical residents was guided via a screen cursor with an investigator present to ensure practice adherence.”

    From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [79]

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References 34 · Cited by 23

Research works printed but not linked: 32

  1. [1]Isbell LM Boudreaux ED Chimowitz H Liu G Cyr E Kimball E What do emergency department physicians and nurses feel? A qualitative study of emotions, triggers, regulation strategies, and effects on patient care BMJ Qual Saf 2019 0 1 11 PMC7363518 31941799
  2. [2]Harvey A Bandiera G Nathens AB LeBlanc VR Impact of stress on resident performance in simulated trauma scenarios J Trauma Acute Care Surg 2012 72 497 503 10.1097/TA.0b013e31821f84be 22439221 · DOI
  3. [3]Krage R Zwaan L Tjon Soei Len L Kolenbrander MW Di Van G Loer SA Wagner C Schober P Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: Does stress have an influence? Emerg Med J 2017 34 728 733 10.1136/emermed-2016-205754 28844039 PMC5750366 · DOI
  4. [5]Hawryluck L Brindley PG Psychological burnout and critical care medicine: big threat, big opportunity Intensive Care Med 2018 44 2239 2241 10.1007/s00134-018-5063-6 29353460 · DOI
  5. [6]Stillwell SB Vermeesch AL Scott JG Interventions to Reduce Perceived Stress Among Graduate Students: A Systematic Review With Implications for Evidence-Based Practice Worldviews Evidence-Based Nurs 2017 14 507 513 10.1111/wvn.12250 28795775 · DOI
  6. [8]Jones JW Barge BN Steffy BD Fay LM Kunz LK Wuebker LJ Stress and Medical Malpractice: Organizational Risk Assessment and Intervention J Appl Psychol 1988 73 727 735 10.1037/0021-9010.73.4.727 3209582 · DOI
  7. [9]Schlatter S Schmidt L Lilot M Guillot A Debarnot U Implementing biofeedback as a proactive coping strategy: psychological and physiological effects on anticipatory stress Behav Res Ther 2021 3 103834 10.1016/j.brat.2021.103834 33743384 · DOI
  8. [10]Schlatter S Guillot A Schmidt L Mura M Trama R Di Rienzo F Lilot M Debarnot U Combining proactive transcranial stimulation and cardiac biofeedback to substantially manage harmful stress effects. 2021 14 1384 1392 34438047
  9. [11]VanDiest I Verstappen K Aubert AE Widjaja D Vansteenwegen D Vlemincx E Inhalation/Exhalation Ratio Modulates the Effect of Slow Breathing on Heart Rate Variability and Relaxation Appl Psychophysiol Biofeedback 2014 39 171 180 10.1007/s10484-014-9253-x 25156003 · DOI · Paper page
  10. [12]Subhani AR Kamel N Saad MNM Nandagopal N Kang K Malik AS Mitigation of stress: new treatment alternatives Cogn Neurodyn 2018 12 1 20 10.1007/s11571-017-9460-2 29435084 PMC5801283 · DOI
  11. [13]DeWitte N Buyck I Van DT Combining Biofeedback with Stress Management Interventions: A Systematic Review of Physiological and Psychological Effects Appl Psychophysiol Biofeedback 2019 0 0 10.1007/s10484-018-09427-7 30604099 · DOI
  12. [14]Goessl VC Curtiss JE Hofmann SG The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis Psychol Med 2017 47 2578 2586 10.1017/S0033291717001003 28478782 · DOI
  13. [16]Goldberg MB Maher Z Fish JH Milner R Yu D Martin ND Goldberg AJ Optimizing Performance Through Stress Training: An Educational Strategy for Surgical Residents J Am Coll Surg 2014 219 S119 10.1016/j.jamcollsurg.2014.07.283 29275906 · DOI
  14. [17]Motola I Devine LA Chung HS Sullivan JE Issenberg SB Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82 Med Teach 2013 35 142 159 10.3109/0142159X.2013.818632 23941678 · DOI
  15. [18]Gaba DM Crisis resource management and teamwork training in anaesthesia Br J Anaesth 2010 105 3 6 10.1093/bja/aeq124 20551023 · DOI
  16. [19]Krage R Tjon Soei Len L Schober P Kolenbrander M Van GD Loer SA Wagner C Zwaan L Does individual experience affect performance during cardiopulmonary resuscitation with additional external distractors? Anaesthesia 2014 69 983 989 10.1111/anae.12747 24888475 · DOI
  17. [20]Leblanc VR Regehr C Tavares W Scott AK MacDonald R King K The impact of stress on paramedic performance during simulated critical events Prehosp Disaster Med 2012 27 369 374 10.1017/S1049023X12001021 22831965 · DOI · Paper page
  18. [21]Moher D Hopewell S Schulz KF Montori V Gøtzsche PC Devereaux PJ CONSORT explanation and elaboration: updated guidelines for reporting parallel group randomised trials BMJ 2010 340 c869 10.1136/bmj.c869 20332511 PMC2844943 · DOI · Paper page
  19. [22]Rudolph JW Raemer DB Simon R Establishing a safe container for learning in simulation the role of the presimulation briefing Simul Healthc 2014 9 339 349 10.1097/SIH.0000000000000047 25188485 · DOI
  20. [23]Zigmont JJ Kappus LJ Sudikoff SN The 3D Model of Debriefing: Defusing, Discovering, and Deepening Semin Perinatol 2011 35 52 58 10.1053/j.semperi.2011.01.003 21440811 · DOI · Paper page
  21. [24]Sawyer T Eppich W Brett-Fleegler M Grant V Cheng A More Than One Way to Debrief: A Critical Review of Healthcare Simulation Debriefing Methods Simul Healthc 2016 11 209 217 10.1097/SIH.0000000000000148 27254527 · DOI
  22. [25]Evain JN Zoric L Mattatia L Picard O Ripart J Cuvillon P Residual anxiety after high fidelity simulation in anaesthesiology: An observational, prospective, pilot study Anaesth Crit Care Pain Med 2017 36 205 212 10.1016/j.accpm.2016.09.008 27867134 · DOI
  23. [26]Sigwalt F, Petit G, Evain J-N, Claverie D, Bui M, Guinet-Lebreton A, et al. Stress Management Training Improves Overall Performance during Critical Simulated Situations. Anesthesiology. 2020:1–14. 32304404
  24. [27]Evain JN Perrot A Vincent A Cejka JC Bauer C Duclos A Rimmelé T Lehot J-J Lilot M Team planning discussion and clinical performance: a prospective, randomised, controlled simulation trial Anaesthesia 2019 74 488 496 10.1111/anae.14602 30768684 · DOI
  25. [28]Kim J Neilipovitz D Cardinal P Chiu M Clinch J A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study Crit Care Med 2006 34 2167 2174 10.1097/01.CCM.0000229877.45125.CC 16775567 · DOI
  26. [29]Thayer RE Factor analytic and reliability studies on the activation-deactivation adjective check list Psychol Rep 1978 42 747 756 10.2466/pr0.1978.42.3.747 674499 · DOI
  27. [30]Plaisant O Courtois R Réveillère C Mendelsohn GA John OP Validation par analyse factorielle du Big Five Inventory français (BFI-Fr). Analyse convergente avec le NEO-PI-R Ann Med Psychol (Paris) 2010 168 97 106 10.1016/j.amp.2009.09.003 · DOI
  28. [31]Schneider TR The role of neuroticism on psychological and physiological stress responses J Exp Soc Psychol 2004 40 795 804 10.1016/j.jesp.2004.04.005 · DOI
  29. [32]Cichetti DV Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology Psychol Assess 1994 6 284 290 10.1037/1040-3590.6.4.284 · DOI · Paper page
  30. [33]Flin R, Paul O, Crichton M. Safety at the sharp end: a guide to non-technical skills. Crichton. (Ashgate, ed.). Aldershot, 2008.
  31. [34]Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000. PMID: 25077248. 25077248
  32. [35]Bouchard S Bernier F Boivin E Morin B Robillard G Using biofeedback while immersed in a stressful videogame increases the effectiveness of stress management skills in soldiers PLoS One 2012 7 e36169 10.1371/journal.pone.0036169 22558370 PMC3338628 · DOI

Authors
Schlatter, S. T., Thérond, C. C., Guillot, A., Louisy, S. P., Duclos, A., Lehot, J.-J., Rimmelé, T., Debarnot, U. S., & Lilot, M. E.
Affiliations
  • Lyon 1 Université (FR)
  • Hospices Civils de Lyon (FR)
Corresponding author
Schlatter, Sophie T.
ORCID
Venue
BMC Medical Education
Publisher
Springer Science and Business Media LLC
Published
2022-06-02
Volume
22
Issue
1
Pages
422-422
ISSN
1472-6920 (ISSN-L)
DOI
10.1186/s12909-022-03420-9
PMC
PMC9164463
OpenAlex
W4281652426
Cited by
23
References
34
Citations by year
2026: 8 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 2
FWCI
2.32
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Education (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • HAL (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Hospices Civils de Lyon
  • Université Claude Bernard Lyon 1
Topics
  • Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
  • Health Sciences › Medicine › Surgery › Surgical Simulation and Training
Keywords
high-fidelity simulation, simulation-based training, medical residents, anesthesiology residents, critical care residents, stress reduction, relaxation, simulation performance
MeSH terms
Biofeedback, Psychology, Computer Simulation, Heart, Humans, Pilot Projects, Prospective Studies

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