ArticleScandinavian journal of trauma, resuscitation and emergency medicine2015
Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04940455 (Effect of Realistic Simulation and Digital Educational Platforms for Learning Nursing Student), which is not on this map. Cited by 31 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of Realistic Simulation and Digital Educational Platforms for Learning Nursing Student: Randomized Clinical Trial
Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it, 75 citations in OpenAlex.
- Association between cortisol levels and performance in clinical simulation: a systematic review.Revista da Escola de Enfermagem da U S P · 2024Pooled it
- Stress in surgical educational environments: a systematic review.BMC medical education · 2022Pooled it
- Development and evaluation of the SimArena Magdeburg (SAM): A randomized controlled trial of the impact of a low-cost 180° simulation arena for emergency medical simulation training on stress perception and the associated resuscitation quality in medical students.GMS journal for medical education · 2025Trial
- Trial
- Randomized controlled trial of multidisciplinary team stress and performance in immersive simulation for management of infant in shock: study protocol.Scandinavian journal of trauma, resuscitation and emergency medicine · 2016Trial
- Emergency department eCPR: an exploratory observational study of human factors.BMC emergency medicine · 2026Observational
- Occupational Stress in Pre-Hospital Emergency Care: A Review on Influencing Factors and Consequences and Management: A Systematic Review.Advanced biomedical research · 2026Review
- Psychological, physical, and cognitive factors that influence tactical performance during a military relevant virtual reality scenario.Cognitive research: principles and implications · 2025Article
- Associations Between Salivary Cortisol, DHEA-S, and Alpha-Amylase and Longitudinal Sleep Disruption in Shift-Working Healthcare Professionals: A Pilot Study.Nature and science of sleep · 2025Article
- Assessing the psychobiological demands of high-fidelity training in pre-hospital emergency medicine.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- The effect of assessor visibility on student stress and anxiety in emergency care simulation assessments.BMC medical education · 2024Article
- Combining stress inoculation with virtual reality simulation training of malignant hyperthermia.Advances in simulation (London, England) · 2024Article
- Assessing the equivalency of face-to-face and online simulated patient interviews in an educational intervention.Advances in simulation (London, England) · 2024Article
- Feasibility of biomarkers to measure stress, burnout and fatigue in emergency nurses: a cross-sectional study.BMJ open · 2023Observational
- Salivary Biomarkers Analysis and Neurobehavioral Assessment in Nurses Working Rotation Shifts: A Pilot Study.International journal of environmental research and public health · 2023Article
- Manikins versus simulated patients in emergency medicine training: a comparative analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Coordination of autonomic and endocrine stress responses to the Trier Social Stress Test in adolescence.Psychophysiology · 2022Article
- Variations in Salivary Stress Biomarkers and Their Relationship with Anxiety, Self-Efficacy and Sleeping Quality in Emergency Health Care Professionals.International journal of environmental research and public health · 2021Article
- Salivary Proteome Changes in Response to Acute Psychological Stress Due to an Oral Exam Simulation in University Students: Effect of an Olfactory Stimulus.International journal of molecular sciences · 2021Article
- Stress Salivary Biomarkers Variation during the Work Day in Emergencies in Healthcare Professionals.International journal of environmental research and public health · 2021Article
Corrections and comments
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Authors and funding
12 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn emergency medicine, the benefits of high-fidelity simulation (SIM) are widely accepted and standardized patients (SP) are known to mimic real patients accurately. However, only limited data are available concerning physicians' stress markers within these training environments. The aim of this pilot study was to investigate repetitive stress among healthcare professionals in simulated pre-hospital emergency scenarios using either SIM or SPs.
methodsTeams with one emergency medical services (EMS) physician and two paramedics completed three SIM scenarios and two SP scenarios consecutively. To evaluate stress, salivary cortisol and alpha-amylase were measured in saliva samples taken before, during and after the scenarios.
resultsA total of 14 EMS physicians (29% female; mean age: 36.8 ± 5.0 years; mean duration of EMS-experience: 9.1 ± 5.8 years) and 27 paramedics (11% female; age: 30.9 ± 6.9 years; EMS experience: 8.1 ± 6.0 years) completed the study. Alpha-amylase and cortisol levels did not differ significantly between the two professions. Cortisol values showed a gradual and statistically significant reduction over time but little change was observed in response to each scenario. In contrast, alpha-amylase activity increased significantly in response to every SIM and SP scenario, but there was no clear trend towards an overall increase or decrease over time.
conclusionIncreases in salivary alpha-amylase activity suggest that both SIM and SP training produce stress among emergency healthcare professionals. Corresponding increases in salivary cortisol levels were not observed. Among physicians in the emergency setting, it appears that alpha-amylase provides a more sensitive measure of stress levels than cortisol.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.