Impact of stress on EEG functional connectivity during procedural learning.

Objective: In a procedural learning environment, trainees acquire skills for managing life-threatening emergencies, a context that inherently elicits stress. While moderate stress can enhance memory consolidation, excessive stress (distress) may impair learning and performance. Here we elucidated the neurophysiological effects of stress on learners during a procedural learning task. Methods: We examined the effects of stress on learning by assessing EEG functional connectivity (FC) in medical trainees during endotracheal intubation. The cohort comprised medical trainees who were monitored at baseline (rest) and during two high-fidelity simulation scenarios: a calm condition and a stressful condition (intubation during anesthesia induction). Concurrent data were collected, including heart rate, eye blinks and self-reported measures of perceived stress and cognitive load. Results: High-fidelity simulation reliably provokes a physiological stress response, predominantly mediated by sympathetic nervous system activation. Across conditions, FC increased relative to baseline, indicating heightened neural network synchronization during task engagement. Notably, under the stressful condition, FC was further elevated compared with the calm scenario, suggesting that stress within a defined range may enhance neural communication efficiency and learning capacity. Conclusions: These findings imply a potential neurophysiological signature of stress that could be leveraged to design personalized educational interventions, calibrating stress levels to optimize learning while mitigating deleterious effects. Significance: The study demonstrates the feasibility of using real-time EEG to monitor stress-related neural dynamics in medical trainees and underscores the importance of integrating neurophysiological insights into the development of training environments.