gms | German Medical Science

Introduction: Cardiopulmonary resuscitation (CPR) is a crucial skillset which can be taught using high-fidelity simulation. Simulation is a recognised method for teaching procedural skills [1]. Stress may have crucial impact on the learning process [2]. The influence of stress and cognitive load on learning is not entirely known [3]. Over one semester, we investigated the possible influence of context sensitive stress on the learning of CPR in a view to assess the possible effects of stress and changes in cognitive load on student performance.

Methods: 107 students performed baseline and second CPR simulations before and after their teaching sessions in randomised groups respectively. Baseline and second simulations were recorded and graded. The control group received traditional CPR training, the intervention group was taught with various stress factors. Students then repeated the simulation at the end of the semester under OSCE conditions. All simulations were graded using a standard checklist. Cognitive load and perceived stress were quantified using validated questionnaires and scoring scales respectively. Protocol was considered violated if students did not participate in all simulations (19 Participants). A two-way-RM ANOVA for analysis of recordings, Mann-Whitney U test for final exam results and unpaired Student’s t-test was used to quantify group differences and questionnaire scores.

Results: Demographics were well matched. Identifying characteristics showed a female preponderance, 64,9%. 13%percent of students reported previous medical experience such as nursing or paramedic experience. The mean age was 25 years.

We found a significant improvement in second performance F(1,32)=185.743, p<.001, but no effect of stress on performance F(1)=3.946, p=.056. Results during OSCE for intervention group (M_Rank=31,21), control group (M_Rank=33,87), p=.549 showed no differences. Questionnaires revealed no differences between the groups in stress scores (Baseline stress: t(72,70.956)=1.312, p=.194 ; stress before: t(60,59.830)=-.325, p=.746; stress after: t(58,56.729)=1.398, p=.167). Cognitive load differences between the two groups were significant reflecting an increased cognitive load in the intervention group (M=40.23 SD=7.274)compared to control (M=33.17 SD=5.393), t(42)=3.503, p=0.001, d=6.578). This increase was found in extrinsic cognitive load in the intervention group (M=8.23SD=2.673) and control group (M=6.61 SD=2,146), t(42)=2.136, p=.039, d=2.473 and germane cognitive load in the intervention group (M=8.42 SD=3.420) compared to control group (M=6.0 SD=2.544), t(42)=2.553, p=.014, d=3.095.

Discussion: Stress during CPR increases cognitive load but does not significantly influence learner’s performance in CPR during a high-fidelity simulation training as evidenced by unchanged p values throughtought the tests.

Take home message: Stress and increased cognitive load may not have any negative impacts on learning.