Evaluation of Paramedic clinical simulation stress: is it good or bad?

This follow-up study aims to investigate if Paramedic clinical simulation promotes stress and at what level is it helpful or harmful. Further investigation by way of qualitative feedback may well hold the answer to the experience of Paramedic clinical simulation and if the experience was harmful of provided benefit within a learning context.

Below follows a summary of key points discussed to date between all project partners (Paramedicine & CfLAT, AUT; Embodied Group, Chile) on the use of biometric feedback in Paramedic VR education (#MESH360 project). The key points represent a reflection on what we have learnt from the first prototype data collection event (August 2017), and considerations in preparation for the second biofeedback data collection event in late July 2018.


Methodology enhancement

  • Define baseline levels of stress (pre simulation biofeedback measurement / questionnaire)
  • Define baseline levels of GSR
  • Add sound stimulus (beep, crying person, etc.)
  • Record VR experience (first person point of view)
  • Ask participants if they recall external stimuli (multisensorial recall training)
  • Measure how the job simulation emotionally affects the student
  • Remplace pedal with a handheld unit (e.g. including gyroscope?). Note pedal will be replaced over time by algorithm (under development)
  • Replace GSR and Heart Rate units with a glove, to be able to measure biometric data during work with mannequin


Participant ID

  • Determine level of qualification / expertise / clinical background
  • Determine previous states potentially affecting biometric measurement, e.g. recent consumption of coffee, medicine or other similar products pre-simulation
  • Use Control participants (non-paramedicine related students / experts as control)
  • Cortisol measurement through saliva samples (good stress indicator – 30 min adjustments), to complement stress level measurements. Check for available kits


Pre-VR experience

  • Determine the level of stress/anxiety before the VR simulation. This is very important in entering a simulation process


VR experience

  • Increase duration of VR experience to homogenise the experience across participants (needed for comparison purposes). Ideal: Sequence of 2-3 VR scenarios, e.g. ambulance + scene 1 + scene 2
  • Make experience as immersive as possible (technology dependent). Level of VR technology used influences the experience
  • Adding multisensorial elements, e.g. sounds (ambulance, machinery, etc), smell, etc.


Potential pathways for research

  • Pre-simulation investigation (biometric baseline)
  • Simulation assessment
    • Check number of pedal (if used) hits and see if there are any patterns across demographic groups (eg novice vs expert). Important to consider level of stress before starting, during, and after the experience
  • Post-simulation assessment and debrief
  • Explore if wearing current version of embodied unit during simulation with mannequin is possible
  • Investigation of the cognitive influence of teamwork, e.g. measurement of crew mate during mannequin work
  • Amount of ‘appropriate’ Stress level for paramedicine students. Every student responds differently to stress (e.g. some act better under stress):
    • Look into how different lecturers deal with highly stressed students
    • Look into how students respond after 2-3 days of high stress scenarios
    • Start literature review on this topic (Stephen)
  • Investigation of external stimuli, e.g. sound, smell
  • Longitudinal study to follow the student journey over a 5-yr period determining evolution of stress levels across journey
  • Emotional triggers: how students connect with particular medical events that are familiar to them, e.g family members with similar experiences



Data Collection #2 (July 2018)

Methodological plan for upcoming event

  1. Participants to respond entry survey
  2. Participants will be presented with a 4 minutes long ‘Ambulance Ride’ VR experience, which will be divided as follows:
    1. Presentation of ‘calm’ scenario, e.g. nature scene, to smoothly introduce participants to the VR experience (15 seconds)
    2. Transition to static 360 Panorama of the back of the ambulance (45 seconds) to gain baseline data
    3. Transition to 360 video of the back of the ambulance including ambient sound (1 minute)
    4. Presentation of Job Description by Radio Call first, then by text box providing more details, followed by a Job update increasing complexity of job (radio first, then text box).
  3. Following the VR experience, the participants will move to do simulation work with the mannequin. Stressing ambient sound to be included
  4. Final debrief survey

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