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Original Research: Critical Care |

The Emotional and Cognitive Impact of Unexpected Simulated Patient DeathCognitive Impact of Simulated Patient Death: A Randomized Controlled Trial

Kristin Fraser, MD; James Huffman, MD; Irene Ma, MD; Matthew Sobczak, BSc; Joanne McIlwrick, MD; Bruce Wright, MD; Kevin McLaughlin, PhD
Author and Funding Information

From the Department of Medicine (Drs Fraser, Ma, and McLaughlin), Department of Emergency Medicine (Dr Huffman), Office of Undergraduate Medical Education (Mr Sobczak and Drs McIlwrick, Wright, and McLaughlin), Department of Psychiatry (Dr McIlwrick), and Department of Family Medicine (Dr Wright), University of Calgary, Calgary, AB, Canada.

Correspondence to: Kevin McLaughlin, PhD, Office of Undergraduate Medical Education, University of Calgary, Health Sciences Centre, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada; e-mail: kmclaugh@ucalgary.ca


For editorial comment see page 932

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):958-963. doi:10.1378/chest.13-0987
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Background:  Observational studies suggest that emotions experienced during simulation training may affect cognitive load and learning outcomes. The objective of this study was to manipulate emotions during simulation training and assess the impact on cognitive load and learning.

Methods:  In this prospective randomized trial, 116 final-year medical students received training in a simulated scenario of a 70-year-old woman presenting with reduced consciousness due to aminosalicylic acid ingestion. Training groups were randomly allocated to one of two endings for the scenario: The patient was transferred to another service, or she experienced a cardiorespiratory arrest and died. Participants rated their emotions and cognitive load after training. Three months later, we evaluated their performance on a simulation Objective Structured Clinical Examination station of a 60-year-old man presenting with reduced consciousness due to ethylene glycol ingestion.

Results:  Emotions tended to be more negative for students in training groups where the simulated patient died. These students also reported a higher cognitive load (mean ± SD, 7.63 ± 0.97 vs 7.25 ± 0.84; P = .03; d = 0.42) and were less likely to be rated as competent to diagnose and manage a patient with reduced consciousness due to toxin ingestion (OR, 0.37; 95% CI, 0.14-0.95; P = 0.04) 3 months later.

Conclusions:  Students exposed to unexpected simulated patient death reported increased cognitive load and had poorer learning outcomes. Educators need to expose learners to negative experiences; therefore, further studies are needed on how best to use negative emotional experiences during simulation training.

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