Décès pendant une simulation médicale : perspectives des apprenants et impacts sur le stress et la performance des réanimateurs
The acceptability of simulated death has been debated by experts, but there is scarce information regarding trainees' perspective. Pediatric trainees were invited to perform medical simulation, including pre and post questionnaires. Participants were exposed to 2 mock codes of neonates born pulseless. In the RESUSC scenario, the manikin responded to adequate resuscitation; in the DEATH scenario, the manikin remained pulseless. Mock codes were evaluated using the Neonatal Resuscitation Program score sheet. Debriefing was analyzed using qualitative methodology. Salivary cortisol was collected from participants (objective stress).  59/62 trainees answered the questionnaire, and 42 performed mock codes.  All trainees found mock codes beneficial and would appreciate being exposed to more.  Scenario or order of scenario did not affect performance. Only one trainee stopped resuscitation after 10 minutes of asystole, as recommended by clinical guidelines of Neonatal Resuscitation Program (NRP), and 31% had not ceased resuscitation efforts by 20 minutes.  Trainees found the DEATH scenario more stressful than RESUSC. Post-simulation salivary cortisol levels were significantly higher (p<0.001) than before simulation (for both scenario). This increase was not scenario dependent (p = 0.06) nor associated with performance scores. Trainees all answered the following question during debriefing: “How did this go for you?” Two themes were identified in their answers: 1. The manikin does not die; 2. Death equals inadequate resuscitation.  The death of the manikin was stressful, but trainees thought this was acceptable and prepared them for their future. Having a mannequin die during simulation does not interfere with their performance.
Stress Medical simulation resuscitation death neonatolatogy pediatrics palliative care medical education stress salivary cortisol Neonatal Resuscitation Program (NRP)