{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T19:03:18Z","timestamp":1776106998461,"version":"3.50.1"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum W\u00fcrzburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Multimedia Systems"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Medical graduates lack procedural skills experience required to manage emergencies. Recent advances in virtual reality (VR) technology enable the creation of highly immersive learning environments representing easy-to-use and affordable solutions for training with simulation. However, the feasibility in compulsory teaching, possible side effects of immersion, perceived stress, and didactic benefits have to be investigated systematically. VR-based training sessions using head-mounted displays alongside a real-time dynamic physiology system were held by student assistants for small groups followed by debriefing with a tutor. In the pilot study, 36 students rated simulation sickness. In the main study, 97 students completed a virtual scenario as active participants (AP) and 130 students as observers (OBS) from the first-person perspective on a monitor. Participants completed questionnaires for evaluation purposes and exploratory factor analysis was performed on the items. The extent of simulation sickness remained low to acceptable among participants of the pilot study. In the main study, students valued the realistic environment and guided practical exercise. AP perceived the degree of immersion as well as the estimated learning success to be greater than OBS and proved to be more motivated post training. With respect to AP, the factor \u201csense of control\u201d revealed a typical inverse U-shaped relationship to the scales \u201cdidactic value\u201d and \u201cindividual learning benefit\u201d. Summing up, curricular implementation of highly immersive VR-based training of emergencies proved feasible and found a high degree of acceptance among medical students. This study also provides insights into how different conceptions of perceived stress distinctively moderate subjective learning success.<\/jats:p>","DOI":"10.1007\/s00530-023-01102-0","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T04:02:27Z","timestamp":1683864147000},"page":"2239-2252","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Virtual reality in medical emergencies training: benefits, perceived stress, and learning success"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5660-8005","authenticated-orcid":false,"given":"Tobias","family":"M\u00fchling","sequence":"first","affiliation":[]},{"given":"Isabelle","family":"Sp\u00e4th","sequence":"additional","affiliation":[]},{"given":"Joy","family":"Backhaus","sequence":"additional","affiliation":[]},{"given":"Nathalie","family":"Milke","sequence":"additional","affiliation":[]},{"given":"Sebastian","family":"Oberd\u00f6rfer","sequence":"additional","affiliation":[]},{"given":"Alexander","family":"Meining","sequence":"additional","affiliation":[]},{"given":"Marc Erich","family":"Latoschik","sequence":"additional","affiliation":[]},{"given":"Sarah","family":"K\u00f6nig","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,5,12]]},"reference":[{"key":"1102_CR1","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1097\/ACM.0000000000000192","volume":"89","author":"MD McEvoy","year":"2014","unstructured":"McEvoy, M.D., Dewaay, D.J., Vanderbilt, A., et al.: Are fourth-year medical students as prepared to manage unstable patients as they are to manage stable patients? Acad. Med. 89, 618\u2013624 (2014). https:\/\/doi.org\/10.1097\/ACM.0000000000000192","journal-title":"Acad. Med."},{"key":"1102_CR2","doi-asserted-by":"publisher","first-page":"e013656","DOI":"10.1136\/bmjopen-2016-013656","volume":"7","author":"LV Monrouxe","year":"2017","unstructured":"Monrouxe, L.V., Grundy, L., Mann, M., et al.: How prepared are UK medical graduates for practice? A rapid review of the literature 2009-2014. BMJ Open 7, e013656 (2017). https:\/\/doi.org\/10.1136\/bmjopen-2016-013656","journal-title":"BMJ Open"},{"key":"1102_CR3","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1186\/s12909-018-1370-4","volume":"18","author":"TJ Bugaj","year":"2018","unstructured":"Bugaj, T.J., Nikendei, C., Groener, J.B., et al.: Ready to run the wards? A descriptive follow-up study assessing future doctors\u2019 clinical skills. BMC Med. Educ. 18, 257 (2018). https:\/\/doi.org\/10.1186\/s12909-018-1370-4","journal-title":"BMC Med. Educ."},{"key":"1102_CR4","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/1472-6920-11-99","volume":"11","author":"EB Ochsmann","year":"2011","unstructured":"Ochsmann, E.B., Zier, U., Drexler, H., et al.: Well prepared for work? Junior doctors\u2019 self-assessment after medical education. BMC Med. Educ. 11, 99 (2011). https:\/\/doi.org\/10.1186\/1472-6920-11-99","journal-title":"BMC Med. Educ."},{"key":"1102_CR5","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1111\/j.1365-2923.2011.04024.x","volume":"45","author":"VR Tallentire","year":"2011","unstructured":"Tallentire, V.R., Smith, S.E., Skinner, J., et al.: Understanding the behaviour of newly qualified doctors in acute care contexts. Med. Educ. 45, 995\u20131005 (2011). https:\/\/doi.org\/10.1111\/j.1365-2923.2011.04024.x","journal-title":"Med. Educ."},{"key":"1102_CR6","doi-asserted-by":"publisher","first-page":"103","DOI":"10.5116\/ijme.5380.6ef1","volume":"5","author":"HM Goodyear","year":"2014","unstructured":"Goodyear, H.M.: First year doctors experience of work related wellbeing and implications for educational provision. Int. J. Med. Educ. 5, 103\u2013109 (2014). https:\/\/doi.org\/10.5116\/ijme.5380.6ef1","journal-title":"Int. J. Med. Educ."},{"key":"1102_CR7","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/acem.12076","volume":"20","author":"JS Ilgen","year":"2013","unstructured":"Ilgen, J.S., Sherbino, J., Cook, D.A.: Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis. Acad. Emerg. Med. 20, 117\u2013127 (2013). https:\/\/doi.org\/10.1111\/acem.12076","journal-title":"Acad. Emerg. Med."},{"key":"1102_CR8","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/PEC.0b013e3182131fe0","volume":"27","author":"RP ten Eyck","year":"2011","unstructured":"ten Eyck, R.P.: Simulation in emergency medicine training. Pediatr. Emerg. Care 27, 333\u2013341 (2011). https:\/\/doi.org\/10.1097\/PEC.0b013e3182131fe0","journal-title":"Pediatr. Emerg. Care"},{"key":"1102_CR9","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1097\/00003246-199904000-00045","volume":"27","author":"HA Schwid","year":"1999","unstructured":"Schwid, H.A., Rooke, G.A., Ross, B.K., et al.: Use of a computerized advanced cardiac life support simulator improves retention of advanced cardiac life support guidelines better than a textbook review. Crit. Care Med. 27, 821\u2013824 (1999). https:\/\/doi.org\/10.1097\/00003246-199904000-00045","journal-title":"Crit. Care Med."},{"key":"1102_CR10","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.resuscitation.2010.10.025","volume":"82","author":"LP Roppolo","year":"2011","unstructured":"Roppolo, L.P., Heymann, R., Pepe, P., et al.: A randomized controlled trial comparing traditional training in cardiopulmonary resuscitation (CPR) to self-directed CPR learning in first year medical students: the two-person CPR study. Resuscitation 82, 319\u2013325 (2011). https:\/\/doi.org\/10.1016\/j.resuscitation.2010.10.025","journal-title":"Resuscitation"},{"key":"1102_CR11","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1017\/s1049023x00008505","volume":"25","author":"WL Heinrichs","year":"2010","unstructured":"Heinrichs, W.L., Youngblood, P., Harter, P., et al.: Training healthcare personnel for mass-casualty incidents in a virtual emergency department: VED II. Prehosp. Disaster. Med. 25, 424\u2013432 (2010). https:\/\/doi.org\/10.1017\/s1049023x00008505","journal-title":"Prehosp. Disaster. Med."},{"key":"1102_CR12","doi-asserted-by":"publisher","first-page":"e0203851","DOI":"10.1371\/journal.pone.0203851","volume":"13","author":"A Middeke","year":"2018","unstructured":"Middeke, A., Anders, S., Schuelper, M., et al.: Training of clinical reasoning with a Serious Game versus small-group problem-based learning: a prospective study. PLoS\u00a0One 13, e0203851 (2018). https:\/\/doi.org\/10.1371\/journal.pone.0203851","journal-title":"PLoS\u00a0One"},{"key":"1102_CR13","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1162\/pres.1997.6.6.603","volume":"6","author":"M Slater","year":"1997","unstructured":"Slater, M., Wilbur, S.: A framework for immersive virtual environments (FIVE): speculations on the role of presence in virtual environments. Presence 6, 603\u2013616 (1997). https:\/\/doi.org\/10.1162\/pres.1997.6.6.603","journal-title":"Presence"},{"key":"1102_CR14","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1111\/acem.13308","volume":"25","author":"JL McGrath","year":"2018","unstructured":"McGrath, J.L., Taekman, J.M., Dev, P., et al.: Using virtual reality simulation environments to assess competence for emergency medicine learners. Acad. Emerg. Med. 25, 186\u2013195 (2018). https:\/\/doi.org\/10.1111\/acem.13308","journal-title":"Acad. Emerg. Med."},{"key":"1102_CR15","doi-asserted-by":"publisher","first-page":"e12959","DOI":"10.2196\/12959","volume":"21","author":"BM Kyaw","year":"2019","unstructured":"Kyaw, B.M., Saxena, N., Posadzki, P., et al.: Virtual reality for health professions education: systematic review and meta-analysis by the digital health education collaboration. J. Med. Internet Res. 21, e12959 (2019). https:\/\/doi.org\/10.2196\/12959","journal-title":"J. Med. Internet Res."},{"key":"1102_CR16","first-page":"155","volume":"125","author":"F Guti\u00e9rrez","year":"2007","unstructured":"Guti\u00e9rrez, F., Pierce, J., Vergara, V.M., et al.: The effect of degree of immersion upon learning performance in virtual reality simulations for medical education. Stud. Health Technol. Inform. 125, 155\u2013160 (2007)","journal-title":"Stud. Health Technol. Inform."},{"key":"1102_CR17","doi-asserted-by":"crossref","unstructured":"Davis S, Nesbitt K, Nalivaiko E: A Systematic Review of Cybersickness. In: Blackmore K, Nesbitt K, Smith SP (eds) Proceedings of the 2014 Conference on Interactive Entertainment. ACM, New York, NY. pp 1\u20139 (2014)","DOI":"10.1145\/2677758.2677780"},{"key":"1102_CR18","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.ijsu.2016.03.034","volume":"29","author":"M Alaker","year":"2016","unstructured":"Alaker, M., Wynn, G.R., Arulampalam, T.: Virtual reality training in laparoscopic surgery: a systematic review & meta-analysis. Int. J. Surg. 29, 85\u201394 (2016). https:\/\/doi.org\/10.1016\/j.ijsu.2016.03.034","journal-title":"Int. J. Surg."},{"key":"1102_CR19","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1016\/j.wneu.2017.06.140","volume":"106","author":"A Bernardo","year":"2017","unstructured":"Bernardo, A.: Virtual reality and simulation in neurosurgical training. World Neurosurg. 106, 1015\u20131029 (2017). https:\/\/doi.org\/10.1016\/j.wneu.2017.06.140","journal-title":"World Neurosurg."},{"key":"1102_CR20","doi-asserted-by":"publisher","first-page":"e29586","DOI":"10.2196\/29586","volume":"9","author":"T Birrenbach","year":"2021","unstructured":"Birrenbach, T., Zbinden, J., Papagiannakis, G., et al.: Effectiveness and utility of virtual reality simulation as an educational tool for safe performance of COVID-19 diagnostics: prospective randomized pilot trial. JMIR Serious Games 9, e29586 (2021). https:\/\/doi.org\/10.2196\/29586","journal-title":"JMIR Serious Games"},{"key":"1102_CR21","volume-title":"Medical and surgical education\u2014past present and future","author":"P Pantelidis","year":"2018","unstructured":"Pantelidis, P., Chorti, A., Papagiouvanni, I., et al.: Virtual and augmented reality in medical education. In: Tsoulfas, G. (ed.) Medical and surgical education\u2014past present and future. InTech, London (2018)"},{"key":"1102_CR22","doi-asserted-by":"publisher","DOI":"10.1002\/bdm.2242","author":"K Skagerlund","year":"2022","unstructured":"Skagerlund, K., Forsblad, M., Tingh\u00f6g, G., et al.: Decision-making competence and cognitive abilities: which abilities matter? Behav. Decis. Mak. (2022). https:\/\/doi.org\/10.1002\/bdm.2242","journal-title":"Behav. Decis. Mak."},{"key":"1102_CR23","doi-asserted-by":"publisher","unstructured":"Costello AB, Osborne J: Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. PARE.\n2005;10:7. https:\/\/doi.org\/10.7275\/jyj1-4868","DOI":"10.7275\/jyj1-4868"},{"key":"1102_CR24","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/j.jsurg.2020.10.015","volume":"78","author":"C Klemmt","year":"2021","unstructured":"Klemmt, C., Backhaus, J., Jeske, D., et al.: Psychometric properties and calibration of the SPOREEM (students\u2019 perception of the operating room educational environment measure). J. Surg. Educ. 78, 1151\u20131163 (2021). https:\/\/doi.org\/10.1016\/j.jsurg.2020.10.015","journal-title":"J. Surg. Educ."},{"key":"1102_CR25","first-page":"1","volume-title":"Noise reduction in speech processing","author":"J Benesty","year":"2009","unstructured":"Benesty, J., Chen, J., Huang, Y., et al.: Pearson correlation coefficient. In: Cohen, I., Huang, Y., Chen, J., et al. (eds.) Noise reduction in speech processing, vol. 2, pp. 1\u20134. Springer, Berlin, Heidelberg (2009)"},{"key":"1102_CR26","doi-asserted-by":"publisher","first-page":"431","DOI":"10.2307\/2281561","volume":"19","author":"M Ezekiel","year":"1924","unstructured":"Ezekiel, M.: A method of handling curvilinear correlation for any number of variables. J. Am. Stat. Assoc. 19, 431 (1924). https:\/\/doi.org\/10.2307\/2281561","journal-title":"J. Am. Stat. Assoc."},{"key":"1102_CR27","volume-title":"Wiley series in probability and statistics and statistics Ser, v.333","author":"RJA Little","year":"2002","unstructured":"Little, R.J.A.: Statistical analysis with missing data. In: Wiley series in probability and statistics and statistics Ser, v.333, 2nd edn. John Wiley & Sons Incorporated, New York (2002)","edition":"2"},{"key":"1102_CR28","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1002\/cne.920180503","volume":"18","author":"RM Yerkes","year":"1908","unstructured":"Yerkes, R.M., Dodson, J.D.: The relation of strength of stimulus to rapidity of habit-formation. J. Comp. Neurol. Psychol. 18, 459\u2013482 (1908). https:\/\/doi.org\/10.1002\/cne.920180503","journal-title":"J. Comp. Neurol. Psychol."},{"key":"1102_CR29","doi-asserted-by":"publisher","first-page":"e18822","DOI":"10.2196\/18822","volume":"8","author":"D Lerner","year":"2020","unstructured":"Lerner, D., Mohr, S., Schild, J., et al.: An immersive multi-user virtual reality for emergency simulation training: usability study. JMIR Serious Games 8, e18822 (2020). https:\/\/doi.org\/10.2196\/18822","journal-title":"JMIR Serious Games"},{"key":"1102_CR30","unstructured":"Pawlik V (2022) Umfrage unter Frauen und M\u00e4nnern zur H\u00e4ufigkeit des Spielens von Computerspielen 2021. https:\/\/de.statista.com\/statistik\/daten\/studie\/828207\/umfrage\/umfrage-unter-frauen-und-maennern-zur-haeufigkeit-des-spielens-von-computerspielen\/"},{"key":"1102_CR31","doi-asserted-by":"publisher","first-page":"Doc100","DOI":"10.3205\/zma001496","volume":"38","author":"S Walter","year":"2021","unstructured":"Walter, S., Speidel, R., Hann, A., et al.: Skepticism towards advancing VR technology\u2014student acceptance of VR as a teaching and assessment tool in medicine. GMS J. Med. Educ. 38, Doc100 (2021). https:\/\/doi.org\/10.3205\/zma001496","journal-title":"GMS J. Med. Educ."},{"key":"1102_CR32","doi-asserted-by":"publisher","first-page":"96","DOI":"10.3389\/fnhum.2020.00096","volume":"14","author":"D Saredakis","year":"2020","unstructured":"Saredakis, D., Szpak, A., Birckhead, B., et al.: Factors associated with virtual reality sickness in head-mounted displays: a systematic review and meta-analysis. Front. Hum. Neurosci. 14, 96 (2020). https:\/\/doi.org\/10.3389\/fnhum.2020.00096","journal-title":"Front. Hum. Neurosci."},{"key":"1102_CR33","doi-asserted-by":"publisher","first-page":"203","DOI":"10.3233\/VES-130501","volume":"23","author":"AC Paillard","year":"2013","unstructured":"Paillard, A.C., Quarck, G., Paolino, F., et al.: Motion sickness susceptibility in healthy subjects and vestibular patients: effects of gender, age and trait-anxiety. J. Vestib. Res. 23, 203\u2013209 (2013). https:\/\/doi.org\/10.3233\/VES-130501","journal-title":"J. Vestib. Res."},{"key":"1102_CR34","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s10916-021-01737-4","volume":"45","author":"L Campillos-Llanos","year":"2021","unstructured":"Campillos-Llanos, L., Thomas, C., Bilinski, \u00c9., et al.: Lessons learned from the usability evaluation of a simulated patient dialogue system. J. Med. Syst. 45, 69 (2021). https:\/\/doi.org\/10.1007\/s10916-021-01737-4","journal-title":"J. Med. Syst."},{"key":"1102_CR35","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1097\/SIH.0000000000000195","volume":"12","author":"K Maicher","year":"2017","unstructured":"Maicher, K., Danforth, D., Price, A., et al.: Developing a conversational virtual standardized patient to enable students to practice history-taking skills. Simul. Healthc. 12, 124\u2013131 (2017). https:\/\/doi.org\/10.1097\/SIH.0000000000000195","journal-title":"Simul. Healthc."},{"key":"1102_CR36","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1002\/j.0022-0337.2002.66.1.tb03510.x","volume":"66","author":"AE Sanders","year":"2002","unstructured":"Sanders, A.E., Lushington, K.: Effect of perceived stress on student performance in dental school. J. Dent. Educ. 66, 75\u201381 (2002)","journal-title":"J. Dent. Educ."},{"key":"1102_CR37","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1111\/j.1600-0579.2010.00640.x","volume":"15","author":"AM Alzahem","year":"2011","unstructured":"Alzahem, A.M., van der Molen, H.T., Alaujan, A.H., et al.: Stress amongst dental students: a systematic review. Eur. J. Dent. Educ. 15, 8\u201318 (2011). https:\/\/doi.org\/10.1111\/j.1600-0579.2010.00640.x","journal-title":"Eur. J. Dent. Educ."},{"key":"1102_CR38","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.bbr.2018.06.013","volume":"353","author":"D Momi","year":"2018","unstructured":"Momi, D., Smeralda, C., Sprugnoli, G., et al.: Acute and long-lasting cortical thickness changes following intensive first-person action videogame practice. Behav. Brain. Res. 353, 62\u201373 (2018). https:\/\/doi.org\/10.1016\/j.bbr.2018.06.013","journal-title":"Behav. Brain. Res."},{"key":"1102_CR39","doi-asserted-by":"publisher","first-page":"673","DOI":"10.3758\/s13414-013-0440-2","volume":"75","author":"S Wu","year":"2013","unstructured":"Wu, S., Spence, I.: Playing shooter and driving videogames improves top-down guidance in visual search. Atten. Percept. Psychophys. 75, 673\u2013686 (2013). https:\/\/doi.org\/10.3758\/s13414-013-0440-2","journal-title":"Atten. Percept. Psychophys."},{"key":"1102_CR40","doi-asserted-by":"publisher","first-page":"e02583","DOI":"10.1016\/j.heliyon.2019.e02583","volume":"5","author":"J Piccione","year":"2019","unstructured":"Piccione, J., Collett, J., de Foe, A.: Virtual skills training: the role of presence and agency. Heliyon 5, e02583 (2019). https:\/\/doi.org\/10.1016\/j.heliyon.2019.e02583","journal-title":"Heliyon"},{"key":"1102_CR41","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.concog.2017.06.015","volume":"53","author":"D Makowski","year":"2017","unstructured":"Makowski, D., Sperduti, M., Nicolas, S., et al.: \u201cBeing there\u201d and remembering it: presence improves memory encoding. Conscious Cogn. 53, 194\u2013202 (2017). https:\/\/doi.org\/10.1016\/j.concog.2017.06.015","journal-title":"Conscious Cogn."},{"key":"1102_CR42","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1097\/SIH.0000000000000347","volume":"14","author":"M-S Bracq","year":"2019","unstructured":"Bracq, M.-S., Michinov, E., Jannin, P.: Virtual reality simulation in nontechnical skills training for healthcare professionals: a systematic review. Simul. Healthc. 14, 188\u2013194 (2019). https:\/\/doi.org\/10.1097\/SIH.0000000000000347","journal-title":"Simul. Healthc."},{"key":"1102_CR43","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.psyneuen.2010.06.011","volume":"36","author":"A Keitel","year":"2011","unstructured":"Keitel, A., Ringleb, M., Schwartges, I., et al.: Endocrine and psychological stress responses in a simulated emergency situation. Psychoneuroendocrinology 36, 98\u2013108 (2011). https:\/\/doi.org\/10.1016\/j.psyneuen.2010.06.011","journal-title":"Psychoneuroendocrinology"},{"key":"1102_CR44","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.psyneuen.2012.05.009","volume":"38","author":"LK McGraw","year":"2013","unstructured":"McGraw, L.K., Out, D., Hammermeister, J.J., et al.: Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation. Psychoneuroendocrinology 38, 135\u2013144 (2013). https:\/\/doi.org\/10.1016\/j.psyneuen.2012.05.009","journal-title":"Psychoneuroendocrinology"},{"key":"1102_CR45","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1097\/SLA.0b013e3181b3b2be","volume":"251","author":"CM Wetzel","year":"2010","unstructured":"Wetzel, C.M., Black, S.A., Hanna, G.B., et al.: The effects of stress and coping on surgical performance during simulations. Ann. Surg. 251, 171\u2013176 (2010). https:\/\/doi.org\/10.1097\/SLA.0b013e3181b3b2be","journal-title":"Ann. Surg."},{"key":"1102_CR46","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18105448","author":"E Mauriz","year":"2021","unstructured":"Mauriz, E., Caloca-Amber, S., C\u00f3rdoba-Murga, L., et al.: Effect of psychophysiological stress and socio-emotional competencies on the clinical performance of nursing students during a simulation practice. Int. J. Environ. Res. Public Health (2021). https:\/\/doi.org\/10.3390\/ijerph18105448","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"1102_CR47","doi-asserted-by":"publisher","first-page":"551","DOI":"10.3928\/01484834-20160914-02","volume":"55","author":"JN Shearer","year":"2016","unstructured":"Shearer, J.N.: Anxiety, nursing students, and simulation: state of the science. J. Nurs. Educ. 55, 551\u2013554 (2016). https:\/\/doi.org\/10.3928\/01484834-20160914-02","journal-title":"J. Nurs. Educ."},{"key":"1102_CR48","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1037\/a0016563","volume":"98","author":"SE Taylor","year":"2010","unstructured":"Taylor, S.E., Seeman, T.E., Eisenberger, N.I., et al.: Effects of a supportive or an unsupportive audience on biological and psychological responses to stress. J. Pers. Soc. Psychol. 98, 47\u201356 (2010). https:\/\/doi.org\/10.1037\/a0016563","journal-title":"J. Pers. Soc. Psychol."},{"key":"1102_CR49","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s12909-018-1338-4","volume":"18","author":"B Bensouda","year":"2018","unstructured":"Bensouda, B., Mandel, R., Mejri, A., et al.: Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial. BMC Med. Educ. 18, 230 (2018). https:\/\/doi.org\/10.1186\/s12909-018-1338-4","journal-title":"BMC Med. Educ."},{"key":"1102_CR50","doi-asserted-by":"publisher","DOI":"10.3390\/s19173805","author":"K Kyriakou","year":"2019","unstructured":"Kyriakou, K., Resch, B., Sagl, G., et al.: Detecting moments of stress from measurements of wearable physiological sensors. Sens. (Basel) (2019). https:\/\/doi.org\/10.3390\/s19173805","journal-title":"Sens. (Basel)"},{"key":"1102_CR51","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/SIH.0000000000000402","volume":"15","author":"R Bhoja","year":"2020","unstructured":"Bhoja, R., Guttman, O.T., Fox, A.A., et al.: Psychophysiological stress indicators of heart rate variability and electrodermal activity with application in healthcare simulation research. Simul Healthc 15, 39\u201345 (2020). https:\/\/doi.org\/10.1097\/SIH.0000000000000402","journal-title":"Simul Healthc"}],"container-title":["Multimedia Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00530-023-01102-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00530-023-01102-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00530-023-01102-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T06:29:18Z","timestamp":1689316158000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00530-023-01102-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,12]]},"references-count":51,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["1102"],"URL":"https:\/\/doi.org\/10.1007\/s00530-023-01102-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-2197674\/v1","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-2197674\/v2","asserted-by":"object"}]},"ISSN":["0942-4962","1432-1882"],"issn-type":[{"value":"0942-4962","type":"print"},{"value":"1432-1882","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,12]]},"assertion":[{"value":"11 November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 April 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Tobias M\u00fchling was involved in the software development process of STEP-VR.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}