{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:46:28Z","timestamp":1780065988539,"version":"3.54.0"},"reference-count":66,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T00:00:00Z","timestamp":1688169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","award":["ES\/P000630\/1"],"award-info":[{"award-number":["ES\/P000630\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asmepublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Education"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Experiencing psychological stress may affect clinician performance in acute emergencies. While simulation is used extensively in healthcare education, it is unknown whether simulation effectively replicates the psychophysiological stress of real\u2010world conditions. Thus, this study explored whether measurable differences exist in psychophysiological responses to acute stress in simulated compared with real\u2010world clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this within\u2010subjects observational study, stress appraisals, state anxiety and heart rate variability (HRV) were recorded during simulated and real\u2010world emergencies in a 6\u2010month training placement in neonatal medicine. Eleven postgraduate trainees and one advanced neonatal nurse practitioner participated. Mean (\n                      <jats:italic>SD<\/jats:italic>\n                      ) participant age was 33\u00a0(8)\u00a0years; and eight participants (67%) were female. Data were collected at rest and immediately before, during and 20\u2009min after simulated and real\u2010world neonatal emergencies. In situ simulation scenarios were modelled on those used in accredited neonatal basic life support training. Stress appraisals and state anxiety were assessed using Demand Resource Evaluation Scores and the short State\u2010Trait Anxiety Inventory, respectively. High\u2010frequency power, a component of HRV associated with parasympathetic tone, was derived from electrocardiogram recordings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Simulation was associated with greater likelihood of threat appraisal and higher state anxiety. High\u2010frequency HRV reduced from baseline in simulated and real\u2010world emergencies but recovered further towards baseline 20\u2009min after simulated events. Possible explanations for the observed differences between conditions include participants' previous experiences and expectations of simulation and the effect of post\u2010simulation debrief and feedback.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study identifies important differences in psychophysiological stress responses to simulated and real\u2010world emergencies. Threat appraisals, state anxiety and parasympathetic withdrawal are educationally and clinically significant, given their known associations with performance, social functioning and health regulation. While simulation may facilitate interventions aimed at optimising clinicians' stress responses, it is vital to confirm that outcomes transfer to real\u2010world clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/medu.15155","type":"journal-article","created":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T08:03:17Z","timestamp":1688198597000},"page":"1248-1256","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Psychophysiological fidelity: A comparative study of stress responses to real and simulated clinical emergencies"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3149-8414","authenticated-orcid":false,"given":"Russell","family":"Peek","sequence":"first","affiliation":[{"name":"Department for Health University of Bath  Bath UK"},{"name":"Department of Paediatrics and Child Health Gloucestershire Hospitals NHS Foundation Trust  Gloucester 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