<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03233750</url>
  </required_header>
  <id_info>
    <org_study_id>20170081-01H</org_study_id>
    <nct_id>NCT03233750</nct_id>
  </id_info>
  <brief_title>Simulation-Based Stress Inoculation Training</brief_title>
  <official_title>Preparing for High Acuity Events: Simulation-Based Stress Inoculation Training</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Ottawa Hospital Research Institute</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>University of Toronto</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Ottawa Hospital Research Institute</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Previous research has shown that health professionals can experience stress responses during&#xD;
      high acuity events such as trauma resuscitations. These stress responses can lead to impaired&#xD;
      clinical performance. The goal of this proposed project is to adapt Stress Inoculation&#xD;
      Training (SIT) to the healthcare setting. Stress Inoculation Training is a&#xD;
      cognitive-behavioural approach to stress management that has proven effective in reducing&#xD;
      stress and improving performance in domains outside of healthcare.&#xD;
&#xD;
      Thirty-two emergency medicine residents will be randomly divided into two groups. The SIT&#xD;
      group will receive the simulation-based stress inoculation training. We will measure the&#xD;
      effectiveness of the training by looking at reduction of stress levels and improvements in&#xD;
      clinical performance in a pre-intervention and a post-intervention simulated trauma scenario.&#xD;
      The control group will be exposed to the same simulation scenarios and pre/post intervention&#xD;
      scenarios as the SIT group, but will not receive the stress inoculation training.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Health care contains many stressors for health professionals, both chronic and acute. There&#xD;
      is accumulating evidence that clinical performance can be significantly impaired by stress&#xD;
      responses during acute events, both in the psychology and healthcare domains. Paramedics,&#xD;
      medical residents and surgeons have all shown impaired performance when faced with high&#xD;
      acuity situations that triggered subjective and physiological stress responses. Impairments&#xD;
      have been observed in the ability to perform drug calculations, trauma and cardiac&#xD;
      resuscitations, in technical skills, as well as on tasks that rely on memory recall. In some&#xD;
      cases, the magnitude of the stress response has been associated with the degree of&#xD;
      performance impairments. In many studies in which performance impairments have been observed,&#xD;
      baseline levels of performance were acceptable, suggesting that these impairments are not due&#xD;
      to a lack of relevant knowledge or skills required to provide patient care in these&#xD;
      situations.&#xD;
&#xD;
      The findings of impaired performance with stress responses suggests that training for high&#xD;
      acuity events needs to go beyond training that is oriented solely towards the acquisition of&#xD;
      clinical skills and knowledge. Training needs to also include interventions aimed at&#xD;
      developing the trainees' ability to cope with stressors and to minimize their personal stress&#xD;
      responses. In the psychology, aviation and military domains, several approaches have been&#xD;
      developed to optimize performance during stressful events. These can be categorized either as&#xD;
      skills-based training (providing individuals or teams with the specific skills required&#xD;
      during a crisis) or as stress management interventions (modifying the individual's appraisal&#xD;
      of potentially stressful situations).&#xD;
&#xD;
      The implementation of skill based training, such as crisis resource management (CRM), has&#xD;
      resulted in improved performance in team interactions. However, CRM-type of training requires&#xD;
      that health professionals be able to remember those skills that were learned, yet memory&#xD;
      recall is often impaired under stress. As for overlearning, it can lead to rigid approaches&#xD;
      to problem solving, and is less likely to be efficient in dynamic situations that require&#xD;
      flexibility in approaches and judgment. Therefore, educators also need to develop&#xD;
      complementary approaches to train health professionals in recognizing stress responses and in&#xD;
      managing and minimizing their emotional responses. Stress management approaches are focused&#xD;
      on reducing the emotional and physiological response itself. The premise is that by reducing&#xD;
      the stress response, the cognitive facilities (including recall of relevant knowledge and&#xD;
      skills) required during a high acuity situation are more likely to remain intact.&#xD;
&#xD;
      Two important predictors of stress responses to high acuity events are individuals' coping&#xD;
      styles and their cognitive appraisals of the situation. Task-oriented coping styles, as well&#xD;
      as appraisals of perceived resources being equal to or above the perceived demands of a&#xD;
      situation, are associated with lower stress responses in high acuity events. As such, stress&#xD;
      management approaches focused on coping styles and cognitive structuring are likely to reduce&#xD;
      the subjective and physiological stress responses of clinicians and trainees during high&#xD;
      acuity events.&#xD;
&#xD;
      A promising method of reducing stress responses and performance impairments under acutely&#xD;
      stressful conditions is stress inoculation training (SIT). This 3-phase cognitive-behavioural&#xD;
      approach to stress management has proven effective in domains outside of healthcare. SIT has&#xD;
      been found to be effective in reducing general state anxiety, performance anxiety (anxiety&#xD;
      specific to the skills being addressed in the training), and in enhancing performance under&#xD;
      stress. SIT appears to be effective when run with groups of 8-10 participants and it can be&#xD;
      implemented successfully without an inordinate number of training sessions. Finally, the&#xD;
      beneficial effects of the SIT can generalize to novel stress conditions and novel tasks,&#xD;
      which is crucial for any applied area in which the conditions of real life environments are&#xD;
      often dynamic, ambiguous and emergent.&#xD;
&#xD;
      The proposed study consists of the adaptation and evaluation of a simulation-based stress&#xD;
      inoculation training (SIT) intervention for Emergency Medicine and Surgery residents during&#xD;
      trauma rotations.&#xD;
&#xD;
      SPECIFIC AIMS AND HYPOTHESES The study hypothesis is that residents who have received the SIT&#xD;
      intervention will have lower stress levels and higher performance levels during a&#xD;
      post-intervention simulated trauma scenario than will residents in a control group.&#xD;
&#xD;
      SIGNIFICANCE During high acuity events, such as pre-hospital, trauma and cardiac&#xD;
      resuscitations, patient care must be provided in conditions that can be noisy, chaotic, time&#xD;
      pressured and with uncertainty. These conditions, and the urgent nature of the care required,&#xD;
      are very unforgiving to gaps in recall, attention or decision-making. In these environments,&#xD;
      research has shown that health professionals experience significant stress responses and that&#xD;
      these stress responses can lead to impairments in memory, attention and clinical performance.&#xD;
&#xD;
      Adapting a proven stress training approach to healthcare has the possibility of significantly&#xD;
      improving care to patients during high acuity events, both in terms of care during the high&#xD;
      acuity component of care, as well as further along in the chain of care.&#xD;
&#xD;
      INNOVATION If, as predicted, the results of this study reveal that stress inoculation&#xD;
      training is effective for preparing emergency medicine and surgery residents, in terms of&#xD;
      reducing their stress levels and increasing their performance during simulated trauma&#xD;
      resuscitation, this proposed study will be further developed for a multi-centre study with&#xD;
      outcome measures of stress and performance during actual patient events.&#xD;
&#xD;
      In the development of the course content and scenarios for the SIT training in the context, a&#xD;
      course manual will be produced. This manual will be shared with colleagues internationally,&#xD;
      for the purposes of adapting and validating the course internationally and in a variety of&#xD;
      clinical contexts.&#xD;
&#xD;
      APPROACH The proposed study of stress inoculation training (SIT) intervention will be for&#xD;
      emergency medicine and surgery residents during trauma rotations. The adaptation of SIT to&#xD;
      the trauma context will consist of a 3-phase training intervention, conducted over one 1/2&#xD;
      day session.&#xD;
&#xD;
      Phase 1: Conceptualization / Educational Phase (60 minutes) The goal of this phase is to help&#xD;
      individuals gain a better understanding of the nature of stress and its effects. This phase&#xD;
      will focus on the provision of preparatory information, to allow the participants to form&#xD;
      accurate expectations regarding the stress environment and stress reaction that can occur&#xD;
      during trauma cases. The goal is to provide the participants with a sense of predictability&#xD;
      and control. This phase will consist of descriptions of the stressors encountered in the&#xD;
      clinical setting, the provision of information about how these stressors might make the&#xD;
      participants feel affect performance.&#xD;
&#xD;
      Phase 2: Skill Acquisition and Rehearsal (60 minutes) The objective of this phase is the&#xD;
      development and practice of cognitive restructuring techniques and relaxing training to&#xD;
      reduce anxiety and enhance the individual's capacity to respond effectively to stressful&#xD;
      situations. The cognitive restructuring techniques will provide the participants with the&#xD;
      skills to regulate negative emotions and distracting thoughts brought on by stressors. The&#xD;
      relaxation training will provide the participants with the skills to enhance physiological&#xD;
      control, such as awareness and control of muscle tension and breathing. The session will&#xD;
      include mental imagery and visualization exercises to allow the participants to practice the&#xD;
      skills in a low stress environment.&#xD;
&#xD;
      Phase 3: Application of Coping Skills (180 minutes) In this phase, the coping skills are&#xD;
      applied in increasingly stressful conditions that approximate the real-world stressor&#xD;
      environment. Participants will practice the cognitive restructuring and relaxation skills in&#xD;
      a series of simulated trauma scenarios in which they will be exposed to increasing levels of&#xD;
      stress in a gradual manner. All of the scenarios will be developed using a combination of&#xD;
      computerized mannequin-based simulators and standardized patients (SP). The use of simulation&#xD;
      modalities allows investigators to carefully manipulate the levels of stressors inherent in&#xD;
      each scenario and to control for any extraneous factors beyond the intervention that could&#xD;
      influence stress responses and performance.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">September 15, 2017</start_date>
  <completion_date type="Actual">August 30, 2019</completion_date>
  <primary_completion_date type="Actual">August 30, 2019</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <intervention_model_description>This is a cohort study, comparing two interventions aimed at decreasing stress responses during acute events, with a pre and a post intervention assessment.</intervention_model_description>
    <primary_purpose>Treatment</primary_purpose>
    <masking>Single (Outcomes Assessor)</masking>
    <masking_description>Group assignment will be masked from the assessors of performance. Expert educators will score videotaped performances of the participants obtained pre and post intervention. Assessors will be blinded to group allocation as well as to whether the video they are scoring is of the pre or the post intervention scenario.</masking_description>
  </study_design_info>
  <primary_outcome>
    <measure>Change in scores on State-Trait Anxiety Inventory</measure>
    <time_frame>prior to each scenairo as well as immediately at the end of each simulation scenario</time_frame>
    <description>Subjective stress measure</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in salivary cortisol levels</measure>
    <time_frame>prior to each scenario, as well as 20 and 30 minutes after each scenario</time_frame>
    <description>physiological indicator of stress</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Performance</measure>
    <time_frame>Experts will review the videotapes of the scenarios within one month of data collection</time_frame>
    <description>Expert scoring of clinical management of the scenario</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">20</enrollment>
  <condition>Stress, Psychological</condition>
  <arm_group>
    <arm_group_label>Stress Inoculation Training</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Phase 1: Conceptualization / Educational Phase (60 minutes) Provision of preparatory information, to allow the participants to form accurate expectations regarding the stress environment and stress reactions.&#xD;
Phase 2: Skill Acquisition and Rehearsal (60 minutes) Development and practice of cognitive restructuring techniques and relaxing training to reduce anxiety and enhance the individual's capacity to respond effectively to stressful situations, in low stress conditions.&#xD;
Phase 3: Application of Coping Skills (180 minutes) Coping skills are applied in increasingly stressful conditions that approximate the real-world stressor environment.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Crisis Resource Management Training</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>The CRM training targets the non-technical skills (e.g. behavioural and cognitive skills) required for effective teamwork during crisis situations. It focuses on communication, teamwork, situational awareness and leadership</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Stress Inoculation Training</intervention_name>
    <description>see description in arm/group descriptions</description>
    <arm_group_label>Stress Inoculation Training</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Crisis Resource Management</intervention_name>
    <description>During each scenario, facilitators identify performance gaps in either situation awareness, leadership, communication or resource allocations. During debriefing session, these are raised with the learner and their cognitive frames are identified and corrected as necessary.</description>
    <arm_group_label>Crisis Resource Management Training</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Emergency medicine residents enrolled in post graduate training at the University of&#xD;
             Toronto or the University of Ottawa&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  endocrine disease or medication that can affect cortisol levels or responses&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>25 Years</minimum_age>
    <maximum_age>45 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Vicki LeBlanc, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of Ottawa</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>University of Ottawa Skills and Simulation Centre</name>
      <address>
        <city>Ottawa</city>
        <state>Ontario</state>
        <zip>K1Y 4E9</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Canada</country>
  </location_countries>
  <verification_date>March 2023</verification_date>
  <study_first_submitted>July 13, 2017</study_first_submitted>
  <study_first_submitted_qc>July 26, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">July 31, 2017</study_first_posted>
  <last_update_submitted>March 13, 2023</last_update_submitted>
  <last_update_submitted_qc>March 13, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">March 14, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Stress, Psychological</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>Undecided</sharing_ipd>
    <ipd_description>anonymized data shared on an individual basis</ipd_description>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03233750
org study id: 20170081-01H
nct id: NCT03233750
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Previous research has shown that health professionals can experience stress responses during
      high acuity events such as trauma resuscitations. These stress responses can lead to impaired
      clinical performance. The goal of this proposed project is to adapt Stress Inoculation
      Training (SIT) to the healthcare setting. Stress Inoculation Training is a
      cognitive-behavioural approach to stress management that has proven effective in reducing
      stress and improving performance in domains outside of healthcare.

      Thirty-two emergency medicine residents will be randomly divided into two groups. The SIT
      group will receive the simulation-based stress inoculation training. We will measure the
      effectiveness of the training by looking at reduction of stress levels and improvements in
      clinical performance in a pre-intervention and a post-intervention simulated trauma scenario.
      The control group will be exposed to the same simulation scenarios and pre/post intervention
      scenarios as the SIT group, but will not receive the stress inoculation training.
Health care contains many stressors for health professionals, both chronic and acute. There
      is accumulating evidence that clinical performance can be significantly impaired by stress
      responses during acute events, both in the psychology and healthcare domains. Paramedics,
      medical residents and surgeons have all shown impaired performance when faced with high
      acuity situations that triggered subjective and physiological stress responses. Impairments
      have been observed in the ability to perform drug calculations, trauma and cardiac
      resuscitations, in technical skills, as well as on tasks that rely on memory recall. In some
      cases, the magnitude of the stress response has been associated with the degree of
      performance impairments. In many studies in which performance impairments have been observed,
      baseline levels of performance were acceptable, suggesting that these impairments are not due
      to a lack of relevant knowledge or skills required to provide patient care in these
      situations.

      The findings of impaired performance with stress responses suggests that training for high
      acuity events needs to go beyond training that is oriented solely towards the acquisition of
      clinical skills and knowledge. Training needs to also include interventions aimed at
      developing the trainees' ability to cope with stressors and to minimize their personal stress
      responses. In the psychology, aviation and military domains, several approaches have been
      developed to optimize performance during stressful events. These can be categorized either as
      skills-based training (providing individuals or teams with the specific skills required
      during a crisis) or as stress management interventions (modifying the individual's appraisal
      of potentially stressful situations).

      The implementation of skill based training, such as crisis resource management (CRM), has
      resulted in improved performance in team interactions. However, CRM-type of training requires
      that health professionals be able to remember those skills that were learned, yet memory
      recall is often impaired under stress. As for overlearning, it can lead to rigid approaches
      to problem solving, and is less likely to be efficient in dynamic situations that require
      flexibility in approaches and judgment. Therefore, educators also need to develop
      complementary approaches to train health professionals in recognizing stress responses and in
      managing and minimizing their emotional responses. Stress management approaches are focused
      on reducing the emotional and physiological response itself. The premise is that by reducing
      the stress response, the cognitive facilities (including recall of relevant knowledge and
      skills) required during a high acuity situation are more likely to remain intact.

      Two important predictors of stress responses to high acuity events are individuals' coping
      styles and their cognitive appraisals of the situation. Task-oriented coping styles, as well
      as appraisals of perceived resources being equal to or above the perceived demands of a
      situation, are associated with lower stress responses in high acuity events. As such, stress
      management approaches focused on coping styles and cognitive structuring are likely to reduce
      the subjective and physiological stress responses of clinicians and trainees during high
      acuity events.

      A promising method of reducing stress responses and performance impairments under acutely
      stressful conditions is stress inoculation training (SIT). This 3-phase cognitive-behavioural
      approach to stress management has proven effective in domains outside of healthcare. SIT has
      been found to be effective in reducing general state anxiety, performance anxiety (anxiety
      specific to the skills being addressed in the training), and in enhancing performance under
      stress. SIT appears to be effective when run with groups of 8-10 participants and it can be
      implemented successfully without an inordinate number of training sessions. Finally, the
      beneficial effects of the SIT can generalize to novel stress conditions and novel tasks,
      which is crucial for any applied area in which the conditions of real life environments are
      often dynamic, ambiguous and emergent.

      The proposed study consists of the adaptation and evaluation of a simulation-based stress
      inoculation training (SIT) intervention for Emergency Medicine and Surgery residents during
      trauma rotations.

      SPECIFIC AIMS AND HYPOTHESES The study hypothesis is that residents who have received the SIT
      intervention will have lower stress levels and higher performance levels during a
      post-intervention simulated trauma scenario than will residents in a control group.

      SIGNIFICANCE During high acuity events, such as pre-hospital, trauma and cardiac
      resuscitations, patient care must be provided in conditions that can be noisy, chaotic, time
      pressured and with uncertainty. These conditions, and the urgent nature of the care required,
      are very unforgiving to gaps in recall, attention or decision-making. In these environments,
      research has shown that health professionals experience significant stress responses and that
      these stress responses can lead to impairments in memory, attention and clinical performance.

      Adapting a proven stress training approach to healthcare has the possibility of significantly
      improving care to patients during high acuity events, both in terms of care during the high
      acuity component of care, as well as further along in the chain of care.

      INNOVATION If, as predicted, the results of this study reveal that stress inoculation
      training is effective for preparing emergency medicine and surgery residents, in terms of
      reducing their stress levels and increasing their performance during simulated trauma
      resuscitation, this proposed study will be further developed for a multi-centre study with
      outcome measures of stress and performance during actual patient events.

      In the development of the course content and scenarios for the SIT training in the context, a
      course manual will be produced. This manual will be shared with colleagues internationally,
      for the purposes of adapting and validating the course internationally and in a variety of
      clinical contexts.

      APPROACH The proposed study of stress inoculation training (SIT) intervention will be for
      emergency medicine and surgery residents during trauma rotations. The adaptation of SIT to
      the trauma context will consist of a 3-phase training intervention, conducted over one 1/2
      day session.

      Phase 1: Conceptualization / Educational Phase (60 minutes) The goal of this phase is to help
      individuals gain a better understanding of the nature of stress and its effects. This phase
      will focus on the provision of preparatory information, to allow the participants to form
      accurate expectations regarding the stress environment and stress reaction that can occur
      during trauma cases. The goal is to provide the participants with a sense of predictability
      and control. This phase will consist of descriptions of the stressors encountered in the
      clinical setting, the provision of information about how these stressors might make the
      participants feel affect performance.

      Phase 2: Skill Acquisition and Rehearsal (60 minutes) The objective of this phase is the
      development and practice of cognitive restructuring techniques and relaxing training to
      reduce anxiety and enhance the individual's capacity to respond effectively to stressful
      situations. The cognitive restructuring techniques will provide the participants with the
      skills to regulate negative emotions and distracting thoughts brought on by stressors. The
      relaxation training will provide the participants with the skills to enhance physiological
      control, such as awareness and control of muscle tension and breathing. The session will
      include mental imagery and visualization exercises to allow the participants to practice the
      skills in a low stress environment.

      Phase 3: Application of Coping Skills (180 minutes) In this phase, the coping skills are
      applied in increasingly stressful conditions that approximate the real-world stressor
      environment. Participants will practice the cognitive restructuring and relaxation skills in
      a series of simulated trauma scenarios in which they will be exposed to increasing levels of
      stress in a gradual manner. All of the scenarios will be developed using a combination of
      computerized mannequin-based simulators and standardized patients (SP). The use of simulation
      modalities allows investigators to carefully manipulate the levels of stressors inherent in
      each scenario and to control for any extraneous factors beyond the intervention that could
      influence stress responses and performance.
allocation: Randomized
intervention model: Parallel Assignment
intervention model description: This is a cohort study, comparing two interventions aimed at decreasing stress responses during acute events, with a pre and a post intervention assessment.
primary purpose: Treatment
masking: Single (Outcomes Assessor)
masking description: Group assignment will be masked from the assessors of performance. Expert educators will score videotaped performances of the participants obtained pre and post intervention. Assessors will be blinded to group allocation as well as to whether the video they are scoring is of the pre or the post intervention scenario.
measure: Change in scores on State-Trait Anxiety Inventory
time frame: prior to each scenairo as well as immediately at the end of each simulation scenario
description: Subjective stress measure
measure: Change in salivary cortisol levels
time frame: prior to each scenario, as well as 20 and 30 minutes after each scenario
description: physiological indicator of stress
measure: Performance
time frame: Experts will review the videotapes of the scenarios within one month of data collection
description: Expert scoring of clinical management of the scenario
arm group label: Stress Inoculation Training
arm group type: Experimental
description: Phase 1: Conceptualization / Educational Phase (60 minutes) Provision of preparatory information, to allow the participants to form accurate expectations regarding the stress environment and stress reactions.
Phase 2: Skill Acquisition and Rehearsal (60 minutes) Development and practice of cognitive restructuring techniques and relaxing training to reduce anxiety and enhance the individual's capacity to respond effectively to stressful situations, in low stress conditions.
Phase 3: Application of Coping Skills (180 minutes) Coping skills are applied in increasingly stressful conditions that approximate the real-world stressor environment.
arm group label: Crisis Resource Management Training
arm group type: Active Comparator
description: The CRM training targets the non-technical skills (e.g. behavioural and cognitive skills) required for effective teamwork during crisis situations. It focuses on communication, teamwork, situational awareness and leadership
intervention type: Behavioral
intervention name: Stress Inoculation Training
description: see description in arm/group descriptions
arm group label: Stress Inoculation Training
intervention type: Behavioral
intervention name: Crisis Resource Management
description: During each scenario, facilitators identify performance gaps in either situation awareness, leadership, communication or resource allocations. During debriefing session, these are raised with the learner and their cognitive frames are identified and corrected as necessary.
arm group label: Crisis Resource Management Training
criteria: 
gender: All
minimum age: 25 Years
maximum age: 45 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Vicki LeBlanc, PhD
role: Principal Investigator
affiliation: University of Ottawa
facility: 
country: Canada
responsible party type: Sponsor
mesh term: Stress, Psychological
sharing ipd: Undecided
ipd description: anonymized data shared on an individual basis