Optimising stress to maximise learning in medical simulation environments
Applications are now CLOSED
Simulation is widely used in medical education. Difficult exercises often trigger feelings of stress and high emotion. Whilst the notion of ‘stress’ usually has negative connotations, controlled stress might assist learning since such situations can assist with memory formation, and optimally stressed individuals are often felt to complete tasks well. We hypothesize that ‘controlled stress’ might be a useful technique to assist in the formation of memories and thus be helpful in training. We also postulate that the real-time monitoring of stress during simulation might permit the difficulty level of the simulation to be altered to enable the learner to be optimally challenged and therefore achieve the best educational experience possible. Year 1 Problematise the topic and engage with experts. Perform a scoping review of the literature. Develop focused research questions. Engage with stakeholders. Establish a research protocol. Acquire ethical and governance approvals. Year 2 Perform observational studies to investigate how objective measures of stress compare to self-reported perceptions. Conduct a participatory study in which stress is monitored and used to tailor the difficulty of simulation depending on how a candidate is coping. Year 3 Finalise research work. Collate and analyse data. Complete writing up thesis. Present and publish work.
Simulation based education (SBE) utilises techniques that aim to assist learners with an invaluable opportunity to rehearse and incrementally advance their clinical skills before transferring them into practice1. SBE traditionally focused on critically ill patients requiring urgent intervention for situations such as cardiac arrest and airway obstruction. More recently, the use of SBE has extended such that it now touches on areas as diverse as surgical procedures, managing challenging conversations and training in team-working2.
Persons who have been involved in a difficult medical simulation exercise will often use the word ‘stressful’ to describe their experience, and recent work in our department has provided an insight into the fact that SBE can be a highly emotive time for participants (current research programme with Prof Gormley and Maastricht University). Whilst the common usage of the term ‘stress’ has negative connotations, used appropriately, controlled stress might be helpful in assisting with the learning process. The interplay between acute stress and memory formation has been studied in some detail with varying results published, but there is a definite suggestion in the literature that in some circumstances, stress can enhance learning3. We hypothesize that ‘controlled stress’ during SBE might be a useful technique to assist in the formation of memories and thus be helpful to the training of healthcare professionals.
Furthermore, the notion of an inverted U-shaped relationship between arousal and performance is also often described4. This concept refers to the fact that a very under-stimulated or, conversely, a grossly over-stimulated person will perform sub-optimally when performing a task. In contrast, a person who is intellectually or physically challenged to an ideal level will perform best. Translating this concept into the simulation environment, one can appreciate that an overly simplistic or excessively complex scenario might respectively bore or frighten a candidate, whereas an ideally pitched scenario that challenges a participant to an optimised level, might produce the best learning outcomes. We postulate that the real-time monitoring of stress during an SBE event might therefore permit the difficulty level of the simulation to be altered to enable the person performing the stimulation to be optimally challenged and therefore achieve the best educational experience possible.
A variety of methodologies are available to assist in the monitoring of physiological parameters that might reflect stress in an individual as they perform a task. In recent years, ‘wearable’ devices (e.g. smart watches) with heart rate monitoring capability have become commonplace. More sophisticated equipment allows for the capturing of a myriad of data such as measures of skin temperature and sweat production. These devices have been used to monitor humans in a variety of stressful scenarios, such as soldiers in combat5, pilots in malfunctioning planes6 and sports persons engaged in competition7, but there is a distinct lack of their application in medicine generally, and in simulation in particular.
A better understanding of how stress impacts learning would also potentially have far-reaching implications outside of the medical simulation environment.
Aims and Purpose
This research project is programmatic, building upon previous and current work undertaken in the Centre for Medical Education. The research will be particularly timely, since the new Faculty of Medicine, Health and Life Sciences multi-disciplinary Simulation Centre is due to open in Autumn 2020. Furthermore, the Principal Supervisor (Dr Paul Hamilton) has established a connection with the ‘Neil and Elise Wallace STRATUS Center for Medical Simulation’ (affiliated with Harvard Medical School, Boston, USA) and has secured Faculty Collaboration Seed Funding to assist in the fostering of a research link between that centre and Queen’s University Belfast. It is hoped that a successful PhD student would be able to assist with this collaboration and could potentially contribute to future international partnerships in this area.
The overarching aims of this project are to investigate how stress might be best measured during medical simulation events, and to explore the notion that tailoring a medical simulation to challenge a candidate optimally might result in an ideal learning environment.
Outline Plan of Investigation
The following scheme provides an overview of the anticipated activity during the 3 year PhD programme.
Problematise the research topic and engage with experts in the field.
Perform an initial literature search that will lead to a scoping review of the literature to obtain an overview of current knowledge in this area.
Develop focused research questions.
Engage with relevant stakeholders in the research.
Develop a research protocol.
Acquire all necessary ethical and governance approvals.
Perform a series of observational studies to investigate various measures of stress in individuals carrying out medical simulations to enable the relationship between perceived stress and objective measures of stress to be investigated. The nature of the measures taken will be informed by the literature review but will likely include physiological measures (e.g. heart rate, galvanic skin response – a measure of sweat production and skin temperature). The relationships between stress level and performance will also be assessed.
Conduct a participatory research study in which stress is monitored in real-time during a medical simulation exercise and used to tailor the difficulty of the simulation depending on how a candidate is coping. This will be useful in exploring how best to manage stress to optimise learning within simulation.
Finalise research work.
Collate and analyse data.
A thesis will be written over the course of the three years, but a concerted effort to complete it will be made in year 3.
Present work at academic meetings.
Publish work in academic journals.
It is the opinion of both supervisors that a fully engaged PhD candidate should be able to complete this body of work within the normal time-frame of 3 years full-time study. The medical education research group in the Centre of Medical Education has a track record of supporting PhD students in medical education research.
1. So, H. et al. (2019) Simulation in medical education. Journal of the Royal College of Physicians of Edinburgh 49, 52-7.
2. Yule, S. et al. (2015) Coaching Non-technical Skills Improves Surgical Residents’ Performance in a Simulated Operating Room. Journal of Surgical Education 72, 1124-30.
3. Duncko, R. et al. (2007) Acute exposure to stress improves performance in trace eyeblink conditioning and spatial learning tasks in healthy men. Learning and Memory 14, 329-35.
4. Westman, M., and Eden, D. (1996). The inverted-U relationship between stress and performance: A field study. Work and Stress 10, 165-173.
5. Hoyt, R. (2010) Real-time physiological and psycho-physiological status monitoring for human protection and operational health applications. Chapter 1 in NATO Research and Technology Organisation Task Group HFM-132 (2010) Real-time physiological and psycho-physiological status monitoring. RTO/NATO, Virginia, USA.
6. Dismikes, R. et al. (2015) Effects of acute stress on aircrew performance: literature review and analysis of operational aspects. National Aeronautics and Space Administration (NASA), California, USA.
7. Levels, K. et al. (2012) The effect of skin temperature on performance during a 7.5-km cycling time trial. European Journal of Applied Physiology 112, 3387–3395.
The School of Medicine, Dentistry and Biomedical Sciences trains ~250 postgraduate research students undertaking PhD, MD and MPhil degrees in Cancer Research and Cell Biology, Experimental Medicine, Public Health and Medical Education. Its diverse postgraduate student population comprises both basic and clinical scientists from across the globe engaged in wide-ranging research projects spanning the breadth of the School’s research portfolio from bioinformatics through molecular and cell biology to clinical trials.
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- Postgraduate students in the School of Medicine, Dentistry and Biomedical Sciences are closely supervised by experienced academic staff and are viewed as a central and critical component of their world-leading research programmes.
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Research students are encouraged to play a full and active role in relation to the wide range of research activities undertaken within the School and there are many resources available including:
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The School has current collaborative partnerships with the NIH National Cancer Institute (Washington) and the Princess Margaret Cancer Centre (Toronto), together with developing relationships with international institutions in the Middle East, such as Hashemite University (Zarqa, Jordan). In addition, some of our current students conduct the majority of their research abroad (currently US and China) with supervisors from both QUB and the external institution. The School also supports short-term research training opportunities for its postgraduate students in the groups of international collaborators; these enriching experiences not only benefit the project but provide valuable insight into research in a global context.
Patrick G Johnston Centre for Cancer Research
The global burden of cancer is increasing with incidence now at 15 million new diagnoses each year. The Patrick G Johnston Centre for Cancer Research (PGJCCR) is attuned to this global health issue and specialises in integrating academic discovery, industrial/commercial enterprise and innovative health care practice to promote effective delivery of precision cancer medicine, to improve patient health and outcomes, generate wealth and alleviate suffering. PGJCCR has established successful multi-disciplinary teams focusing on cancers of Gastrointestinal, Prostate, Breast and Ovarian origin. Each team incorporates disease-specialist clinicians, accredited molecular pathology expertise bringing affiliated biobank tissue repositories, and academics skilled in the art of (i) biomarker discovery and bioinformatics, (ii) biological investigation and therapeutic development, and (iii) the prosecution of early-phase translation-driven clinical trials. Our significant success has resulted from a strong team-based approach.
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The Wellcome Wolfson Institute for Experimental Medicine (WWIEM) is committed to research excellence by making scientific breakthroughs in the mechanisms of disease, which we translate to innovative therapeutics to improve patient outcomes. We are an international hub of excellence on eye disease, infectious diseases and respiratory disease with a core emphasis on immunology, molecular cell biology and patient-based investigations. WWIEM comprises three main research themes focussed on Immunology and Microbes, Respiratory Medicine, and Vision and Vascular Medicine. Our Immunobiology and Microbes research group focusses on understanding the immune system which is essential for defence of the human body, not only in preventing a wide variety of diseases but also aiding recovery from them. Our Respiratory Medicine research group focusses on understanding the processes that lead to common lung illnesses such as asthma, cystic fibrosis, and acute respiratory distress syndrome. Our Vision and Vascular Medicine research group particularly focusses on inflammation within the cardiovascular system as a frequent cause of cardiac and other vascular diseases which represent a significant health burden on society. Our work makes an important impact in the fight against conditions such as diabetes, cardiovascular disease, and eye disease.
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Research students joining the Centre for Medical Education will have the opportunity to develop an education project using a range of qualitative and quantitative methods, for which specific training is made available. Research encompasses a range of learning environments and spans the continuum of medical education. Projects are linked by an underlying commitment to improve patient care through education. Current research interests include GP pedagogy, technology-enhanced learning, identity, critical research, and diversity and inclusion. Students are mentored to develop their own research questions and methodologies within the broad remit of the Centre.
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The overall mission of the Centre for Public Health (CPH) is to improve health and reduce inequalities, prevent and manage chronic disease and disability more effectively, and to improve the delivery of health and social care. CPH comprises four main research themes focussed on Epidemiology and Public Health, Cancer Epidemiology, Nutrition and Public Health, and Health Services and Global Health. Our Epidemiology and Public Health research group harnesses Big Data in discovery science and its application to clinical and public health practice, to help to understand how both genes and environments (including social norms and networks) shape risk in individuals and populations. Our Cancer Epidemiology research group includes programmes focussed on pre-malignancy molecular epidemiology, gastrointestinal cancer progression and precision medicine, and pharmaco-epidemiology exploring the potential for drug re-purposing. Our Nutrition and Public Health research group works across the life-course to understand the determinants of a healthy diet in individuals, at risk groups (e.g. schoolchildren, pregnant women, older people) and whole populations, and on identifying ways to improve it. Our Health Services and Global Health research group focusses on health care for people with chronic conditions and poor mental health, quality improvement and implementation science, oral health and related cancers, trials methodology, health economics, and global eye health.
Funded postgraduate research studentships are advertised on the School of Medicine, Dentistry and Biomedical Sciences website: https://www.qub.ac.uk/schools/mdbs/Study/PostgraduateResearch/CurrentOpportunities/.
We will also consider applications from externally or self-funded students who should identify potential academic supervisors aligned with their research interests: https://www.qub.ac.uk/schools/mdbs/Research/find-a-phd-supervisor/.
Please note that we can only support projects which fit within our main research themes of Experimental Medicine, Cancer Research and Cell Biology, Medical Education, and Public Health.
The School of Medicine, Dentistry and Biomedical Sciences drives research excellence and impact, delivering innovative solutions to the specific challenges we have identified in healthcare. The School has three central aims:
(1)To address key global challenges in health care by making scientific breakthroughs in mechanisms of disease, translating these to innovative therapeutics and preventive interventions to improve patient outcomes.
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Current postgraduate research projects and potential opportunities.
In the last Research Excellence Framework exercise, over 75% of research activity in the School of Medicine, Dentistry and Biomedical Sciences was judged to be internationally-excellent or world-leading, whilst Queen’s University Belfast was ranked 8th in the UK for research intensity.
Current PGR Student Profiles
Current postgraduate research projects and potential opportunities.
The School of Medicine, Dentistry and Biomedical Sciences is dedicated to providing postgraduate research students with a supportive environment to effectively promote their education, training and professional development. Our students are highly valued as a central and critical component of the School’s research strategy and benefit from both exceptional facilities and supervision by world-leading academic researchers.
The majority of postgraduate research students within the School of Medicine, Dentistry and Biomedical Sciences continue to successfully secure appropriate employment upon completion of their studies. Chosen careers are generally relevant to their qualification within industry, academia and the National Health Service and have included postdoctoral research across the world, clinical/non-clinical academia, return to full-time clinical work, medical writing, industry research, management/financial consultancy, and R&D software development. The School runs a dedicated careers session at its annual Postgraduate Research Forum and careers-focussed peer mentoring from postdoctoral researchers whilst students are expected to discuss potential careers with their supervisors as part of their individual Postgraduate Development Programme.
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All postgraduate research students can avail of careers advice from the Graduate School whilst postdoctoral employment opportunities are highlighted at the annual School Postgraduate Research Forum within a dedicated session. Students should also discuss potential careers with their supervisors as a central focus of their individual Postgraduate Development Programme.
As a postgraduate student in the School of Medicine, Dentistry and Biomedical Sciences you will receive high-quality training and support for a career in scientific research with real potential to contribute to development of improved strategies for the management and treatment of life-threatening diseases.
The School of Medicine, Dentistry and Biomedical Sciences is dedicated to providing its postgraduate research students with a supportive environment to effectively promote their education, training and professional development. First year students enrol on a tailored training programme comprising a series of lectures, workshops and practical sessions focused on key research skills, including bioimaging, informatics, genomics, mass spectrometry, animal models and clinical trials. In addition, all students receive wide-ranging and ongoing training in generic and transferable skills, such as scientific writing, data analysis, presentation and critical appraisal, through dedicated communication courses and seminars. They also benefit from presentation of their research findings at major national and international conferences, which is an expectation of all postgraduate research students, and through regular interaction with the QUB Graduate School, whose specific function is to support postgraduate training, development and careers.
Students undertake their specific research project under the close guidance of an experienced principal supervisor with support from 1 or 2 co-supervisors as appropriate. All postgraduate research students are initially registered as ‘undifferentiated’ which means that they are required to complete a probationary period after which they are assessed for their suitability to undertake a postgraduate research degree during the differentiation process. Differentiation normally takes place at 9-12 months for full time students and 18-24 months for part time students. Each student is required to complete a literature review, give an oral presentation of their research within their Centre, and provide evidence of appropriate training and completion of their Postgraduate Development Plan. They are then interviewed by a differentiation panel, comprising 2 or 3 academic staff, who assess the students understanding of their project and progress, based on both their submitted paperwork and response to questions. Differentiated students are required to complete a similar Annual Progress Review process in each subsequent year of their research degree. The duration of a full-time PhD programme is normally 3-4 years. For completion of their doctoral qualification students are required to submit a thesis of their research of appropriate length and content (as advised by their supervisors) which will be assessed by oral examination conducted by an external and internal examiner.
Funded postgraduate research studentships are advertised on the School of Medicine, Dentistry and Biomedical Sciences website: https://www.qub.ac.uk/schools/mdbs/Study/PostgraduateResearch/CurrentOpportunities/. We will also consider applications from externally or self-funded students who should identify potential academic supervisors aligned with their research interests: https://www.qub.ac.uk/schools/mdbs/Research/find-a-phd-supervisor/. Please note that we can only support projects which fit within the overall research strategy of the School and individual research focus of our academic staff.
Students who meet the eligibility criteria for postgraduate research should select ONE potential supervisor from our list of academic staff, https://www.qub.ac.uk/schools/mdbs/Research/find-a-phd-supervisor/, and send an email containing: (1) a brief CV (1-2 pages maximum), (2) a concise statement of motivation including research interests, (3) source of funding, and (4) intended start date.
Our academic staff welcome approaches from prospective students and are happy to develop research proposals of mutual interest. Often this process will involve an informal face-to-face meeting (in person or via Skype) prior to an invitation to submit a formal application. If you have difficulty identifying or contacting an appropriate supervisor, please contact Professor David Grieve, Director of Postgraduate Research, email@example.com, or the School Postgraduate Office, firstname.lastname@example.org, who will be happy to help.
Postgraduate students in the School of Medicine, Dentistry and Biomedical Sciences will receive ongoing training in scientific writing, presentation and critical analysis as the basis for a research career. The School supports and challenges its postgraduate research students through robust annual progress review, requiring satisfactory assessment of written work, symposia presentations, supervisor reports and panel interview, the success of which is evidenced by its excellent completion rates. At the end of their postgraduate research training period, students are required to submit a thesis of their research of appropriate length and content which is assessed by oral examination conducted by an external and internal examiner.
Postgraduate research students in the School of Medicine, Dentistry and Biomedical Sciences receive feedback on their written and oral work throughout the period of registration for their degree. This may be both formal and informal and is provided regularly by their supervisors, peers, academic/postdoctoral colleagues, and annual progress review panel.
Postgraduate students in the School of Medicine, Dentistry and Biomedical Sciences benefit from world-class infrastructure and academic faculty and are highly valued as a central and critical component of its research strategy. All students will have access to shared laboratory and office space as required by their research project.https://www.qub.ac.uk/schools/mdbs/
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