Does high fidelity neonatal resuscitation simulation increase salivary cortisol levels of health care providers

BACKGROUND The use of simulation-based medical education is strongly recommended to insure neonatal resuscitation skills for health caregivers. High fidelity simulation was executed to allow the evaluation of technical and non-technical skills. Salivary cortisol level was considered reliable biomarkers of adrenocortical activity and useful tool to learning assessment and stress response. METHODS Our primary aim was to test changes in salivary cortisol levels before and after the simulation for neonatal resuscitation between high and low fidelity setting. Secondary aim was to evaluate salivary cortisol level in the participants, leader and not leader. Fifty-two health care providers were divided in ratio 1:1 into low-fidelity (LF group) and high-fidelity scenario (HF group) of neonatal resuscitation. In each group the participants assumed the role of team leader or not team leader. Salivary samples were collected from all participants 5 minutes before and after each simulation scenario by using oral swab. Analysis of difference was analysed by Kruskal Wallis test. RESULTS Salivary cortisol levels were significantly higher in HF group (n=26) than LF group (n=26) before the performance (5,407 mmol/l vs 3,090 mmol/l; p=0.018). In the HF group, salivary cortisol levels were significantly lower after simulation than before (p=0.007), moreover not team leader showed higher salivary cortisol levels before of the simulation than after (p=0.003). Team leaders showed higher salivary cortisol levels than not team leader after high-fidelity scenario (p=0.039). CONCLUSIONS High-fidelity simulation scenario had a great impact on stress level, furthermore leaders showed higher salivary cortisol levels than not team leaders.