Simulation-based training has revolutionized medical education over the past few decades. By allowing trainees to practice procedures in a controlled, risk-free environment, simulation helps them build the necessary technical skills without the fear of causing harm to patients. High-fidelity simulations are particularly advanced, incorporating realistic patient mannequins, authentic medical equipment, and scenarios that closely mimic real-life emergencies. These simulations are designed to be as immersive as possible, often including unexpected complications or time-sensitive decisions to replicate the pressures of clinical practice. However, while the technical benefits of simulation are well-documented, its ability to accurately reproduce the psychological stress of real clinical situations has been a subject of debate. Dr Cunningham’s study addresses this crucial question by examining heart rate responses—a reliable physiological indicator of stress—during intubation in both simulated and clinical settings.

The study recruited 25 critical care registrars, who are medical professionals in the advanced stages of their training but have not yet fully qualified as specialists. These registrars were observed performing airway intubations in both a high-fidelity simulated environment and a real clinical setting. To monitor their stress levels, the researchers used FitBit® Charge 2 devices, a type of wearable technology capable of providing continuous, real-time heart rate data. This approach allowed the researchers to capture the trainees’ physiological responses throughout the intubation process, offering a detailed picture of how their stress levels fluctuated before, during, and after the procedure.

The use of heart rate as a measure of stress is well-supported by scientific literature. When a person encounters a stressful situation, their sympathetic nervous system activates, leading to a series of physiological changes collectively known as the “fight-or-flight” response. Among these changes, an increased heart rate is one of the most immediate and easily measurable indicators of stress. By tracking heart rate changes from baseline levels, the researchers could infer the intensity of the stress experienced by the trainees in both environments.

The study’s results were both surprising and informative. In the clinical environment—where the stakes are high, and the outcomes directly impact patient lives—the median heart rate change from baseline to during the intubation period was 14.72%. This increase reflects the significant stress that trainees experience when performing intubation in a real-world setting, where the pressure to succeed is immense and errors can have serious consequences.

In the simulated environment, one might expect a lower stress response due to the absence of real patient risk. However, the median heart rate change in the simulation was slightly higher, at 15.96%. This finding challenges the assumption that simulation is inherently less stressful than clinical practice. In fact, at the exact moment of intubation—a particularly critical and challenging part of the procedure—the median heart rate change was 16.03% in the clinical setting and 25.65% in the simulation setting. This spike in heart rate during simulation suggests that the trainees experienced significant stress, possibly due to the immersive nature of the simulation, the awareness that they were being observed and assessed, and the understanding that their performance could impact their progression in training.

Another noteworthy aspect of the study was the variation in heart rate responses among individual trainees. Some registrars exhibited relatively stable heart rates across both environments, indicating a consistent level of stress tolerance. In contrast, others showed more pronounced fluctuations, particularly in the simulated setting, where the controlled environment may have amplified their awareness of being evaluated. These variations highlight the importance of considering individual differences when designing and implementing training programs, as trainees may respond to stress in unique ways.

The findings of this study have significant implications for the field of medical education, particularly regarding the role of simulation in training critical care professionals. The fact that heart rate responses in the simulated environment were comparable to, and in some cases even exceeded, those in the clinical environment suggests that simulation is not only effective in teaching the technical skills required for procedures like intubation but also in preparing trainees for the psychological demands of these tasks.

For medical educators, this study underscores the importance of incorporating high-fidelity simulations into training curricula. These simulations provide a safe and controlled space where trainees can experience the stress of critical care procedures without the risk of harming patients. By exposing trainees to the physiological and psychological pressures of clinical practice, these sessions help build resilience and develop coping strategies that will serve them well in their future careers. Moreover, the study’s findings suggest that simulation could be particularly beneficial in helping trainees manage performance anxiety, which can be heightened by the knowledge that they are being observed and assessed.

As medical education continues to evolve, the role of simulation in training programs is likely to expand. This study by Dr Cunningham and his colleagues offers compelling evidence that high-fidelity simulations can effectively replicate the stress of real clinical environments, making them an invaluable tool in preparing trainees for the challenges of critical care without incurring patient risk. However, the study also raises important questions about how to optimize simulation training to account for individual differences in stress response. Future research could explore ways to tailor simulation experiences to better meet the needs of each trainee, potentially incorporating personalized feedback or stress management techniques.

In conclusion, the research conducted by Dr Neil Cunningham and his colleagues provides crucial insights into the effectiveness of simulation as a training tool in critical care medicine. By demonstrating that simulation can induce a stress response similar to that of real clinical practice, the study validates the use of high-fidelity simulations as a core component of medical education. As the medical field continues to evolve, studies like this one will play a vital role in shaping the training of future healthcare professionals, ensuring that they are not only technically proficient but also mentally prepared to handle the intense pressures of their work.

Pressure injuries occur in bed-bound individuals due to the constant force of the mattress surface against the skin. Patients with loss of feeling are at particular risk, since they are unable to detect any pain and alert a healthcare worker. Similarly, very young patients may be unable to adequately communicate their discomfort, due to limited speech and descriptive abilities.

Although pressure injuries may appear on any area of the body, bonier regions such as the head, heels, and lower spine may be more prone. Furthermore, the areas affected may vary in adults and children due to their differing size, weight, and bodily proportions. There is plenty of accessible research regarding the causes and treatment of pressure sores in adults; however, the same cannot be said for younger patients. Research assessing the prevalence and incidence of pressure injuries in children is scarce, and there is little evidence to indicate how many children develop pressure sores during their hospital stay, or how they can be prevented.

Interventions including repositioning patients every 2 to 4 hours and using pressure distribution mattresses to avoid pressure sores developing in adults. However, there is little research regarding the optimal repositioning interval for infants and children. Similar tailor-made mattresses for use in cribs and baby warmers have not yet been widely introduced.

Additional considerations include the tolerance of young skin to pressure, and the requirement for diapers, which may further irritate the skin and alter bodily contact with the mattress. Nurses caring for newborn babies currently use modified versions of adult risk assessment tools when determining how likely they are to develop pressure injuries. Moreover, in an effort to improve comfort levels, nurses will often resort to using rolled up blankets or other soft objects as pressure distribution devices, even though these are actually repositioning aids.

To address this disparity, Dr. Ivy Razmus and her colleagues explored the specific issues around pressure sores affecting children who are admitted to hospital in the medium to long term, and who may require ongoing care at home.

In a recent study, Dr. Razmus and her colleagues investigated the differences in pressure distributions on mattresses between children and adults, and how these differences might inform optimal clinical practice. The study participants were allocated a standard coil mattress of a size appropriate to their height to mimic typical hospital conditions. A pressure sensor mat was placed on top of the mattress to record the differences in load at different bodily regions.

The research team took readings over a set time while the patient lay as still as possible, recording the average pressure at the head, shoulders, lower spine, and heels. They discovered that the heels were high-pressure regions in both children and adults. For children, the area of highest pressure was at the head. In contrast, the head represented the least pressure bearing region for adults. This is unsurprising given that children’s heads are heavier than adults’ heads in proportion to the rest of the body. Additionally, the back of the head is the most prominent bony protrusion throughout infancy and early childhood.

This finding further highlights the need for age-specific equipment designs for use in healthcare settings. Not only will this ensure increased patient comfort, but it will also minimize the occurrence of pressure injuries in children confined to bed for extended periods.

Advanced practice nurses hold additional professional credentials and have exceptional expertise in specific fields of medicine. The contribution of specialist nurses in the management of hospital-acquired wounds has traditionally been undervalued, although this has improved during the last decade or so. However, recognition of the role of specialist nurses in the context of caring for children and babies has been virtually non-existent.

This has presented research opportunities for dedicated advanced practice nurses such as Dr. Razmus, who has worked tirelessly to investigate the unique considerations of young people at risk of developing pressure sores during hospital stays. Her research has shed new light on the ways in which injuries can be minimized and clinical practices refined, whilst highlighting the indispensable role of the specialist nurse in a range of pediatric settings, including acute care and community health centers.

Awareness of other friction injuries in babies and young children, such as those associated with feeding tubes or diaper wearing, may also be boosted in response to these essential insights. Crucially, the importance of family engagement and support in the ongoing prevention and management of pressure injuries in chronically ill children must not be underestimated.

Together, these vital yet overlooked aspects of care will enhance the healthcare experiences of minors across the globe, and assist in equalizing the level of care for adults and children.