Evaluation of biofeedback components for the management of acute stress in healthcare

Medical error is the third leading cause of death in the United States, with surgery being a critical area for improvement. Of particular interest for this dissertation is understanding and mitigating the impact of acute stress experienced by surgeons. Previous research demonstrates the detrimental effects mismanaged acute stress can have on cognitive performance integral in optimal surgical practice. Biofeedback consists of objectively monitoring signs of stress, presenting physicians with their own physiological output in real time. Introducing appropriate, targeted coping mechanisms when they are most needed may facilitate behavioral adjustments in the face of acute stress. The goal of this dissertation research was to evaluate the potential benefit of biofeedback and coping instructions, measured by reduced perceived and physiological stress, and improved task performance. In the first study, college students participated in a first-person shooter videogame while receiving visual coping instructions. Instructions that were presented at moments of elevated stress improved downstream physiology compared to randomly administered instruction, and the presence of coping instructions was more beneficial than their absence at highly stressful times. In the second study, I adapted and validated a computer-based task to focus on components of workload experienced by physicians. This study yielded one high-stress and one-low stress version of a more demographic-appropriate task. In the final study, medical students and residents completed this task. The independent variables tested included a visual biofeedback interface, intermittent auditory coping instructions, and/or brief training on stress management and emotional intelligence. Results from this study showed that despite high cognitive workload experienced by participants receiving both biofeedback and coping instructions, performance across stress levels was indistinguishable, and physiological indicators of stress immediately following discrete coping instructions was reflective of decreased stress. Taken together, the results of these studies validate the generation of a new lab-based task to induce stress among healthcare providers, and the physiological and performance benefits associated with physiologically-based coping instructions. Future work should investigate how these concepts can be tailored towards surgical workflow with feedback modality in mind, extended to teams, and/or scaled up to higher levels of fidelity to better capture the work environment.