This study provides results about the impact of an SBTT program on stress, anxiety, and depression in HP during a crisis. We found that in the IG when they were exposed to COVID-19 care patients, they suffered more anxiety and depression levels (HADS) than the HP who did not receive the education SBTT program. To our knowledge, this is the first study focusing on mental health symptomatology on SBTT participants.
HP taking care of patients with COVID-19 are at risk of developing psychological distress and other mental health symptoms22. Numerous psychiatric or psychological departments, psychological counselling centres, and university psychology units have launched specialized programs to attend HP in hospitals, through telematics systems, telephone lines, and apps, to provide psychological treatment in crisis. In this context, we found that HP who have received an SBTT program presented more anxiety and depression when dealing with COVID-19 patients. Firstly, higher perception and awareness levels are observed after SBTT23, and usually, these professionals are more involved and committed in education tasks in hospitals, entailing otherwise more responsibility tasks. Another study found similar results showing a relationship between awareness attitude, anxiety experience, and perceived mental health care needs in the community during the COVID19 pandemic24. Secondly, collective efficacy was independently associated with flow in simulation practice, but no significant results were found for stress and self-esteem25.
As in our study conducted in the general population4, we observed that individuals with minors in charge and women had higher anxiety and depressive symptoms. Besides, we also found that HP who worked with COVID-19 patients had more symptoms of stress, anxiety, and depression, and women had more symptoms of stress probably related to the working environment, huge workload, long-term fatigue, infection threat, and frustration with the death of patients whom they care. There is evidence that healthcare simulation improves healthcare performance and degree of retention of what is learned when compared to all traditional teaching methods26. Our study results show that the emergency together with the knowledge of these abilities by part of the entire working group may be determining factors for the psychological state of the skills previously trained by using SBTT.
Despite that, it is necessary to keep working on stress levels in HP during the simulation and in real settings. Simulation educators need to create scenarios that purposely change stress to enhance learning as it was found that psychological stress and anxiety is greater during simulation compared with hospital settings27. The intervention used is a faculty training programme rather than a simulation based education programme for delegates. Subsequent research should focus on studying the degree of distress that students present in crisis situations based on the profile of the educator. Besides, health professions education programs must build student competencies in the affective domain of learning28.
For this reason, it is crucial to be able to train professionals, promoting skills through SBTT that increases job security and reduces levels of distress generated in crises, both in technical aspects (performing cardiopulmonary resuscitation, placement of line or tube, tracheostomy, etc.) as in non-technical skills (communication, situational awareness, etc.) because stress triggers diseases and increases health resources.
Strengths and limitations
Study strengths are that it is the first study focus on stress, anxiety, and depression in simulation instructors after a pandemic, and it combined different new areas never studied before, such as professional’s health and simulation training after COVID-19.
We acknowledge that our survey has several limitations. Firstly, there is likely to have been a degree of selection bias in the CG. Secondly, the number surveyed varied greatly between the two groups. Thirdly, we cannot rule out the presence of residual confounders.