When students entered the simulator room, the patient was conscious and responded to the questions of the students. Two minutes after the medical student started to take the medical history, the patient fainted and the monitor displayed ventricular tachycardia. Assessment of stress parameters Upon completion of the simulation, perceived levels of stress and feeling overwhelmed were measured for Fulvestrant mw different time points during the study period: (a) the baseline period immediately before resuscitation, (b) during the resuscitation period, (c) when the “patient” awakes, and d) during the debriefing period after the resuscitation. For each time point, we asked the

students to quantify Inhibitors,research,lifescience,medical perceived levels of stress and feeling overwhelmed, measured on a Likert scale ranging from 1–20 (1 being lowest and 20 being highest). In a previous study, we found that perceived stress was best represented by Inhibitors,research,lifescience,medical a combination

of these two items: feeling “stressed” and feeling “overwhelmed” [14]. We therefore combined the two items into a “stress/overload” index. Outcomes and measurements The primary outcome was the average level of stress/overload during the resuscitation period for the experimental and the control group. Secondary outcomes were three performance measures, two relating to medical performance Inhibitors,research,lifescience,medical and one relating to team coordination. The two medical performance measures were: (a) hands-on time defined as duration of uninterrupted chest compressions Inhibitors,research,lifescience,medical and defibrillation in the first 120 seconds after the onset of the cardiac arrest. Each defibrillation was rated as 10 seconds of hands-on time. Interruptions of chest compressions

to perform ventilation were rated as continuous hands-on time if the interruption was < 10 sec; (b) the time elapsed until CPR was started, defined as the time to the first meaningful measure (either defibrillation, chest compression or ventilation) after the onset of the cardiac arrest; the team coordination measure (c) was Inhibitors,research,lifescience,medical the number of leadership statements coded, using a predefined checklist containing the following categories based on previous research these [5,7,8,38,39]: task assignment/task distribution, decision what to do, decision how to do, command. We also assessed the effectiveness of the instruction in the intervention group by investigating whether the two structuring questions were, indeed, asked aloud. Data analysis Using frame-in-frame technology, the teams’ performance and the monitor displaying the “patient’s” vital signs were simultaneously recorded. Data to assess CPR performance measures and leadership statements were assessed based on the video-tapes recorded during simulation. More precisely, CPR-related actions were coded second by second; communication was transcribed, and each statement was coded as outlined above.