Table 5

Mean (95% CI) of salivary cortisol (nmol/L), STAI and CA during simulation in management of an emergency caesarean section and postpartum haemorrhage conducted as ISS and OSS

  BaselinePostsimulation
0 min
Mean*
Postsimulation
5 min
Mean*
Postsimulation
10 min
Mean*
Peak-level mean*†Mean difference*‡ of baseline to peak of ΔOSS versus ΔISS
First simulation: emergency caesarean section
 CortisolISS7.0 (6.3 to 7.8)8.9 (7.2 to 10.6)8.1 (6.6 to 9.6)8.1 (6.6 to 9.5)9.3 (7.6 to 11.0)−0.5 (−1.6 to 2.5) p=0.64
OSS7.3 (5.3 to 9.2)8.2 (6.3 to 10.2)7.8 (6.1 to 9.6)8.0 (6.2 to 9.8)9.0 (6.9 to 11.1)
 STAIISS32.2 (30.4 to 34.0)34.8 (32.7 to 37.0)31.3 (29.5 to 33.1)36.5 (34.3 to 38.7)−0.2 (−2.1 to 2.5) p=0.85
OSS33.1 (31.1 to 35.0)34.8 (32.2 to 37.3)30.7 (29.0 to 32.4)37.0 (34.7 to 39.3)
 CAISS1.0 (0.9 to 1.1)0.8 (0.7 to 1.0)0.8 (0.7 to 0.9)0.8 (0.7 to 1.0.)0.0 (−0.2 to 0.2) p=0.93
OSS1.0 (1.0 to 1.1)0.8 (0.7 to 0.9)0.8 (0.6 to 0.9)0.9 (0.7 to 0.9)
Second simulation: postpartum haemorrhage
 CortisolISS7.4 (6.5 to 8.3)9.2 (7.7 to 10.7)7.7 (6.6 to 8.8)7.4 (6.3 to 8.5)9.4 (7.9 to 10.9)−1.2 (−0.1 to 0.25) p=0.07
OSS6.9 (5.9 to 7.9)7.5 (6.6 to 8.4)6.7 (5.8 to 7.7)6.8 (6.0 to 7.6)7.7 (6.7 to 8.7)
 STAIISS31.8 (30.0 to 33.6)31.8 (30.1 to 33.6)28.5 (27.3 to 29.7)32.2 (30.5 to 33.9)−0.5 (−2.2 to 1.3) p=0.61
OSS32.1 (29.9 to 34.2)32.4 (30.5 to 34.3)30.1 (28.5 to 31.8)32.8 (31.0 to 34.7)
 CAISS1.0 (0.9 to 1.1)0.8 (0.7 to 0.9)0.8 (0.7 to 0.9)0.8 (0.7 to 0.9)0.1 (−0.2 to 0.1) p=0.56
OSS1.1 (1.0 to 1.2)0.9 (0.7 to 1.0)0.8 (0.7 to 0.9)0.9 (0.7 to 1.0)
  • *Based on generalised estimating equations to account for potential correlation within teams.

  • †Peak level is the maximum of the measurements obtained at 0, 5 and 10 min after the end of the simulation.

  • ‡Adjusted for pre-cortisol, pre-STAI and pre-CA (ANCOVA).

  • ANCOVA, analysis of covariance;CA, cognitive appraisal (range 0.1–10); ISS, in situ simulation; OSS, off-site simulation; STAI, Stress-Trait Anxiety Inventory (range 20–80).