Participants trait anxiety predicted the intensity of worry, distress and task engagement. The participants reported decreased worry, followed by increased emotional distress after the simulation training (T 1). It was found that the onset of task performance was related to increased anticipatory worry and higher oxygen saturation. Cortisol, testosterone, secretory immunoglobulin class A (sIgA), alpha-amylase, and oxygen saturation level were measured at T 0, T 1, and T 2, as was the physiological response indicated by heart rate (HR) and blood pressure (BP). Psychological stress and anxiety were measured at T 0 and T 1, using the State-Trait Anxiety Inventory (STAI) and Dundee Stress State Questionnaire (DSSQ). Subsequently, each participant was assessed before the scenario (T 0), after the procedure (T 1), and two hours later (T 2).

Fifty-six undergraduate medicine students who took part in a medical simulation session were assigned team roles (physician, nurse or assistant). This prospective observational study assessed psychological, physiological, immunological, and humoral levels of stress during high-fidelity simulation training. These sessions may also generate a complex stress response in the learners. Simulation sessions can produce high-fidelity emergency situations that facilitate the learning process.