{"doi":"10.1371/journal.pone.0331488","title":"An adaptive simulation intervention decreases emergency physician physiologic stress while caring for patients during COVID-19: A randomized clinical trial","abstract":"BACKGROUND: Stressful work environments and burnout in emergency medicine (EM) physicians adversely impact patient care quality. The future EM workforce will need to prioritize clinician well-being to ensure optimal patient care. METHODS: This prospective, randomized, controlled study aimed to determine whether an adaptive simulation intervention, COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS), decreased physiologic stress as measured by heart rate variability (HRV) in front-line EM physicians during the COVID-19 pandemic. HRV was measured with smart shirts and self-reported State-Trait Anxiety Inventory (STAI) were collected at baseline and during four 8-hour clinical shifts for all participants. The intervention group (n = 40) received a 3-hour virtual educational simulation intervention consisting of four simulation scenarios (CRI:SIS). The control group (n = 41) received no simulation intervention. RESULTS: There were no significant differences in demographics between groups. HRV data collected from 81 physicians across a total of 324 clinical shifts showed an increase in HRV (decrease in physiologic stress) in shifts immediately following CRI:SIS in the intervention group as measured by a root mean square standard deviation (RMSSD) difference of 11.55 ms (95% CI, -19.90 to -3.20; P = 0.007) compared to the control group. Post-intervention STAI did not significantly differ between intervention and control. CONCLUSION: An adaptive simulation-based educational intervention led to decreased physiologic stress (increased HRV) among emergency physicians who received a simulation education intervention. Reduced physiologic stress generated by adaptive simulation interventions may improve both patient safety and clinician well-being.","journal":"PLoS ONE","year":2025,"id":574117,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9533,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":657686,"name":"James W. Bonz","orcid":null,"position":1,"is_corresponding":false},{"id":657685,"name":"Samuel Buck","orcid":null,"position":2,"is_corresponding":false},{"id":828641,"name":"Jeffrey Gerwin","orcid":"0000-0003-4657-2605","position":3,"is_corresponding":false},{"id":750203,"name":"Shacelles Bonner","orcid":null,"position":4,"is_corresponding":false},{"id":1481906,"name":"Suzette Ikejiani","orcid":null,"position":5,"is_corresponding":false},{"id":1481907,"name":"Tatiana Moylan","orcid":null,"position":6,"is_corresponding":false},{"id":656766,"name":"Melissa Joseph","orcid":"0000-0003-2287-2742","position":7,"is_corresponding":false},{"id":1481591,"name":"Gustavo de Oliveira Almeida","orcid":"0000-0003-0672-6649","position":8,"is_corresponding":false},{"id":274419,"name":"Jessica M. Ray","orcid":"0000-0003-3410-1507","position":9,"is_corresponding":false},{"id":230349,"name":"James Dziura","orcid":"0000-0001-8953-6183","position":10,"is_corresponding":false},{"id":413443,"name":"Arjun K. Venkatesh","orcid":"0000-0002-8248-0567","position":11,"is_corresponding":false},{"id":237718,"name":"Ambrose H. Wong","orcid":"0000-0001-7471-1647","position":12,"is_corresponding":false},{"id":432167,"name":"Leigh V. Evans","orcid":"0000-0002-9667-4071","position":0,"is_corresponding":true}],"reference_count":64,"raw_metadata":null,"created_at":"2026-07-19T02:57:40.686992Z","pmid":"40901855","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}