Gersten Jonker

94   Chapter 4 I didn’t dare to do everything, like stabbing the manikin with a needle in case of a pneumothorax. (P3) The scenarios were considered very compelling, and all students believed they could end up in similar situations as newly qualified doctors. The only unrealistic aspect of the scenarios was the fact that no one appeared after the student called for help. Most students accepted this as part of the simulation, assuming “nobody would arrive anyway.” During the scenario Scenarios started gently, but the manikin soon started to deteriorate, rapidly increasing pressure on the participants, oftentimes overwhelming them. The simulation started gradually and then stimulus 1, and stimulus 2, and stimulus 3 hit me, and I had to filter. . . . There are so many possibilities. And where is everything stocked? So many things to be sought, so many things not to be found, all those options. Leave them be; let’s focus on the patient. (P4) Sometimes I felt like a deer caught in the headlights. That unease, that is what I call stress. (P3) Virtually all participants experienced the deterioration as stressful. Some students noticed sweaty palms or an increase in heart rate, whereas others were unaware of any bodily sensations. A few students described the room as “intimidating,” experienced the “walls closing in” in relation to stress about the deteriorating manikin: You are sweating more, are getting a real adrenaline rush. It made me double my efforts, but once the patient deteriorates, you start to feel a little claustrophobic in that room. (P2) Primarily, stress manifested mentally. Students felt pressed to take decisions and do things but struggled to think clearly. Students indicated having difficulty accessing their knowledge or prioritizing and sometimes forgetting what they intended to do. When I saw on the monitor that it wasn’t going well, thoughts were racing through my mind. “It could be this, or this, or this. I could do several things, but which one? And when? (P6)