Can Psychological Stress-Inoculation Training Improve Performance in Emergency Medicine Education?

Abstract

Emergency medicine concentrates high-stakes decision-making, uncertainty, and severe time pressure into brief clinical encounters, and it does so precisely when acute stress most powerfully distorts cognition. This narrative review examines stress-inoculation training (SIT) as a framework for preparing emergency medicine trainees to perform under pressure, and asks whether repeated, graduated exposure to simulated emergencies can produce durable stress adaptation. Synthesizing foundational work in cognitive-behavioural psychology, human-factors research from aviation and military settings, and a growing simulation-based literature in health professions education, the review finds converging evidence that acute stress degrades attention, memory retrieval, and decision-making during resuscitation, and that structured stress exposure paired with explicit coping-skills training can mitigate these impairments. The medical evidence also warrants caution: brief, one-off interventions rarely produce measurable improvements in objective performance outcomes, which suggests that the benefits of inoculation are dose-dependent and skills-mediated rather than resulting from stress exposure alone. Repeated simulation appears to improve performance under pressure not simply by familiarizing trainees with stress, but by rehearsing the cognitive and behavioural strategies that help preserve performance under acute stress. The review closes with design principles for embedding longitudinal stress-inoculation curricula in emergency medicine training and priorities for future research.