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Nicholas Murray (Exercise and Sport Science) helps Dr. Joe Khoury, an ECU gastroenterology fellow, attach a device that tracks and records heart rate variability. (Photo by Erica Plouffe Lazure)

ECU Researchers Measure Doctors' Stress, Heart Rate

By Erica Plouffe Lazure

Researchers at East Carolina University hope to help doctors think more like athletes when they prepare for high-performance situations such as operations and medical procedures.

Carmen Russoniello, director of ECU’s Psychophysiology Lab, is working with Dr. Joe Khoury, a gastroenterology fellow at Brody School of Medicine/Pitt County Memorial Hospital, to gauge stress and skill level in physicians during endoscopic and colonospic procedures.

“We are trying to see the stress, as marked by heart rate variability, when the residents perform medical procedures,” Russoniello said. “We want to bring HRV into a medical setting and get a sense of how doctors manage stress under pressure and during procedures. If you can control your nervous system you can, to an extent, limit unpredictability.”

Heart Rate Variability is a measure of sympathetic and parasympathetic nervous system activity in the body that provides information about bodily functions such as stress, said Russoniello. Bluetooth powered sensory devices attached to the residents during medical procedures enable real-time tracking of HRV.

“If we can identify stress levels, we can hopefully reduce medical errors,” said Khoury, who is the study’s principle investigator and a participant. “If results show I’m stressed, I’m happy to try techniques to improve my performance.”

Since August, all of the gastroenterology residents at BSOM/PCMH have participated in the pilot study. They have undergone baseline stress tests in Russoniello’s lab, and their HRV has been tracked and recorded during both practice-session simulators, and actual endoscopic and colonoscopy procedures with patients.

The goal is to discover the variables – such as skill level, age, type of procedure – that can contribute to stress. Dr. Dennis Sinar, a professor of medicine at the Brody School of Medicine and director of the Gastroenterology Fellowship Program, said the study would be useful because it could provide doctors with valuable information about themselves that, in turn, could provide better service to patients.

“We want our residents to be less anxious and more comfortable and confident with these procedures,” Sinar said. “With interventions like these, our goal is to have better, more efficient and confident trainees in the medical profession.”

Khoury, Russoniello and Sinar are working with Nicholas Murray, professor of exercise and sports science, to track and record HRV. Eventually, they hope to integrate relaxation and preparation strategies from sports into doctors’ pre-procedure routines.

“In sport what we look at is how people manage stress through some pre-event or pre-performance routines,” Murray said. “In this case if you have a physician who is stressed we recommended they do something before the operation to minimize the impact of stress.” The strategies, which range from visualization, yoga, and deep breathing, are used by professional athletes in high-performance situations.

“We think the best performance occurs when you’re in what is called ‘flow’, or when skill is equal to the task minus anxiety,” said Russoniello. “We think your best performance occurs, with the least amount of errors, in this state.”

The pilot study between ECU and the GI program could extend these preparation strategies to doctors about to perform surgery.

While the sample of medical residents tested is too small and too premature for a statistical analysis, there is a general correlation between an increase in stress and an increase in the complexity of the procedure. He noted that the age of the residents could also play a factor in stress and recovery, because younger bodies tend to be more resilient in managing stress. Plans are now in the works to expand the study to doctors in other areas of the hospital, and Khoury has submitted the pilot study to the American Gastroenterology Association’s Digestive Disease Week meeting scheduled for this spring. “Our hope is that once we get a sense of this, we can develop some powerful normative data of what a physician would look like under normal conditions and under stress,” Russoniello said. “We could predict, ideally, who might need intervention strategies, like breathing or yoga, to help control their autonomic nervous system.”

This page originally appeared in the Dec. 8, 2006 issue of Pieces of Eight. Complete issue is archived at