English to Italian Bus/Financial Medical: Health Care

In this context it probably just means the physicians'/midwives' ability to assert one's will. The sample comes from a text on medical simulation in obstetrics:
"The obstetric simulation course was lengthened to 6 hours to accommodate 3 scenarios and provide adequate time to debrief all issues of concern to participants. The 6-hour session allowed clinicians to attend personal or clinical obligations during the late afternoon or evening hours. The third scenario was designed to unfold slowly throughout the day thus providing a sense of passing time and highlighting issues related to long-term vigilance and assertion."