Crew Resource Management Skills Research Articles

Training for a Mass Casualty Incident: Conception, Development and Implementation of a Crew-Resource Management Course for Forward Surgical Teams.

The purpose of this article is to describe the development of a crew resource management (CRM) training course dedicated for the forward surgical teams (FSTs) of the French Military Health Service. Since 2021, the predeployment training of French FSTs has included a simulation-based curriculum consisting of organizational and human factors. It combines lectures, laboratory exercises, and situational training exercises to consider four fundamental "nontechnical" (cognitive and social) skills for effective and safe combat casualty care: (a) leadership, (b) decision-making, (c) coordination, and (d) situational awareness. The approach was based on three steps: (1) establishment of a conceptual framework of FSTs deployment; (2) development and implementation of an aircrew-like CRM training dedicated to combat casualty care; and (3) assessment of FSTs' CRM skills using an audio/video recording of a simulated mass-casualty incident. To ensure complete and high-quality predeployment training, French FSTs undergo a high-quality training that takes into account both technical and non-technical skills to maintain quality of combat care during mass-casualty incidents.

The effects of crew resource management on flight safety culture: corporate crew resource management (CRM 7.0)

Abstract The main purpose of crew resource management (CRM) is to ensure safe flights by preventing possible errors with the effective use of non-technical skills. The aim of the current study is to examine the effects of CRM on flight safety culture (FSC) with the help of the structural equation model with 451 airline pilots. As a result of the analysis, it was determined that there was a significant correlation between CRM and FSC and that CRM has a significant positive effect on FSC. It has been demonstrated that if CRM awareness and skills are used effectively, the perception of FSC will also improve. Furthermore, these findings indicate that there is a need to progress to the corporate CRM phase, i.e., CRM 7.0, to ensure that organisation-wide FSC awareness is established through CRM awareness.

Closing the Gap in Human Factors Everybody Has a Role To Play

Human factors is a broad technical discipline focused on enhancing people’s performance in complex organizations where people interact with equipment and processes over time and across levels of hierarchy. Despite this relatively clear definition, human factors is still poorly understand and doesn’t yet yield the full potential that the practical insights and actions can produce. Despite a substantial effort on the part of many industry bodies, including the UK Energy Institute (EI) and the International Oil and Gas Producers Association (IOGP), to raise awareness of human-factors principles, with some exceptions in a few organizations, progress on implementation has been slow. Momentum is now finally building with the formation of the Human Performance Oil and Gas Group (HPOG), which is designed to be an industry membership organization modeled on the highly successful Dropped Objects Prevention Safety initiative, DROPS. Its purpose is to embed human factors concepts into practical organizational processes and operational procedures. There is a common misconception that human-factors skills are solely for frontline employees and once suitably trained, their behavior will change and performance will improve. This approach rests on the belief that the behavior of frontline operators is the source of all problems, which is wide of the mark. Human factors is a challenge for the organization as a whole and extends beyond simply understanding how the human brain works or silver-bullet solutions such as training crew resource-management skills.

군(軍) 전투기 경력 신입 민항조종사 리더십 경험이 민간항공 CRM Skill 습득에 미치는 영향

Flight safety in modern commercial aircraft depends on the ability of pilots to manage overall flight operations. ICAO has made it mandatory for airlines to adhere to Crew Resource Management(CRM) policies to reduce operational safety threats. CRM is a set of techniques designed to effectively manage the human resources, aircraft, and environmental factors in order to promote safety and enhance efficient air operations. When looking at the career backgrounds of new pilots joining the Republic of Korea’s commercial airlines, discharged military fighter pilots represent the largest demographic. Fighter pilots are experienced in empowering leadership and directive leadership from their military training and culture. New commercial airline pilots with military fighter pilot training should effectively acquire the required civil aviation CRM skills. The present study has been carried out to determine how the leadership experience of this demographic affects the acquisition of CRM skills for commercial airlines, and it confirms that there is a positive correlation.

Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country

BackgroundGlobally perinatal and maternal mortality rates remain unacceptably high. There is increasing evidence that simulation-based training in obstetric emergencies is associated with improvement in clinical outcomes. However, the results are not entirely consistent. The need for continued research in a wide variety of clinical settings to establish what works, where and why was recommended. The aim of this study is to investigate the effectiveness of an emergency obstetric simulation-based training program with medical technical and teamwork skills on maternal and perinatal mortality in a low-income country.MethodsA stepped wedge cluster randomized trial will be conducted at the medium to high-risk labour ward at Mulago Hospital, Kampala, Uganda, with an annual delivery rate of over 23,000. The training will be performed using a train-the-trainers model in which training is cascaded down from master trainers to local facilitators (gynaecologists) to learners (senior house officers). Local facilitators will be trained during a four-day train-the-trainers course with an annual repetition. The senior house officers will be naturally divided in seven clusters and randomized for the moment of training. The training consists of a one-day, monodisciplinary, simulation-based training followed by repetition training sessions. Scenarios are based on the main local causes of maternal and neonatal mortality and focus on both medical technical and crew resource management skills. Kirkpatrick’s classification will be used to evaluate the training program. Primary outcome will be the composite of maternal and neonatal mortality ratios. Secondary outcome will comprise course perception, evaluation of the instructional design of the training, knowledge, technical skills, team performance, percentage of ventouse deliveries, percentage of caesarean sections, and a Weighted Adverse Outcome Score.DiscussionThis stepped wedge cluster randomized trial will investigate the effect of a monodisciplinary simulation-based obstetric training in a low-income country, focusing on both medical technical skills and crew resource management skills, on patient outcome at one of the largest labour wards worldwide. We will use a robust study design which will allow us to better understand the training effects, and difficulties in evaluating training programs in low-income countries.Trial registrationISRCTN98617255, retrospectively registered July 23, 2018.

Comparing the effectiveness of a hybrid simulation/lecture session versus simulation alone in teaching crew resource management (CRM) skills: a randomised controlled trial.

Various methods have been used to teach crew resource management (CRM) skills, including high-fidelity patient simulation. It is unclear whether a didactic lecture added on to a simulation-based curriculum can augment a learner's education. Using an already existing simulation-based curriculum for interdisciplinary teams composed of both residents and nurses, teams were randomised to an intervention or control arm. The intervention arm had a 10 min didactic lecture after the first of three simulation scenarios, while the control arm did all three simulation scenarios without any didactic component. The CRM skills of teams were then scored, and improvement was compared between the two arms using general estimating equations. The differences in mean teamwork scores between the intervention and control arms in scenarios 2 and 3 were not statistically significant. Mean scores in the intervention arm were lower than in the control arm (-0.57, p=0.78 for scenario 2; -3.12, p=0.13 for scenario 3), and the increase in scores from scenario 2 to 3 was lower in the intervention arm than in the control arm (difference in differences: -2.55, p=0.73). Adding a didactic lecture to a simulation-based curriculum geared at teaching CRM skills to interdisciplinary teams did not lead to significantly improved teamwork.

Methods to Evaluate Pilots’ Cockpit Communication: Cross-Recurrence Analyses vs. Speech Act–Based Analyses

The training and evaluation of the crew resource management skills of pilots play an essential role in increasing flight safety, as they aim to reduce human error in aviation operations. Communicat...

Effect of High-fidelity Shoulder Dystocia Simulation on Emergency Obstetric Skills and Crew Resource Management Skills Among Residents

(Int J Gynaecol Obstet. 2016. pii: S0020-7292(16)30348–4) Shoulder dystocia is associated with a high incidence of neonatal morbidity and mortality. Effective management of this obstetric complication requires swift collaboration between the lead physician and obstetrics team. In the present study, the authors determineed the impact of high-fidelity simulation training on the ability of obstetrics and gynecology residents to effectively manage shoulder dystocia emergencies.

Effect of high-fidelity shoulder dystocia simulation on emergency obstetric skills and crew resource management skills among residents

ObjectiveTo determine the effect of a simulation training program for residents in obstetrics and gynecology in terms of technical and nontechnical skills for the management of shoulder dystocia. MethodsA prospective study was performed at a center in Italy in April–May 2015. Thirty-two obstetrics and gynecology residents were divided into two groups. Residents in the control group were immediately exposed to an emergency shoulder dystocia scenario, whereas those in the simulation group completed a 2-hour training session with the simulator before being exposed to the scenario. After 8weeks, the residents were again exposed to the shoulder dystocia scenario and reassessed. Participants were scored on their demonstration of technical and nontechnical skills. ResultsIn the first set of scenarios, the mean score was higher in the simulation group than the control group in terms of both technical skills (P=0.008) and nontechnical skills (P<0.001). This difference was retained after 8weeks. ConclusionHigh-fidelity simulation programs could be used for the training of residents in obstetrics and gynecology to diagnose and manage obstetric emergencies such as shoulder dystocia.

Interprofessional sepsis education module: a pilot study.

Although there is an increasing emphasis on interprofessional collaboration for safer health care systems, there remains a paucity of opportunities for postgraduate trainees to engage in formal interprofessional education (IPE). Current opportunities for interprofessional learning, such as simulation sessions, typically do not provide true IPE because they often utilize actors or confederates as support staff, making residents the only stakeholders in the education experience. Here, we describe a flexible educational module designed to provide genuine IPE for physicians, nurses, and respiratory therapists. We outline how simulation, feedback, and group discussions can be used to teach interprofessional team communication, collaboration, and crew resource management skills-while, at the same time, also teaching a highly relevant medical topic (sepsis management) and thus resulting in learner engagement and motivation.

Assessing Competence for Reentry

Assessing Competence for Reentry

Exploring the Pilot Reliability Certification Program and Changing Attitudes on Reducing Pilot Errors

The greatest opportunity to improve aviation safety is to focus on reducing human errors in the cockpit. This research evaluated whether there was knowledge gain and difference in attitudes toward reducing human error in the cockpit after implementation of the Pilot Reliability Certification (PRC) program at Federal Aviation Regulation (FAR) 135 air carriers and FAR 91 corporate flight departments. The program is a human factors training curriculum focused on personal vulnerabilities to human error and countermeasures in support of aviation safety. Three levels of measurement were used: reactions to training, a knowledge test, and a modified version of the cockpit management attitudes questionnaire to assess attitude change. A mixed-method approach was used with quantitative data to measure knowledge gain and attitude change along with qualitative data to explore pilot reactions to the training. A quasi-experimental group (n = 41) that completed the 2-day course was compared with a control group (n = 62). The control group showed no significant improvement in attitude related to crew resource management skills or the PRC objectives. The quasi-experimental group had significantly improved attitudes and knowledge gain. Reaction to training was positive, with pilots citing a strengthened human factors knowledge base as the greatest benefit. They thought that the training differed from previous human factors training by being more detailed and in depth. After taking the course, pilots said that they would be more conscious of evaluating themselves, their flying partners, and their attitudes.

Surgical training in the 48-h week: a novel simulation and educational tool. From amateur golfer to professional pilot

Compliance with the European Working Time Directive has made obvious the need for a surgical skills training system that will produce surgeons fast and reliably. We have previously proposed a model for objective assessment of surgical dexterity. In this paper we aim to place an updated version of that model into the context of a holistic approach on assessment of a trainee's progress towards becoming an independently operating surgeon. The PAR matrix breaks down an operation into clearly defined skills that need to be successively acquired. It consists of a 3 x 6 table depicting 18 skill-goals. The y-axis is divided into six levels and the x-axis into three columns. The initials of the three skills on each level form the acronym PAR. Each skill is further graded from 1 to 3 (unsatisfactory, competent, good). The levels are: Level 1--posture, address, relaxation; Level 2--pick-up, airtime, rotation; Level 3--placing, angles, rhythm; Level 4--precision, adaptability, reproducibility; Level 5--pace, awareness, relations; Level 6--planning, announce, review/reflexion. The format of the PAR model is such that it allows trainer and trainee to objectively assess progress, identify deficiencies and strengths and formulate an appropriate plan of action. Ergonomics and crew resource management skills are essential for a safe operating environment. The PAR matrix may prove helpful in selection of trainees and revalidation of trainee surgeons as a competence and performance testing method, placed in the appropriate training curriculum.

Use of High Fidelity Operating Room Simulation to Assess and Teach Communication, Teamwork and Laparoscopic Skills: Initial Experience

Structured opportunities for learning communication, teamwork and laparoscopic principles are limited for urology residents. We evaluated and taught teamwork, communication and laparoscopic skills to urology residents in a simulated operating room. Scenarios related to laparoscopy (insufflator failure, carbon dioxide embolism) were developed using mannequins, urology residents and nurses. These scenarios were developed based on Accreditation Council for Graduate Medical Education core competencies and performed in a simulation center. Between the pretest scenario (insufflation failure) and the posttest scenario (carbon dioxide embolism) instruction was given on teamwork, communication and laparoscopic skills. A total of 19 urology residents participated in the training that involved participation in at least 2 scenarios. Performance was evaluated using validated teamwork instruments, questionnaires and videotape analysis. Significant improvement was noted on validated teamwork instruments between scenarios based on resident (pretest 24, posttest 27, p = 0.01) and expert (pretest 16, posttest 25, p = 0.008) evaluation. Increased teamwork and team performance were also noted between scenarios on videotape analysis with significant improvement for adherence to best practice (p = 0.01) and maintenance of positive rapport among team members (p = 0.02). Significant improvement in the setup of the laparoscopic procedure was observed (p = 0.01). Favorable face and content validity was noted for both scenarios. Teamwork, intraoperative communication and laparoscopic skills of urology residents improved during the high fidelity simulation course. Face and content validity of the individual sessions was favorable. In this study high fidelity simulation was effective for assessing and teaching Accreditation Council for Graduate Medical Education core competencies related to intraoperative communication, teamwork and laparoscopic skills.

Crew resource management training for surgeons: feasibility and impact

This paper describes a prospective, within-subjects study to measure the before-after effect of training five general surgery attendings on crew resource management (CRM) strategies on the resultant use and perceived utility of those strategies. Subjects were trained via a 1-h lecture on seven CRM skills after their second observed case, and participated in a 15 min debriefing with the trainers immediately following their fourth through sixth observed cases. These interventions led to a significant increase in frequency (by 26–70%) of preoperative briefing elements over baseline. There was a significant correlation between the use of CRM practices and their perceived utility in improving team coordination and reducing error.

The Mayo High Performance Teamwork Scale: Reliability and Validity for Evaluating Key Crew Resource Management Skills

To develop and evaluate a participant rating scale for assessing high performance teamwork skills in simulation medicine settings. In all, 107 participants in crisis resource management (CRM) training in a multidisciplinary medical simulation center generated 273 ratings of key CRM skills after participating in two or three simulation exercises. These data were analyzed using Rasch and traditional psychometric approaches to develop the 16-item Mayo High Performance Teamwork Scale (MHPTS). Sensitivity to change as a result CRM training was also evaluated. The MHPTS showed satisfactory internal consistency and construct validity by Rasch (person reliability = 0.77; person separation = 1.85; item reliability = 0.96; item separation = 5.04) and traditional psychometric (Cronbach's alpha = 0.85) indicators. The scale demonstrated sensitivity to change as a result of CRM training (pretraining mean = 21.44 versus first posttraining rating mean = 24.37; paired t = -4.15, P < 0.0001; first posttraining mean = 24.63 versus second posttraining mean = 26.83; paired t = -4.31 P < 0.0001). The MHPTS provides a brief, reliable, practical measure of CRM skills that can be used by participants in CRM training to reflect on and evaluate their performance as a team. Further evaluation of validity and appropriateness in other simulation and medical settings is desirable.

A new simulator-based psychological training on crisis management

The context and setting In aviation, one aspect of safety improvement for over 30 years has been the implementation of crew resource management (CRM) seminars. This psychological teaching form focuses on the CRM competencies task management, dynamic decision making, teamwork and situation awareness. The same competencies can be applied to the medical field. Until now, training of these basic skills has not been established in undergraduate medical education, although they would be as helpful for medical teams as they are for people working in other complex environments. Why the idea was necessary Full-scale patient simulators have been available for more than 15 years. Crisis resource management courses have been developed for doctors with a focus on the CRM competencies. In contrast to aviation, most medical CRM courses are held without psychologists, although the course objectives are psychological competencies. Furthermore, no psychological exercises concerning CRM skills are offered, in contrast to CRM seminars for air crews. In particular, beginners in the medical profession have difficulty applying knowledge and working effectively under stress. For this reason, non-technical skills should already be taught during undergraduate medical education. What was done We established a curriculum for medical students to teach non-technical skills. A 3-hour pilot course with a focus on situation awareness was set up as part of the mandatory 2-week course in ‘Anaesthesiology’ for students between the third and the fifth year. After a lecture about human factors and error prevention (20 minutes), 1 psychologist and 2 anaesthesiologists demonstrated a short resuscitation sequence on a METI-ECS patient simulator (METI, FL, USA). The students had to observe the scenario and discuss how CRM skills were practised (40 minutes). This was followed by a 45-minute seminar about situation awareness, held by a psychologist. The exercises were designed for a medical context by a team of psychologists prior to the course. After the seminar the students completed a resuscitation scenario with the simulator, followed by a debriefing focussed on situation awareness. In all, the simulator training lasted 60 minutes. Participants were asked to complete a questionnaire at the end of the course. Evaluation of results and impact We received 22 evaluation questionnaires from the 22 students who took part in the course. The overall mark was 1.8 ± 0.8 [marks from 1 (excellent) to 6 (poor), mean ± standard deviation (SD)]. The course was rated as suitable for linking theoretical knowledge with clinical contents (2.0 ± 1.0). The marks for the simulator training and the psychological seminar were 1.5 ± 0.7 and 2.0 ± 0.9, respectively. The lecture was marked with 1.7 ± 0.9. The content versus time ratio revealed an average mark of 4.2 ± 0.5 (1: too much content to 7: too much time; 4: ideal ratio) and the theory versus practice ratio was rated nearly perfect (3.9 ± 0.4, 1: too much theory to : too much practice). As our students valued teaching about error prevention and crisis management, we will offer similar courses focusing on the other 3 CRM competencies within the next semester.

Can PC-Based Systems Enhance Teamwork in the Cockpit?

We used a personal computer (PC)-based flight simulator to develop a crew resource management (CRM) training module. Two-person teams practiced with the simulator and also received feedback from an instructor about their performance. We evaluated training effectiveness by comparing trained teams (N = 24) to control teams (N = 24) in a high-fidelity simulator. Raters who were blind to condition provided evaluations of the teams on both CRM and technical proficiency. The results show positive transfer of training of CRM skills from the PC-based system to the high-fidelity simulator. This study supports the effectiveness of relatively inexpensive PC-based systems for CRM training.

Predictors of Threat and Error Management: Identification of Core Nontechnical Skills and Implications for Training Systems Design

In normal flight operations, crews are faced with a variety of external threats and commit a range of errors that have the potential to impact negatively on the safety of airline operations. The effective management of these threats and errors therefore forms an essential element of enhancing performance and minimizing risk. Recent research has reinforced the need to examine a range of nontechnical or crew resource management skills that form threat and error countermeasures. This article provides an analysis of the predictors of threat and error management in normal flight operations within the context of a Southeast Asian airline. Through the structured observation of crews' performance during normal flight operations, data were collected in relation to a set of contextual factors and nontechnical skills. Crews' threat and error management actions were then analyzed in relation to these factors, and predictive models of threat and error management at various phases of flight were developed. The results of this study demonstrate the ways in which this type of data analysis can highlight the strengths and weaknesses of operational performance and suggest that this type of performance evaluation can offer individual organizations invaluable information for enhanced training system design through the further development of scenario-based training.

Improving the Construct Validity of Line Operational Simulation Ratings: Lessons Learned From the Assessment Center

Line operational simulations (LOS) are commonly used for training and evaluating pilot crews under realistic conditions. Despite their widespread use, the construct validity of LOS ratings remains largely unexplored. Preliminary evidence suggests that LOS ratings cluster by phase of flight, rather than by the technical and crew resource management skills that they are intended to measure. These results are consistent with findings from the assessment center literature. After comparing and contrasting the LOS and assessment center techniques, we provide research-based guidelines for improving the construct validity of LOS ratings.