Crew Resource Management Training 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.

306 The effect of simulation-based Crew Resource Management training on interprofessional teamclimate in a hospital setting – a single center study

306 The effect of simulation-based Crew Resource Management training on interprofessional teamclimate in a hospital setting – a single center study

Effects of flight crew role assignment on aviation accidents and incidents: Evidence of a systemic safety issue

To investigate whether a reported association between flight crew role assignment and accident/incident frequency has persisted subsequent to reforms introduced to address it, we analyze global civil aviation data on 841 accidents and safety critical incidents for the period 2000–2020 resulting in 5318 fatalities. We find that significantly more such events occur, and significantly more fatalities result, when the Captain (Pilot-in-Command) rather than the Co-pilot (Second-in-Command) is acting on the controls as “Pilot Flying” rather than acting as “Pilot Monitoring” – prima facie evidence that the regular combination of command and control (Pilot-in-Command as Pilot Flying) presents a significant systemic safety risk. The yearly proportion of events with the Pilot-in-Command as Pilot Flying significantly increased over 2000–2020. Moreover most (72.2%) events occurred in the absence of any emergency, in technically airworthy aircraft and most (87.9%) were also judgmentally assessed as preventable by the flight crew. Our findings are consistent with accounts of the crew assignment effect that invoke role-dependent status hierarchy effects interfering with effective monitoring and with cognitive overload debilitating the Pilot-in-Command when assigned as the Pilot Flying. We interpret these findings as evidence that measures specifically introduced to implement effective flight crew teamwork, such as Crew Resource Management training, fail to prevent ineffective flight crew teamwork. We consider the implications of our findings for the aviation industry and present options for mitigation and issues for further research.

Suitability of Virtual Reality for Supplemental Scenario-based Training to Facilitate Crew Resource Management Outcomes

Researchers and practitioners are exploring the efficacy of virtual reality (VR) in education and training, including in aviation (Hight et al., 2022). In this poster presentation, we briefly discuss existing literature that has examined the effectiveness of VR for training within aviation. We then specifically address the potential adoption of VR as a simulation training tool to enhance crew resource management (CRM) training in what we refer to as supplemental Scenario-based Training (SBT).

The Influence of Human Factors Training in Air Rescue Service on Patient Safety in Hospitals: Results of an Online Survey

Background: Air rescue crew members work equally in aviation and medicine, and thus occupy an important interface between the two work environments of aviation and medicine. The aim of this study was to obtain responses from participants to a validated online-based questionnaire regarding whether hospitals may benefit from the commitment of a medical hospital staff which is also professionally involved in the aviation system as emergency physicians and Helicopter Emergency Medical Services Technical Crew Members (HEMS TC). Furthermore, it focused on the question of whether the skills acquired through Crew Resource Management (CRM) training in the air rescue service might also be used in the ground-based rescue service and, if so, whether they may have a positive effect. Methods: Medical air rescue staff of 37 German air rescue stations was included. Between 27 November 2020 and 03 March 2021, 253 out of 621 employees (response rate: 40.7%) participated voluntarily in a validated anonymized online survey. A quantitative test procedure was performed using the modified questionnaire on teamwork and patient safety (German version). Results: The examination and interpretation of the internal consistency (Cronbach's alpha) resulted in the following reliabilities: Factor I (Cooperation): α = 0.707 (good); Factor II (Human factors): α = 0.853 (very good); Factor III (Communication): α = 0.657 (acceptable); and Factor IV (Safety): α = 0.620 (acceptable). Factor analysis explained 53.1% of the variance. Conclusions: The medical clinicians participating in this online survey believed that the skills they learned in human factors training such as CRM are helpful in their daily routine work in hospitals or other medical facilities, as well as in their ground-based rescue service activities. These findings may result in the recommendation to make CRM available on a regular to the medical staff in all medical facilities and also to ground-based rescue service staff aiming to increase patient safety and employee satisfaction.

Further development of crew resource management training : Needs assessment by means of teamwork-context analysis in anesthesia and intensive care teams.

BackgroundTeams in anesthesia and intensive care work as high responsibility teams (HRT). Success in this environment partly depends on the use of nontechnical skills which can be learned through simulation-based training. A teamwork context analysis could help to identify training requirements for crew resource management training.Material and methodsWe used a multicentric observational cross-sectional study design utilizing survey methodology to evaluate the teamwork context of different work environments, using the 62-item TAKAI inventory. We surveyed anesthesia and intensive care staff from nine hospitals in Germany which provide varying levels of care.ResultsIn total, 128 people (44.5% male, 53.9% female) from 9 German hospitals participated in the study. The topics “interconnectedness: departments”, “interconnectedness: information flow”, “dynamics”, “polytely”, “velocity of the team’s movement”, “velocity of system changes”, “hierarchy” and “hierarchy: leadership”, “shared task mental model”, “shared team mental model” and all aspects of the scale “adaptive behaviors” were identified as focal aspects to be implemented into Crew-Resource-Management (CRM) training for the evaluated work environments.ConclusionThe TAKAI scales meet quality criteria (Cronbach’s alpha > 0.6) and are appropriate for use in the analysis of the teamwork environment. The results indicate many similarities between the work contexts surveyed but also slight differences. TAKAI can be an additional method to design an appropriate simulation training program for HRT in anesthesia and intensive care medicine as there does not seem to be a one-size-fits-all simulation concept. For a special focus on the needs of a work context, the easy to perform TAKAI analysis in the needs analysis step is worthwhile.Supplementary InformationThe online version of this article (10.1007/s00101-022-01170-3) contains further illustrations, the questionnaires and a table of the demographic data of the participants.

Organizational Safety Climate and Job Enjoyment in Hospital Surgical Teams With and Without Crew Resource Management Training.

The association between organizational safety climate (OSC) and job enjoyment (JE) for team members in surgical units in 2 hospitals was investigated. The treatment hospital received airline industry-based crew resource management (CRM) training, and the comparison hospital did not. Strong OSC has been positively associated with healthy hospital work environments and was expected to also be associated with employee job enjoyment. Two hundred sixty-two surgical personnel responded to surveys about OSC and JE. The effects of OSC on JE did not depend on having CRM training. However, OSC and JE scores were higher in the treatment hospital, and the main effect of OSC and JE scores in the treatment hospital was highly significant (P < 0.001), with higher safety climate scores associated with higher JE. A strong OSC is important to employee job enjoyment. Nurse leaders should promote measures to strengthen the OSC in their surgical services departments.

Generic Crew Resource Management training to improve non-technical skills in acute care - Phase 2: A pre-post multicentric intervention study

BackgroundCrew Resource Management (CRM) training aims to improve non-technical skills to reduce preventable errors in healthcare. This study evaluates a generic CRM training program for acute care settings by assessing its’ effect on the four levels of Kirkpatrick. MethodsThe intervention entails a theoretical part and a simulation-based multidisciplinary team training including debriefing. Pre-post measurements were taken using questionnaires, observations and interviews. 231 Belgian physicians, midwives and nurses participated. ResultsOn level 1, respondents provided high scores and perceived the training as important. On level 2, a shift in knowledge, skills and awareness was found for 9/23 items. Observations showed safer teamwork on level 3 for all specialty areas. On level 4, a significant improvement was measured only for perceptions of management. Hierarchy and lack of a safety culture hinder the application of CRM in practice. ConclusionsA generic CRM-training invokes a positive reaction, changes attitude, knowledge, non-technical skills, and behavior. A one-time CRM-training is insufficient to change safety culture. The possibility of a generic training for acute specialty areas was confirmed.

Enhancing Maritime Crew Resource Management Training by Applying Resilience Engineering: A Case Study of the Bachelor Maritime Officer Training Programme in Rotterdam

This paper sets out to enhance current Maritime Crew Resource Management (MCRM) training, and with that to improve the training of technical and non-technical skills given to bachelor maritime officers. The rationale for CRM training is improving safety performance by reducing accidents caused by human error. The central notion of CRM training is that applying good resource management principles during day-to-day operations will lead to a beneficial change in attitudes and behaviour regarding safety. This article therefore indicates that enhanced MCRM should play a more structural role in the training of student officers. However, the key question is: what are the required changes in attitude and behaviour that will create sufficient adaptability to improve safety performance? To provide an answer, we introduce the Resilience Engineering (RE) theory. From an RE point of view, we elaborate on the relation between team adaptability and safety performance, operationalized as a competence profile. In addition, a case study of the ‘Rotterdam Approach’ will be presented, in which the MCRM training design has been enhanced with RE, with the objective to train team adaptability skills for improved safety performance.

Gender Discrimination in the Flight Deck: An Analysis on the Experiences of Ab-initio Pilots

Gender-related issues among pilots are increasingly recognized as a serious, worldwide safety concern. A considerable amount of literature has been published on gender discrimination in commercial aviation and general aviation. However, to the best of authors’ knowledge, no research has been found that examined the gender-related issues among ab-initio pilots in Turkey. The aim of this research project has therefore been to investigate the gender discrimination among ab-initio pilots. With consideration in mind, a survey was developed by using previously published two questionnaires in the field of gender-related issues in aviation and conducted to collect data. By the end of the survey period, data had been collected from 104 ab-initio pilots. The independent sample t-test was employed to analyze the results of the survey. It has been concluded that female ab-initio pilots face gender discrimination. Furthermore, it has been found that there was no significant difference in difficulties faced during the training due to gender-related issues between male and female ab-initio pilots. The results of this study provided an understanding on gender-related issues among ab-initio pilots. The findings of this study may provide important implications in the field of crew resource management training for ab-initio pilots and increase overall safety in aviation

Crew Resource Management Training for Surgical Teams, A Fragmented Landscape

Medical Crew Resource Management (CRM) training courses are designed to increase patient safety by reducing the effects of human errors. These training courses are most popular in surgery and a wide range of medical CRM training courses for surgical teams is now available. However, the effects of these CRM training courses on patient outcomes are inconclusive. Although surgical teams feel the need to be trained in team collaboration skills, they are often puzzled about what criteria to apply when choosing a medical CRM training course. This study aimed to compare CRM training courses on didactic components and simulation-exercises to explore if these courses are interchangeable. In this qualitative study, semi-structured interviews were conducted among 10 main CRM training providers of surgical teams in the Netherlands. Although a large variety was found in the content of CRM training courses, the most substantial differences were found in the simulation-exercises. Nine out of 10 trainers stated that standard simulation-exercises would be a step forward to ensure quality in CRM trainings. According to the trainers, the implementation of medical CRM can reduce human errors and as a result, preventable patient complications. They suggested a quality standard for CRM trainers in the medical field to ensure the quality of medical team training as a way to reach this. Medical CRM training courses are diverse and noninterchangeable. Trainers expect that if CRM becomes part of surgical training and is embedded in operating theatre culture, it could be of great value for patients and professionals.

The conservative emergency room - care of acutely critically ill non-trauma patients

Treatment of critically ill non-trauma patients is challenging, due to the broad spectrum of underlying diseases in this clinical setting. It has been shown that outcome in these patients is poor due to high age, comorbidities and severeness of acute disease. In most cases it is crucial to establish diagnosis and start specific treatment immediately to improve patients' outcome. In contrast to the management of severely injured patients, general guidelines for the initial diagnostic and therapeutic approaches in these patients have been lacking until now. As a consequence, little is known about both: patients' characteristics and outcome. This article provides an overview of the current information available on this group of patients.All critically ill patients should first be managed in the resuscitation room, as it is necessary to provide the optimal infrastructure, including material and personal resources, to maintain high quality care. For non-trauma patients, indication can be defined using the ABCDE approach. Expertise in emergency ultrasound as a key diagnostic tool, profound knowledge of intensive care treatment and of diagnostic and therapeutic approaches according to current specific guidelines are required. These requirements can be implemented by assembling nursery and medical staff trained in emergency care, supported by accredited continued professional development and regular simulation trainings.The best transition from preclinical to in-hospital care is achieved through detailed preparation and the use of standardized handover tools. Subsequent patient management can be organized using the primary and secondary survey. These aim to detect and treat life threatening pathologies first and, within a second step, to expand the diagnosis and therapy according to the individual case. Special focus should be put on communication, using crew resource management training, and on the provision on an open and constructive approach to making mistakes.

Improving Incident Reporting in a Hospital-Based Radiation Oncology Department: The Impact of a Customized Crew Resource Training and Event Reporting Intervention.

BackgroundRadiation oncology (RO) is a high-risk environment with an increased potential for error due to the complex automated and manual interactions between heterogeneous teams and advanced technologies. Errors involving procedural deviations­­ can adversely impact patient morbidity and mortality. Under-reporting of errors is common in healthcare for reasons such as fear of retribution, liability, embarrassment, etc. Incident reporting is a proven tool for learning from errors and, when effectively implemented, can improve quality and safety. Crew resource management (CRM) employs just culture principles with a team-based safety system. The pillars of CRM include mandatory error reporting and structured training to proactively identify, learn from, and mitigate incidents. High-reliability organizations, such as commercial aviation, have achieved exemplary safety performance since adopting CRM strategies.ObjectiveOur aim was to double the rate of staff error reporting from baseline rates utilizing CRM strategies during a six-month study period in a hospital-based radiation oncology (RO) department.MethodsThis quasi-experimental study involved a retrospective review of reported radiation oncology incidents between January 2015 and March 2016, which helped inform the development and implementation of a two-step custom CRM training and incident learning system (ILS) intervention in May 2016. A convenience sample of approximately 50 RO staff (Staff) performing over 100 external beam and daily brachytherapy treatments participated in weekly training for six months while continuing to report errors on a hospital-enterprise system. A discipline-specific incident learning system (ILS) customized for the department was added during the last three months of the study, enabling staff to identify, characterize, and report incidents and potential errors. Weekly process control charts used to trend incident reporting rates (total number of reported incidents in a given month /1000 fractions), and custom reports characterizing the potential severity as well as the location of incidents along the treatment path, were reviewed, analyzed, and addressed by an RO multidisciplinary project committee established for this study.ResultsA five-fold increase in the monthly reported number of incidents (n = 9.3) was observed during the six-month intervention period as compared to the 16-month pre-intervention period (n = 1.8). A significant increase (>3 sigma) was observed when the custom reporting system was added during the last three study months.ConclusionA discipline-specific electronic ILS enabling the characterization of individual RO incidents combined with routine CRM training is an effective method for increasing staff incident reporting and engagement, leading to a more systematic, team-based mitigation process. These combined strategies allowed for real-time reporting, analysis, and learning that can be used to enhance patient safety, improve teamwork, streamline communication, and advance a culture of safety.

Generic Crew Resource Management Training to Improve Non-technical Skills in Acute Care—Phase 1: An Interdisciplinary Needs Assessment Survey

BackgroundAs the first phase of a larger multicentric study, a needs assessment was conducted to develop generic crew resource management training for all critical care wards in hospitals. MethodThe online survey study included 103 Belgian physicians, nurses, and midwives working in obstetric units, emergency rooms, operating rooms, and intensive care units. ResultsAcute care professionals across specialty areas and professions had a positive attitude toward non-technical skills and multidisciplinary simulation-based team training. The majority preferred simulation-based training as an educational format to train non-technical skills. Preferred training content and the gap between attitude and skill were similar across specialty areas and professions. However, perceived barriers during emergency situations did differ somewhat between specialty areas. ConclusionsA generic crew resource management training program for all acute care professionals is feasible provided that barriers, needs, and concerns are taken into account.

What Do We Really Know About Crew Resource Management in Healthcare?: An Umbrella Review on Crew Resource Management and Its Effectiveness.

The aim of this article was to present an overview of the crew resource management (CRM) literature in healthcare. The first aim was to conduct an umbrella review on CRM literature reviews. The second aim was to conduct a new literature review that aims to address the gaps that were identified through the umbrella review. First, we conducted an umbrella review to identify all reviews that have focused on CRM within the healthcare context. This step resulted in 16 literature reviews. Second, we conducted a comprehensive literature review that resulted in 106 articles. The 16 literature reviews showed a high level of heterogeneity, which resulted in discussing 3 ambiguities: definition, outcome, and information ambiguity. As a result of these ambiguities, a new comprehensive review of the CRM literature was conducted. This review showed that CRM seems to have a positive effect on outcomes at Kirkpatrick's level 1, 2, and 3. In contrast, whether CRM has a positive effect on level 4 outcomes and how level 4 should be measured remains undetermined. Recommendations on how to implement and embed CRM training into an organization to achieve the desired effects have not been adequately considered. The extensive nature of this review demonstrates the popularity of CRM in healthcare, but at the same time, it highlights that research tends to be situated within certain settings, focuses on particular outcomes, and has failed to address the full scope of CRM as a team intervention and a management concept.

Crew resource management training as a human factor management tool.

Crew resource management training as a human factor management tool.

Safety culture transformation-The impact of training on explicit and implicit safety attitudes.

The present paper investigates the changeability of safety culture elements such as explicit and implicit safety attitudes by training. Therefore, three studies with different time frames, training durations, and settings will be presented. In the first study, the short‐term attitude change of students from an international environmental sciences study program was measured after safety training in a chemical laboratory. In the second study, the medium‐term attitude change was assessed after a Crew Resource Management training for German production workers in the automotive industry. In the third study, the long‐term attitude changes were measured after safety ethics training in a sample of German occupational psychology and business students. Different self‐report measures were used to evaluate the training effectiveness of explicit safety attitudes. The change of implicit safety attitudes was assessed by Implicit Association Tests. The results of all three studies revealed a significant training effect on the explicit safety attitudes, but not on the implicit ones. Besides the training effect on the explicit attitudes, there was no effect of time frame (short‐, medium‐, long‐term), training duration (2 h, 2 days, 12 weeks), and setting (chemical laboratory, automotive industry, safety ethics study program) on the attitude change. Based on the results, conceptual, methodological, and practical implications for training effectiveness and safety culture transformation are discussed.

A Systematic Review of Trauma Crew Resource Management Training: What Can the United States and the United Kingdom Learn From Each Other?

Crew Resource Management (CRM) training incorporates methods such as simulation, debrief, and teamwork training to emphasize human factors skills. This systematic review aimed to assess differences in CRM between UK and USA trauma personnel. A structured search of the databases MEDLINE and Embase in addition to unstructured reference review and Google Scholar search was undertaken without time restraint to identify articles describing CRM training courses of trauma personnel. Predetermined criteria for inclusion included comprehensive reports of CRM training in trauma personnel with participant assessment. Articles were analyzed for course details and descriptions, Kirkpatrick domains and levels utilized, and measure items and outcomes. Twenty-nine full-text articles (24 USA, 5 UK) met predetermined criteria. UK-based CRM had a heavy emphasis on doctors while USA-based CRM reached a range of multidisciplinary civilian and military professionals. UK-based CRM focused on skills outcomes using pre- and post-training questionnaires, whereas USA-based training focused on behavior and nontechnical skills utilizing validated standardized measures. CRM-based training, and particularly courses incorporating simulation and multidisciplinary methods, resulted in significantly improved preparedness for trauma, emergency skills, and clinical behavioral change. CRM training has the potential to give significant benefits to participant learning, teamwork behaviors, and clinical care outcomes. The USA appears to utilize a focused multidisciplinary and human factors approach to trauma training, which could be adopted by UK institutions to improve cohesive team performance and patient care.

Simulation in obstetric anesthesia: an update.

Simulation training (crew resource management training and scenario training) has become an important tool in the education of anesthesiologists. This review summarizes recent research performed in this area, focusing more specifically on obstetric anesthesia. Simulation training is becoming more integrated in the modern education of anesthesiologists. Research regarding the most effective way to perform simulation training in terms of learning outcomes and long-term skill retention has started to appear. Scenarios which are played independently and that allow for simulated mortality, as well as relaxation techniques before debriefing might have positive effects in this regard. Furthermore, simulation has been investigated as a tool to improve patient safety in low-resource settings. In addition, simulation training in the domain of obstetrics has been rapidly expanding and has an important role in this field of medicine as well. Simulation training has acquired a central role in modern education of anesthesiologists. Further research regarding elements to optimize simulation training in terms of learning outcomes and long-term skill retention is desirable. In addition, little data exist concerning the effect of simulation training on possible improvement of patient outcomes in anesthesia.

Learning beyond ‘hands and feet’ in offshore helicopter operations: integrating the individual with the social in CRM and SA

This article makes situated learning theories central to an analysis of offshore helicopter in-flight emergency response, where rule following is mandatory for safety reasons. We examine the ways in which individual learning is connected to situated learning, particularly as relates to multiple forms of knowledge and directive documentation such as standard operating procedures and emergency checklists. The analysis connects to sociotechnical skills, contextual factors, and organizational culture; details five generations of crew resource management (CRM) training, positioning this research within the fifth generation and in relation to situation awareness (SA). It describes and provides guidance on how training, which is focused on error recognition, management, and mitigation, as well as communication, understanding, and innovation, can improve CRM performance. Finally, we make recommendations for future research based on our analysis for combining CRM and SA in ways that enable the sharing of tacit knowledge to increase pilots’ understanding of their work through legitimate peripheral participation.