Crisis Resource Management Training Research Articles

Design and implementation of a “crisis resource management” training program for the initial assessment of polytrauma patients

IntroductionTo describe the design and implementation of a Crisis Resource Management (CRM) training program for the initial assessment of polytrauma patients. MethodsProspectively implemented CRM training program in acute-care tertiary hospital by hospital personnel involved in the care of polytraumatisms. The program has a blended format and 23-h duration, including 11 h of online theoretical training followed by 12-h simulation modules and practical cases devoted to the roles of members of the trauma team, functioning of the polytrauma room, and key aspects of teamwork. The Human Factors Attitude Survey (HFAS) was used to assess attitudes related to non-technical skills, and the End-of-Course Critique (ECC) survey to evaluate satisfaction with training. We evaluated changes in the pre- and post-training assessments. ResultsEighty staff personnel (26% specialists, 16% residents, 29% nurses, 14% nursing assistant, 15% stretcher bearer) participated in three editions of the program. Theoretical knowledge improved from a mean (SD) of 5.95 (1.7) to 8.27 (2.1) (P < .0001). In the HFAS, statistically significant differences in 18 of 23 attitudinal markers were observed, with improvements in all items of “leadership” and “roles”, in 4 of 5 items of “situational awareness”, and in 4 of 8 items of “communication”. Mean values obtained in the ECC questionnaire were also very high. ConclusionsA CRM training model developed for the initial care of polytrauma patients improved theoretical knowledge and participants perceptions and attitudes regarding leadership, communication, roles, and situational awareness of members of the trauma team.

Design and implementation of a “crisis resource management” training program for the initial assessment of polytrauma patients

IntroductionTo describe the design and implementation of a Crisis Resource Management (CRM) training program for the initial assessment of polytrauma patients. MethodsProspectively implemented CRM training program in acute-care tertiary hospital by hospital personnel involved in the care of polytraumatisms. The program has a blended format and 23-h duration, including 11 h of online theoretical training followed by 12-h simulation modules and practical cases devoted to the roles of members of the trauma team, functioning of the polytrauma room, and key aspects of teamwork. The Human Factors Attitude Survey (HFAS) was used to assess attitudes related to non-technical skills, and the End-of-Course Critique (ECC) survey to evaluate satisfaction with training. We evaluated changes in the pre- and post-training assessments. ResultsEighty staff personnel (26% specialists, 16% residents, 29% nurses, 14% nursing assistant, 15% stretcher bearer) participated in three editions of the program. Theoretical knowledge improved from a mean (SD) of 5.95 (1.7) to 8.27 (2.1) (P < .0001). In the HFAS, statistically significant differences in 18 of 23 attitudinal markers were observed, with improvements in all items of “leadership” and “roles”, in 4 of 5 items of “situational awareness”, and in 4 of 8 items of “communication”. Mean values obtained in the ECC questionnaire were also very high. ConclusionsA CRM training model developed for the initial care of polytrauma patients improved theoretical knowledge and participants perceptions and attitudes regarding leadership, communication, roles, and situational awareness of members of the trauma team.

Improvement of Teamwork Nontechnical Skills Through Polytrauma Simulation Cases Using the Communication and Teamwork Skills (CATS) Assessment Tool

To assess acquisition of nontechnical skills (NTS) through clinical simulation cases by healthcare personnel who participated in a Crisis Resource Management (CRM) training program for the initial care of polytraumatisms. Pre-and postintervention study. Acute-care teaching hospital in Sabadell, Barcelona (Spain). Healthcare personnel that composed teamworks providing initial care to polytraumatized patients attended 12-hour simulation training using a SimMan 3G manikin and performed exercises corresponding to 3 clinical scenarios. All simulations lasted 15 to 25 min and were video recorded. The CATS Assessment tool was used for analysis of teamwork NTS, which included 21 behaviors clustered into the categories of coordination, situational awareness, cooperation, communication, and crisis situation. Three editions of the CRM training course were carried out with 12 trauma team groups composed by team leader, anesthesiologist, general surgeon, traumatologist, registered nurses, nursing assistant, and stretcher bearer. There were statistically significant (p <0.001) improvements in the speed of key times of total duration of case resolution, transfusion of hemoderivatives, Focused Assessment Sonography for Trauma, and chest and pelvic X-rays. The percentage of cases correctly resolved improved from 75% to 91.7% but differences were not statistically significant (p = 0.625). Precourse and postcourse results of CATS scores showed a statistically significant increase in the weighted total score as well as in all behavioral categories of coordination, situational awareness, cooperation, communication, and crisis situation. Simulation-based training of NTS was associated with significant improvements in teamwork behaviors in the setting of the initial care of patients with polytraumatisms.

Simulation-Based learning: Is it time for a paradigm shift in training postgraduates for crisis resource management? prospective interventional study

Background: Crisis resource management (CRM) skills are nontechnical skills that are often neglected during the training of residents in the management of clinical emergencies. This study was conducted to assess the utility of high-fidelity simulation to enhance the learning of CRM among internal medicine postgraduates (PGs). Materials and Methods: After obtaining IEC approval, a total of ten (five 1st year and five 3rd year) internal medicine PG students were included by convenience sampling. Each student participated in four simulated emergencies in the simulation laboratory of a tertiary care hospital, one before and three after CRM training. They participated in groups of 3–5 at intervals of 15–30 days. All the scenarios were video graphed and viewed by the investigators and each student was assessed in each session for CRM using Ottawa global rating score (GRS). The outcome variable was an overall score (OS-ordinal from 1to 7). After the last session, a questionnaire was administered to assess the perceptions of the participants about the course. After 1 year, the participants self-assessed their CRM in a real emergency using GRS and also identified barriers for the application of CRM in real life. The statistical tests used were paired t-test, Student's t-test, and repeated measures ANOVA. Results: The mean OS at baseline was 3.9 ± 1.5 and after training, it improved to 4.6 ± 1.26 (P = 0.024). In the three posttraining sessions, the OS did not decline and this indicated good retention of CRM (P = 0.056). PGs had a consistently favorable opinion of this course. The self-assessed OS in a real emergency was 5.7 ± 0.82. The barriers to CRM application in real emergencies were lack of practice and lack of team training. Conclusions: High fidelity simulation is an effective and acceptable method of teaching CRM to internal medicine PGs and should be incorporated into the PG curriculum.

22 Neonatal regional outreach education in Quebec – a formal needs assessment

Abstract Background In Montreal (Quebec, Canada), newborn care is provided in either highly specialized hospitals for complex/critically ill patients or community hospitals for healthier patients. Community health care practitioners (CHP) have varying levels of comfort and competency in newborn care. Also, because of the unpredictable nature of obstetrics, CHP will need to manage critically ill newborns throughout their careers. Such high acuity, low frequency events can be difficult to manage even in experienced hands. Therefore, there is an imperative to develop a neonatal training curriculum for CHP, with an emphasis on critical newborns. Objectives As a first step, the objective of this study was to perform a comprehensive needs assessment of neonatal outreach education for CHP working in the Greater Montreal Area (Quebec, Canada). Design/Methods Using a mixed methods design (figure), the needs assessment was divided in 3 sections. First, the felt educational needs of the target population (CHP) using an online questionnaire. Second, through focus group discussion, the normative needs of the medical personnel who transport critical newborns. Third, the expressed educational needs of CHP through analysis of neonatal transport data between 2017-2020. Quantitative data was analyzed using descriptive statistics, including means and medians. Qualitative data was coded using conventional content analysis, with the primary technique being descriptive and pattern coding. Results The questionnaire reached 158 participants across 13 community hospitals. CHP are seeking training with procedures, critical situations, and resuscitation. Also, resource sharing, more field expertise, and additional resources for training (time, credits) were identified. Three focus groups (15 participants) also revealed that procedural training, critical newborn management and ventilation were important, as well as Crisis Resource Management (CRM) training. Both the questionnaire and focus groups identified specific medical conditions of interest. The expressed needs (transport data, 947 transports) helped reinforce felt and normative needs. Simulation was identified as a key educational technique. Conclusion A neonatal educational outreach curriculum will need to include procedural training, CRM teaching and certain specific medical conditions including extreme prematurity, hypoxic-ischemic encephalopathy (HIE) and pneumothorax. Procedural training and the principles of ventilation are also critically important. Simulation should be integral, in situ and with varied content. The fear of being judged is omnipresent and should be recognized during outreach education. Educational resources should be shared on an easily accessible, central website.

Columbia University: It's All About Relationships and Resiliency

Facility Spotlight| October 2022 Columbia University: It's All About Relationships and Resiliency Amy Gallagher Amy Gallagher Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor October 2022, Vol. 86, 39–40. https://doi.org/10.1097/01.ASM.0000890112.32643.cc Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Amy Gallagher; Columbia University: It's All About Relationships and Resiliency. ASA Monitor 2022; 86:39–40 doi: https://doi.org/10.1097/01.ASM.0000890112.32643.cc Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: internship and residency, protective factors, medical residencies Resilient relationships are at the core of the successful practice of medicine. Within the Department of Anesthesiology at New York-Presbyterian Hospital/Columbia University Irving Medical Center, (NYPH/CUIMC) resiliency is reflected in classrooms, labs, hallways, and hospital units. The University's Margaret Wood Center for Simulation and Education was launched in 2016, where clinicians, fellows, residents, and faculty members hone their clinical skills through an entire spectrum of simulated learning exercises/lessons, from interdisciplinary teams and crisis resource management training. The center is named for – and recognizes the contributions of – the department's longtime chair, Margaret Wood, MBChB, FRCA, who was appointed in 1996 as the first woman to chair a clinical department at Columbia University. When Dr. Wood was an intern in 1970, trainees had to basically teach themselves how to use new equipment/technology in the OR or clinical setting while caring for patients. “Teaching people how to teach simulation is one... You do not currently have access to this content.

WE3.10 The Impact of Simulation Training on Junior Doctors Managing Surgical Emergencies

Abstract Aim The use of simulation for the training of junior doctors in surgery usually involves either practicing technical skills or exercising communication skills. We have identified a gap in crisis resource management training of junior surgical trainees with scenario-based simulation. We have developed a one-day simulation course on general surgical emergencies and evaluated its impact. Methods The course included a human factors presentation and several scenarios of acute surgical emergencies. It was aimed at core surgical trainees, but other junior doctors were invited. High fidelity human simulator (SimMan®) was used and controlled by faculty. Surgical scenarios were selected in order to provide insight for the appropriate resuscitation for acute surgical patients. The impact of the course was evaluated with a post course questionnaire. Results Ten courses were completed between 2015 and 2021. A total of 58 doctors attended, 45 were core surgical trainees. All 51 participants who responded to the questionnaire rated the course “Good (4/5)” or “Excellent (5/5)”. Following the course, of 51 participants, 50 felt better prepared and 51 were confident in recognising unwell surgical patients; 42 felt better prepared and 50 confident in providing resuscitation; 46 felt better prepared and 51 confident in escalating care. During debriefs and on free text feedback, participants frequently reported the course helped develop their non-technical skills. Conclusion The General Surgical Emergencies simulation courses were rated useful by the learners. The course has positively impacted on the preparedness and confidence of junior surgical trainees in recognising unwell surgical patients, providing initial resuscitation and escalating care.

Implementation of Crisis-Resource-Management-based Team Training in Lower Austria.

ObjectiveSequelae of medical errors are a significant problem in acute care. Human-factor-based events are frequent but avoidable causes. Thus, non-technical skills are crucial. In 2008, crisis-resource-management (CRM)-based simulation training was established for the medical staff of the Lower Austria Regional Hospitals, one of the largest hospital operators in Europe.MethodsImplementation and development of simulation training from 2008 until today are described, costs and performance data retrospectively analysed over a 10-year period. The applied methodology and organisational aspects of CRM training are highlighted. To complete the picture, activities triggered through CRM training throughout the hospitals with potential to further improve patient safety are shown.ResultsWith an initial funding of €100,000 by the Landeskliniken Holding and course rates of €350 to €500, a simulation programme was established for approximately 1,900 co-workers in the acute care setting. In the past 10 years, more than 2,300 doctors and nurses took part in one of the courses, held by 14 qualified trainers. Training was held in the simulation centre as well as in hospitals. Over the time, simulation facilities have been expanded to 8 different manikins, high-fidelity ventilation and monitoring simulation. In addition, a variety of patient safety activities like implementation of critical incident reporting, OR checklists and anaesthesia briefing was accompanied by the trainer team. The total cost of the project was just under €20, 00,000.ConclusionSimulation-based CRM training was successfully introduced and sustainably institutionalised at the NOE LKH group of hospitals. The demand for and acceptance of the training were both excellent. The previous costs of training were relatively low; the organisational model of an independent, non-profit registered association allowed the training activities to be implemented without reducing the availability of the instructors in their clinical roles.

In situ interprofessional operating room simulations: Empowering learners in crisis resource management principles

BackgroundGiven the multifaceted nature of operating room teams, miscommunication at various perioperative stages leads to lapses in teamwork and communication, which potentiates adverse events. In situ interprofessional operating room simulations are a valuable tool in identifying the possible threats to patient safety in the operating room. Participant confidence may also increase; however, perceived confidence in specific areas of team communication in the clinical environment remains unclear. This research aims to study how in situ interprofessional operating room simulations increase participants’ individual confidence in 4 team principles derived from crisis resource management: using effective communication, utilizing resources, establishing role clarity, and using effective situational awareness. MethodsOver a 2-year period, interdisciplinary operating room team members were assigned to participate in 13 simulated surgical case scenarios, which were chosen based on the volunteer surgeon’s specialty. These cases were designed to engage all team members and included a crisis scenario (ie, hemorrhage, airway emergency, arrhythmia, or cardiac arrest). All statistical analyses were performed using RStudio version 1.2.1335 software. We analyzed matched pre- and postsimulation self-assessment of individual confidence using the Wilcoxon signed-rank test for each of the 4 aforementioned constructs of interest derived from crisis resource management training principles. Significance was set at P < .0038, using Bonferroni correction, for all comparisons to account for the multiple comparisons problem. ResultsThere was a statistically significant shift in the 4-point scale toward greater self-reported confidence from presimulation to postsimulation for each of the 4 team principles: using effective communication (P = .0019, r = 0.18), utilizing resources well (P = .0014, r = 0.18), establishing role clarity (P < .0010, r = 0.22), and using effective situational awareness (P < .0010, r = 0.27). ConclusionIn this pilot study, we describe how teaching crisis resource management principles in an in situ operative simulation is an effective way to increase the confidence of communication skills among the members of an interdisciplinary procedure/operative team during crisis scenarios. In situ simulation can be used to evaluate system competence and interdisciplinary dynamics, and to identify latent conditions that predispose to medical error. As we continue to conduct these sessions, we aim to evaluate their impact on individual confidence and the advancement of interdisciplinary efforts to improve patient care.

Crisis Resource Management in Medicine: a Clarion Call for Change

Reliable data indicates increasing numbers of patients are harmed when receiving healthcare. The landmark paper “To Err is Human” posited that adverse events occur in the context of the complexity of systems within medicine and are not due to intentional harm. Crisis resource management (CRM) originated in aviation in 1980. CRM is defined as the cognitive, social, and personal resource skills that complement technical skills and contribute to safe task performance. It is a risk-reducing strategy utilized in aviation that has led to significant reduction in human error–related airline fatalities. CRM was adopted from commercial aviation by medicine in 1990 in an attempt to improve patient safety and reduce morbidity and mortality attributed to medical errors. In the last 40 years, commercial and military aviation has standardized CRM training which has led to a track record of success in improving safety for flight crews and passengers with flight-related mortality significantly decreasing. In stark contrast, nearly 30 years of CRM training in healthcare has been highly variable in content, quality, and outcomes. In this time, the number of patient deaths attributed to medical mistakes has increased from an estimated 50,000–100,000 in 1999 to over 250,000 per year from a 2016 estimate. It is time to reassess how CRM is being deployed in healthcare. Full CRM integration will require significant cultural and embedded organizational changes. Proficient CRM skills are a necessary, but not sufficient, condition for adverse event rate reduction: CRM should not be just what we do—it has to be a part of who we are as medical professionals.

Impact of Teamwork and Communication Training Interventions on Safety Culture and Patient Safety in Emergency Departments: A Systematic Review.

This study aimed to narratively summarize the literature reporting on the effect of teamwork and communication training interventions on culture and patient safety in emergency department (ED) settings. We searched PubMed, EMBASE, Psych Info CINAHL, Cochrane, Science Citation Inc, the Web of Science, and Educational Resources Information Centre for peer-reviewed journal articles published from January 1, 1988, to June 8, 2018, that assessed teamwork and communication interventions focusing on how they influence patient safety in the ED. One additional search update was performed in July 2019. Sixteen studies were included from 8700 screened publications. The studies' design, interventions, and evaluation methods varied widely. The most impactful ED training interventions were End-of-Course Critique, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), and crisis resource management (CRM)-based training. Crisis resource management and TeamSTEPPS CRM-based training curriculum were used in most of the studies. Multiple tools, including the Kirkpatrick evaluation model, the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture, the TeamSTEPPS Teamwork Attitudes Questionnaire, the Safety Attitudes Questionnaire, and the Communication and Teamwork Skills Assessment, were used to assess the impact of such interventions. Improvements in one of the domains of safety culture and related domains were found in all studies. Four empirical studies established improvements in patient health outcomes that occurred after simulation CRM training (Kirkpatrick 4), but there was no effect on mortality. Overall, teamwork and communication training interventions improve the safety culture in ED settings and may positively affect patient outcome. The implementation of safety culture programs may be considered to reduce incidence of medical errors and adverse events.

Impact of Simulator-Based Crisis Resource Management Training on Collective Orientation in Anaesthesia: Pre-Post Survey Study With Interprofessional Anaesthesia Teams.

Theory:Individuals have different qualities, levels of willingness, and degrees of engagement for working in teams. This behaviour is termed ‘Collective Orientation’ (CO). Collective orientation can be trained and has a positive influence on team processes. Here, we investigated the effect of a simulator-based, Crisis Resource Management team training upon the participants’ CO.Hypotheses:We hypothesized (1) the scales of CO and Presence for lab-based microworld research (PLBMR) are applicable to the German anaesthesia teams, (2) the CO can be influenced by means of simulation training, (3) the training effect is dependent on sex and/or profession, and (4) the change of CO depends on the perceived presence of the participants in the scenario.Method:In a pre-post study, 66 nurses and doctors from various anaesthetic departments took part in a 1-day training course to improve non-technical skills. The primary outcome was the mean difference between the CO measured (via questionnaires) immediately before (T1) and after (T2) training. The change was then tested for dependence upon other variables, such as sex, professional group, and immersion into the simulation scenarios.Results:Collective orientation improved significantly after training (mean difference: 0.2; P < .001; dz = 0.53). Considering the subscales, affiliation increased significantly (P < .001; dz = 0.59), whereas dominance remained unchanged. Furthermore, no correlation was found regarding sex, professional group, or immersion into the simulation scenarios.Conclusions:Our study demonstrated that simulation-based training improves the participants’ COs, primarily by increasing affiliation. Subjective scenario reality did not significantly influence this. Nonetheless, it remains unclear as to what factors categorically resulted in this benefit. The shared experience in the course by all team members might trigger the effects. However, further studies are needed to identify the modifiable factors that can improve teamwork attitudes.

Reprint of: Computer-Based Simulation Training in Surgery

Computer-based simulation training methods have emerged in mainstream residency training in response to evolving educational demands. These methods include surgical virtual reality (VR), computer driven full patient simulation, and screen-based simulations, of which immersive virtual environments reflect the most recent area of development. Over a single decade, surgical VR has progressed from demonstration of concept to a practical training tool, with a body of validation literature for part-task VR trainers that supports their expanded use, as well as the development of more robust and capable systems to satisfy the need for procedural training. Patient simulation is gradually entering surgical residency training for crisis resource management and team training that might not otherwise be feasible outside clinical settings. In the future, simulation of patient care in virtual environments may constitute a similar experience without the resource demands associated with full patient simulation. Collectively, the use of computers to create simulated learning experiences for surgeons is representative of an experiential learning model that has been far more developed in other undertakings, but which will certainly be more relied on in surgical training in the future.

Improving Clinical Performance of an Interprofessional Emergency Medical Team Through a One-day Crisis Resource Management Training.

IntroductionErrors are frequent in health care and Emergency Departments are one of the riskiest areas due to frequent changes of team composition, complexity and variety of the cases and difficulties encountered in managing multiple patients. As the majority of clinical errors are the results of human factors and not technical in nature or due to the lack of knowledge, a training focused on these factors appears to be necessary. Crisis resource management (CRM), a tool that was developed initially by the aviation industry and then adopted by different medical specialties as anesthesia and emergency medicine, has been associated with decreased error rates.The aim of the studyTo assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team.Material and MethodsSeventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through two in situ simulated exercises. The exercises were videotaped and were evaluated by two assessors who were blinded as to whether it was the initial or the final exercise. Objective measurement of clinical team performance was performed using a checklist that was designed for each scenario and included essential assessment items for the diagnosis and treatment of a critical patient, with the focus on key actions and decisions. The intervention consisted of a one-day training, combining didactic and simulation sessions, followed by instructor facilitated debriefing. All participants went through this training after the initial assessment exercises.ResultsAn improvement was seen in most of the measured clinical parameters.ConclusionOur study supports the use of combined CRM training for improving the clinical performance of an interprofessional emergency team. Empirically this may improve the patient outcome.

Impact of a One Day Crisis Resource Management Training on the Work Satisfaction among Emergency Department Healthcare Staff

Abstract Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for ‘the possibility to refer the patient to a specialist whenever was considered necessary’ for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks. Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary.

Simulation-based Crisis Resource Management in Pharmacy Education

Objective. To describe strategies for implementation of simulation-based crisis resource management (CRM) in pharmacy education and present students' appreciation of an interdisciplinary CRM training at a university in Canada. Methods. In fall 2016, third-year undergraduate pharmacy students at Laval University and pharmacy technician students from Fierbourg school participated in a CRM activity and completed a five-item survey to assess the quality of the CRM activity they had just experienced. Paired t-tests were computed to detect differences of appreciation between pharmacy technician students and pharmacy students. Results. Students rated each item as very good or excellent varying from 81% to 97%. The only difference found between the two types of students was on their overall appreciation of the experience. Pharmacy technician students rated their experience as very good while pharmacy students rated it as excellent. Conclusion. CRM training can easily be adapted to the context of pharmacy education because its key concepts of team management, resource allocation, awareness of environment and dynamic decision-making directly apply to pharmacy practice. Based on the results of this study, students greatly value their CRM training experience. Future research is needed to measure the transfer into practice of CRM principles.

Improving nontechnical skills of an interprofessional emergency medical team through a one day crisis resource management training.

Errors are frequent in healthcare, but Emergency Departments are among the highest risk areas due to frequent changes in team composition, complexity and variety of cases, and difficulties encountered in managing multiple patients simultaneously.Crisis resource management (CRM) training has been associated with decreased error rates in the aviation industry as well as in certain areas of acute medical care, such as anesthesia and emergency medicine. In this study, we assessed whether a single day CRM training, combining didactic and simulation sessions, improves nontechnical skills (NTS) of interprofessional emergency medical teams.Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through 2 in situ simulated exercises. The exercises were videotaped and were evaluated by 2 assessors who were blinded as to whether it was the initial or the final exercise. They used a new tool designed specifically for the assessment of emergency physicians’ NTS. The intervention consisted of one-day training, combining didactic and simulation sessions, followed by an instructor facilitated debriefing. All participants went through this training after the initial assessment exercises.A significant improvement (P < 0.05) was shown for all the NTS assessed, in all professional categories involved, regardless of the duration of prior work experience in the Emergency Department.This study shows that even a short intervention, such as a single day CRM training, can have a significant impact in improving NTS, and can potentially improve patient safety.

P069: Hardened tendencies: persistence of initial appraisals following simulation-based stress training

Introduction: Stress has been shown to impair performance during acute events. The goal of this pilot study was to investigate the effects of two simulation-based training interventions and baseline demographics (gender, age) on stress responses to simulated trauma scenarios. Methods: Sixteen (16) Emergency Medicine and Surgery residents were randomly assigned to one of two groups: Stress Inoculation Training (SIT) or Crisis Resource Management (CRM). Residents served as trauma team leaders in simulated trauma scenarios pre and post intervention. CRM training focused on non-technical skills required for effective teamwork. The SIT group focused on cognitive reappraisal, breathing and mental rehearsal. Training lasted 3 hours, involving brief didactic sessions and practice scenarios with debriefing focused on either CRM or SIT. Stress responses were measured with the State Trait Anxiety Inventory (anxiety), cognitive appraisal (degree to which a person interprets a situation as a threat or challenge) and salivary cortisol levels. Results: Because the pre-intervention stress responses were different between the two groups, the results were analyzed with stepwise regression analyses. The only significant predictor of anxiety and cortisol responses were the residents appraisal responses to that scenario, explaining 31% of the variance in anxiety and cortisol. Appraisals of the post-intervention scenarios were predicted by their appraisals of the pre-intervention scenario and gender, explaining 73% of the variance. Men were more likely than women to appraise the scenarios as threatening. There were no differences in subjective anxiety, cognitive appraisal or salivary cortisol responses as a result of either intervention. Conclusion: Male residents, as well as those who appraised an initial simulated trauma scenario as threatening, were more likely to interpret a subsequent scenario as threatening, and were more likely to have larger subjective (anxiety) and physiological (cortisol) responses a subsequent scenario. Both CRM and SIT training were not effective in overcoming initial appraisals of potentially stressful events.

A Serious Game for Anesthesia-Based Crisis Resource Management Training

Simulation-based training has been widely adopted in medical education as a tool in the practice and development of skills within a safe, controlled, and monitored environment. However, significant cost and logistical challenges exist within traditional simulation practices. The rising popularity of gaming has seen the wide application of serious games to medical education and training. Serious gaming (and virtual simulation in general) offers a viable alternative to traditional training practices, offering students/trainees the opportunity to train until they reach a specific competency level in a safe, interactive, engaging, and cost-effective manner for effective skills transfer to the real world. Here we present a serious game for anesthesia-based crisis resource management (ACRM) training. The ACRM serious game provides trainees the opportunity to react to a simulated medical emergency within a virtual operating room while providing an interactive, and engaging training experience. Results of an experiment that was conducted to examine the usability (the ease of use of the serious game and its interface) of the serious game, and its ability to engage trainees, indicate that although improvements to the user interface can be made, it shows promise as an immersive and engaging complementary training tool.

Interdisciplinary Crisis Resource Management Training: How Do Otolaryngology Residents Compare? A Survey Study.

ObjectiveEmergent medical crises, such as acute airway obstruction, are often managed by interdisciplinary teams. However, resident training in crisis resource management traditionally occurs in silos. Our objective was to compare the current state of interdisciplinary crisis resource management (IDCRM) training of otolaryngology residents with other disciplines.MethodsA survey study examining (1) the frequency with which residents are involved in interdisciplinary crises, (2) the current state of interdisciplinary training, and (3) the desired training was conducted targeting Canadian residents in the following disciplines: otolaryngology, anesthesiology, emergency medicine, general surgery, obstetrics and gynecology, internal medicine, pediatric emergency medicine, and pediatric/neonatal intensive care.ResultsA total of 474 surveys were completed (response rate, 12%). On average, residents were involved in 13 interdisciplinary crises per year. Only 8% of otolaryngology residents had access to IDCRM training, as opposed to 66% of anesthesiology residents. Otolaryngology residents reported receiving an average of 0.3 hours per year of interdisciplinary training, as compared with 5.4 hours per year for pediatric emergency medicine residents. Ninety-six percent of residents desired more IDCRM training, with 95% reporting a preference for simulation-based training.DiscussionResidents reported participating in crises managed by interdisciplinary teams. There is strong interest in IDCRM and crisis resource management training; however, it is not uniformly available across Canadian residency programs. Despite their pivotal role in managing critical emergencies such as acute airway obstruction, otolaryngology residents received the least training.ImplicationIDCRM should be explicitly taught since it reflects reality and may positively affect patient outcomes.