Teach Crisis Resource Management Research Articles

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.

An Evaluation of Pre-Hospital Emergency Care Personnel Knowledge About Crisis Resource Management and Perspectives of Educators About Inclusion of Crisis Resource Management in the Pre-Hospital Emergency Care Curriculum.

PurposeTo evaluate the knowledge of pre-hospital emergency care personnel (PECP) in South Africa on the principles, practice of crisis resource management (CRM), and obtain emergency medical care (EMC) educators’ views on the teaching and learning of CRM skills in the pre-hospital EMC curriculum.MethodsThis research was designed as an exploratory study that used a semi-structured questionnaire administered to 2000 PECP and focus group discussion (FGD) with 19 emergency care educators. Chi-squared test and Cramér’s V were used to examine the existence and the strength of an association between cross-tabulated variables. Responses to open-ended questions, as well as the data generated by the FGD, were analysed qualitatively using iterative inductive coding to identify themes.ResultsA response rate of 76% was obtained for the survey. Findings are that the majority (64.5%) of the PECP were not familiar with CRM, though familiarity varied significantly across cadres of PECP (p <0.001). EMC educators reported that the concept of CRM must be thoroughly researched and developed in the emergency medical service (EMS) context before it is included in the EMC curriculum. The educators reported that early introduction of CRM in the EMC curriculum will have a positive effect on students’ professional development. Difficulties with assessment, knowing what to teach, and lack of universally accepted guidelines or teaching modalities are some of the challenges identified by EMC educators in relation to teaching CRM in the EMC curriculum.ConclusionThe findings of this study provide new insights into PECP’s knowledge and EMC educators’ views on the teaching and learning of CRM in the EMC curriculum. This study highlights that more research is needed to develop an EMS CRM curriculum. Investigation into the development of a teaching and learning framework for CRM in EMC education could be the focus of future studies.

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.

A Microdebriefing Crisis Resource Management Program for Simulated Pediatric Resuscitation in a Community Hospital: A Feasibility Study.

Crisis Resource Management (CRM) is a team training tool used in healthcare to enhance team performance and improve patient safety. Our program intends to determine the feasibility of high-fidelity simulation for teaching CRM to an interprofessional team in a community hospital and whether a microdebriefing intervention can improve performance during simulated pediatric resuscitation. We conducted a single-center prospective interventional study with 24 teams drawn from 4 departments. The program was divided into an initial assessment simulation case (pre), a 40-minute microdebriefing intervention, and a final assessment simulation case (post). Post and pre results were analyzed for each team using t tests and Wilcoxon signed-rank tests. Primary outcome measures included (a) completion of program, (b) percent enrollment, (c) participant reaction, and (d) support of continued programs on completion. Secondary outcomes included (a) change in teamwork performance, measured by the Clinical Teamwork Scale; (b) change in time to initiation of chest compressions and defibrillation; and (c) pediatric advanced life support adherence, measured by the Clinical Performance Tool. We successfully completed a large-scale training program with high enrollment. Twenty-four teams with 162 participants improved in Clinical Teamwork Scale scores (42.8%-57.5%, P < 0.001), Clinical Performance Tool scores (61.7%-72.1%, P < 0.001), and time to cardiopulmonary resuscitation initiation (70.6-34.3 seconds, P < 0.001). Our center ran a well-attended, well-received interprofessional program in a community hospital site demonstrating that teaching CRM skills can improve simulated team performance in a diverse experienced cohort.

Teaching Crisis Resource Management Skills to Nurses Using Simulation

Education programs teaching crisis resource management (CRM) skills (problem solving, situational awareness, resource utilization, communication, and leadership) have been shown to positively affect learner competence in handling crisis events. As part of an education program, a high-fidelity simulation program was used as a learning intervention to teach these skills to practicing nurses. In this repeated-measures observational study, 11 RNs were evaluated at four time points, measuring the effect of an education program on observed performance of CRM skills. Performance was measured using the Ottawa Global Rating Scale and a checklist tool. Statistically significant changes in mean scores occurred between times one and two, and nonstatistically significant improvement occurred in means overall. This study adds evidence of the effectiveness of high-fidelity simulation education and highlights the need for further research. [J Contin Educ Nurs. 2020;51(6):257-266.].

Starting to Think Like an Expert: An Analysis of Resident Cognitive Processes During Simulation-Based Resuscitation Examinations

Simulation is commonly used to teach crisis resource management skills and assess them in emergency medicine residents. However, our understanding of the cognitive processes underlying crisis resource management skills is limited because these processes are difficult to assess and describe. The objective of this study is to uncover and characterize the cognitive processes underlying crisis resource management skills and to describe how these processes vary between residents according to performance in a simulation-based examination. Twenty-two of 24 eligible emergency medicine trainees from 1 tertiary academic center completed 1 or 2 resuscitation-based examinations in the simulation laboratory. Resident performance was assessed by a blinded expert using an entrustment-based scoring tool. Participants wore eye-tracking glasses that generated first-person video that was used to augment subsequent interviews led by an emergency medicine faculty member. Interviews were audio recorded and then transcribed. An emergent thematic analysis was completed with a codebook that was developed by 4 research assistants, with subsequent analyses conducted by the lead research assistant with input from emergency medicine faculty. Themes from high- and low-performing residents were subsequently qualitatively compared. Higher-performing residents were better able to anticipate, selectively attend to relevant information, and manage cognitive demands, and took a concurrent (as opposed to linear) approach to managing the simulated patient. The results provide new insights into residents' cognitive processes while managing simulated patients in an examination environment and how these processes vary with performance. More work is needed to determine how best to apply these findings to improve crisis resource management education.

The impact of a simulation-based approach to teaching crisis resource management for medical emergencies on neonatal intensive care units in the UK, India, Nepal and Saudi Arabia

Effective communication, team working and human factors are given little attention in traditional medical curricula. However, these skills are fundamentally important during crisis resource management (CRM) in healthcare. These skills can be learnt and can be taught very effectively within a simulated environment. Thus simulation-based training on CRM can positively impact patient safety. One such course which focuses on the management of common neonatal emergencies is the ‘Neonatal Emergencies Simulation Team training’ (NEST) program. This one day multiprofessional educational program, originally designed by the London Neonatal Transfer Service, aims to develop multidisciplinary confidence and competence in the management of common neonatal emergencies. This program has been evaluated positively in India, Nepal, Saudi Arabia and the UK and shows promise for wider implementation in high-, middle- and lowincome countries. Here we give an overview of the program and its implications. Citation: Mohinuddin S, Rajkumar Rajendram R, Swamy S. The impact of a simulationbased approach to teaching crisis resource management for medical emergencies on neonatal intensive care units in the UK, India, Nepal and Saudi Arabia. Anaesth Pain &amp; Intensive Care 2018;22(3 Suppl1):S124-S128

Multidisciplinary in-situ simulation to evaluate a rare but high-risk process at a level 1 trauma centre: the “Mega-Sim” approach

Multidisciplinary simulation has been used to successfully teach crisis resource management in operating room and emergency department settings. This article describes a “Mega-Sim” approach using an in-situ simulation that moves among multiple hospital departments to enhance multidisciplinary training and assess institutional response to a rare but high-risk event: trauma in a pregnant patient. It appears that a Mega-Sim can be used to identify systems issues, increase medical knowledge and improve perceptions of teamwork and communication within and among hospital departments.

The blindfolded code training exercise.

Communication errors are the leading cause of preventable patient harm in medicine. There is little description in the literature of advanced techniques to teach crisis resource management (CRM) communication strategies, or how to improve real-time ineffective behaviour or habits that may persist despite appropriate behaviour and leadership witnessed in the simulation lab. This article presents an advanced teaching technique to force the adoption of closed-loop communication strategies. This technique is typically reserved for more advanced learners involved in acute care, or for those struggling to effectively lead medical resuscitations. We describe a relatively well-established, yet not well-described, teaching technique that blindfolds the team leader, known as the blindfolded code training exercise. This advanced method of instruction is cost-effective and does not require special equipment. This was both a successful and popular method of instruction for closed-loop communication. The simple method of blindfolding requires the learner to use both critical thinking skills and a conceptual framework to organise their management of the resuscitation. This provides an avenue for instructors to further develop advanced learners' skills for high-risk communication. Communication errors are the leading cause of preventable patient harm in medicine.

Learning crisis resource management: Practicing versus an observational role in simulation training – a randomized controlled trial

AimSimulation training has been shown to be an effective way to teach crisis resource management (CRM) skills. Deliberate practice theory states that learners need to actively practice so that learning is effective. However, many residency programs have limited opportunities for learners to be “active” participants in simulation exercises. This study compares the effectiveness of learning CRM skills when being an active participant versus being an observer participant in simulation followed by a debriefing. MethodsParticipants were randomized to two groups: active or observer. Active participants managed a simulated crisis scenario (pre-test) while paired observer participants viewed the scenario via video transmission. Then, a trained instructor debriefed participants on CRM principles. On the same day, each participant individually managed another simulated crisis scenario (post-test) and completed a post-test questionnaire. Two independent, blinded raters evaluated all videos using the Ottawa Global Rating Scale (GRS). ResultsThirty-nine residents were included in the analysis. Normally distributed data were analyzed using paired and unpaired t-tests. Inter-rater reliability was 0.64. Active participants significantly improved from pre-test to post-test (P=0.015). There was no significant difference between the post-test performance of active participants compared to observer participants (P=0.12). ConclusionWe found that learning CRM principles was not superior when learners were active participants compared to being observers followed by debriefing. These findings challenge the deliberate practice theory claiming that learning requires active practice. Assigning residents as observers in simulation training and involving them in debriefing is still beneficial.

Does Teaching Crisis Resource Management Skills Improve Resuscitation Performance in Pediatric Residents?*

The effect of teaching crisis resource management skills on the resuscitation performance of pediatric residents is unknown. The primary objective of this pilot study was to determine if teaching crisis resource management to residents leads to improved clinical and crisis resource management performance in simulated pediatric resuscitation scenarios. A prospective, randomized control pilot study. Simulation facility at tertiary pediatric hospital. Junior pediatric residents. Junior pediatric residents were randomized to 1 hour of crisis resource management instruction or no additional training. Time to predetermined resuscitation tasks was noted in simulated resuscitation scenarios immediately after intervention and again 3 months post intervention. Crisis resource management skills were evaluated using the Ottawa Global Rating Scale. Fifteen junior residents participated in the study, of which seven in the intervention group. The intervention crisis resource management group placed monitor leads 24.6 seconds earlier (p = 0.02), placed an IV 47.1 seconds sooner (p = 0.04), called for help 50.4 seconds faster (p = 0.03), and checked for a pulse after noticing a rhythm change 84.9 seconds quicker (p = 0.01). There was no statistically significant difference in time to initiation of cardiopulmonary resuscitation (p = 0.264). The intervention group had overall crisis resource management performance scores 1.15 points higher (Ottawa Global Rating Scale [out of 7]) (p = 0.02). Three months later, these differences between the groups persisted. A 1-hour crisis resource management teaching session improved time to critical initial steps of pediatric resuscitation and crisis resource management performance as measured by the Ottawa Global Rating Scale. The control group did not develop these crisis resource management skills over 3 months of standard training indicating that obtaining these skills requires specific education. Larger studies of crisis resource education are required.

Evaluating Videotaped Role-Modeling to Teach Crisis Resource Management Principles

IntroductionThis descriptive pilot study compares the effectiveness of the addition of videotaped role-modeling to a traditional method of teaching Crisis Resource Management (CRM) principles and clinical management of pediatric patients with respiratory distress. MethodData were collected from nurse practitioner students (N = 16) to evaluate knowledge, self-efficacy, team behaviors, and technical skills at 3 time-points. All students participated in a Pretest (Time 1) scenario and CRM lecture. Group A (control; n = 8) received no further intervention. Group B (experimental group; n = 8) watched a videotape of experts modeling CRM. All groups completed another scenario (Time 2). Twelve weeks later, each group completed a third scenario (Time 3). Satisfaction was measured at 2 times. ResultsNo differences were noted in knowledge, self-efficacy, or technical skills between the groups at the 3 times. There was a significant difference between the groups on both the Pretest and Posttest 1 on team behaviors. Satisfaction scores showed no differences between the groups. DiscussionOne experience watching a 15-minute role-modeling videotape may not be an effective means of instruction for CRM principles or clinical management of pediatric patients.

Simulation and its role in medical education

Medical education is increasingly laying emphasis on a curriculum based on cognitive, psychomotor, and affective domains of learning which were originally proposed nearly 50 years ago. These reforms are framed around best standards of care, error management and patient safety, patient autonomy, and resource allocation. There is a worldwide shift in the method of medical education towards experiential (‘hands-on’) medical learning; however, applying this concept to real patients is less acceptable to society and is subject to legal and ethical issues.Simulation is the artificial representation of a complex real-world process with sufficient fidelity with the aim to facilitate learning through immersion, reflection, feedback, and practice minus the risks inherent in a similar real-life experience. Medical simulation offers numerous potential strategies for comprehensive and practical training, and safer patient care. It is a technique, rather than just a technology that promotes experiential and reflective learning. It is also a key strategy to teach crisis resource management skills. Simulation can benefit the individual learner, the multidisciplinary team, and the hospital as a whole. In this review, the authors discuss the role of simulation in five situations namely undergraduate teaching, postgraduate training, continuing medical education, disaster management, and military trauma management and dwell upon the experience of medical simulation in the Armed Forces.

Simulation-based crisis resource management training for pediatric critical care medicine

To review the essential elements of crisis resource management and provide a resource for instructors by describing how to use simulation-based training to teach crisis resource management principles in pediatric acute care contexts. A MEDLINE-based literature source. OUTLINE OF REVIEW: This review is divided into three main sections: Background, Principles of Crisis Resource Management, and Tools and Resources. The background section provides the brief history and definition of crisis resource management. The next section describes all the essential elements of crisis resource management, including leadership and followership, communication, teamwork, resource use, and situational awareness. This is followed by a review of evidence supporting the use of simulation-based crisis resource management training in health care. The last section provides the resources necessary to develop crisis resource management training using a simulation-based approach. This includes a description of how to design pediatric simulation scenarios, how to effectively debrief, and a list of potential assessment tools that instructors can use to evaluate crisis resource management performance during simulation-based training. Crisis resource management principles form the foundation for efficient team functioning and subsequent error reduction in high-stakes environments such as acute care pediatrics. Effective instructor training is required for those programs wishing to teach these principles using simulation-based learning. Dissemination and integration of these principles into pediatric critical care practice has the potential for a tremendous impact on patient safety and outcomes.

Using Medical Simulation to Teach Crisis Resource Management and Decision‐Making Skills to Otolaryngology Housestaff

Develop a course to use in situ high-fidelity medical simulation (HFS) in an actual operating room (OR) to (1) teach teamwork and crisis resource management (CRM) skills simultaneously to otolaryngology and anesthesia trainees and OR nurses and (2) provide decision-making experience to ear, nose, and throat residents and OR teams in simulated high-risk, low-frequency airway emergencies. A simulation-based, in situ CRM course was developed to teach airway management and CRM in the OR. Upon completion of each course, the participants were surveyed using questions with (1-5) scale answers. The simulated clinical scenarios took place in the intensive care unit and OR at Children's Hospital Boston. The participants consisted of pediatric otolaryngology fellows, otolaryngology residents, anesthesiology residents, fellows, and certified registered nurse anesthetists as well as OR nurses. Fifty-nine individuals participated in 9 simulation-based courses given between October 2008 and May 2010. The team members participated together in 3 simulated medical crises that centered on airway and anesthesia issues. Each simulated crisis was followed by a structured debriefing session conducted by trained debriefers. Embedded within the course were didactics on CRM principles. The participants' responses on the survey included General Course Organization, Realism, Debriefing, and Relevance to Future Practice. Ninety percent of the responses were favorable or very favorable. Using a newly developed, in situ HFS-based course, clinical decision-making skills and teamwork can be effectively taught concurrently to members of an OR team.

Perceptions of Simulation-Based Training in Crisis Resource Management in the Endoscopy Unit

Simulation-based training (SBT) teaches healthcare teams to manage critical events, using crisis resource management skills. The purpose of this study was to assess staff perceptions of using SBT in the endoscopy suite. Nurses and technicians were invited to participate in a training program that used simulation of endoscopy-based scenarios to teach crisis resource management skills. Participants completed surveys prior to, immediately following, and 1-month following SBT. Surveys assessed the usefulness, enjoyment, applicability, and realism of SBT using 5-point Likert scales. Eleven (92%) of the 12 nurses (10 = female, median age = 45 years) and four (80%) of five technicians (3 = female, 37 years of age) participated. Prior to participation, nurses with more than 5 years' experience rated their expected enjoyment of SBT to be lower than less-experienced peers (mean = 2.6 vs. 4.5, p =.005). When surveyed immediately after participation, both groups reported SBT to be highly useful (mean ± SD, 4.6 ± 0.9 vs. 5.0 ± 0), enjoyable (3.8 ± 0.8 vs. 4.6 ± 0.5), applicable (4.0 ± 0.8 vs. 4.7 ± 0.8), and realistic (4.0 ± 0.7 vs. 4.7 ± 0.8). One month after training, 14 of the 15 participants expressed interest in future programs, using simulation to practice crisis resource management skills. Findings suggest that SBT may serve as an enjoyable, applicable, and realistic tool to enhance a team's performance in the endoscopy suite across all caregivers and different levels of experience.

Multimedia instruction for teaching crisis resource management

Multimedia instruction for teaching crisis resource management