Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents

Abstract

IntroductionIn today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM) skills. In emergency medicine (EM), the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents.MethodsThe CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course.ResultsThe CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size.ConclusionThis course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.

A comparative study on the frequency of simulation-based training and assessment of non-technical skills in the Norwegian ground ambulance services and helicopter emergency medical services

“…The assumption that training and assessment increases NTSs is reasonable based on documented experience [ 28 , 29 , 37 , 38 ] and relevant literature [ 6 , 11 , 24 , 25 , 30 ]. However, direct evidence of improved outcomes or reduced amount of errors as results of training in and assessment of NTSs is sparse in the prehospital domain.…”

“…However, experience from other domains is promising [ 26 , 27 ]. Simulations performed by emergency medicine residents improved leadership, communication, teamwork and situation awareness [ 28 ]. Assessment of a simulation increases learning, thus potentially preventing the repetition of incorrect behaviour [ 29 – 31 ].…”

Overcoming Cultural Barriers in Undergraduate Nursing Education Using Voice Enhanced High Fidelity Simulation: The Sultan Qaboos University Experience

“…Parsons, et al [15] in their study involving Simulation-based Crisis Resource Management Training for Emergency Medicine Residents reported similar findings. In their study, the researchers observed that the medical residents after their simulated training course displayed improved skills in leadership, problem solving, communication, situational awareness, teamwork, resource utilization.…”

Simulatiom Based Education as Tool in Emergency Medicine: A Systematic Review

“…For these reasons, new, low-cost approaches are required in the practical training of medical students. 19 Parsons et al 20 demonstrated the use of low-cost simulations in the development of emergency crisis management skills, proving that the method is effective in the teaching process and that observational learning in the simulations is able to minimize the time and resources required.…”