Crew Resource Management and Team Training

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This article reviews medical team training using the principles of crew resource management (CRM). It also briefly discusses crisis resource management, a subset of CRM, as applied to high-acuity medical situations. Guidelines on setting up medical team training programs are presented. Team training programs are classified and examples of simulation-based and classroom-based programs are offered and their merits discussed. Finally, a brief look at the future of team training concludes this review article.

Section snippets

Principles of team training

Early forays into team training started in the 1950s and 1960s, predominantly in the military. Most of the drive behind team training resulted from the review of accidents and failures. In the 1990s, the philosophy behind team training was based largely on the concept of a “shared mental model.” Mental models are knowledge and mechanisms that can be leveraged to describe, explain, and predict events. Effective teams typically use a shared mental model to achieve a mutually agreed upon goal in

Team training using crisis resource management

Many health care organizations have set up team training programs based on the principles of crew resource management. Despite the unproven record of crew resource management principles in the making of an HRO and effective medical teams, most people believe that crew resource management principles are effective and it seems crew resource management in health care is here to stay [1], [11], [15], [16]. The philosophy of crew resource management has been applied to high-acuity environments, such

Guidelines for establishing medical team training and improving the safety culture of an organization

The development of an HRO does not happen easily. Development of medical teams can enhance safety within organizations and make the organization more reliable. These transformations require vision, change of culture, and leadership. King and colleagues [22] based their team training model on the work of Salas and Cannon-Bowers [23], Kilpatrick, [24] and Kotter [25]. The model was prepared for the Department of Defense and later modified for medical teams. Health care organizations wishing to

Types of medical team training programs

Team training programs were traditionally divided into two types [26]. The following are some of the programs found in a literature search and may not be an exhaustive list. These programs provide training to external organizations and personnel and some of them are proprietary.

  • Simulator-based programs

    • Anesthesia Crisis Resource Management Program

    • Team Oriented Medical Simulation

    • Multidisciplinary Obstetric Simulated Emergency Scenarios

  • Classroom-based programs

    • Medical Team Management

    • Geriatric

The effectiveness of simulation-based team training

Simulation-based training provides opportunities for trainees to develop requisite competencies through practice in a simulated environment that is representative of actual operational conditions. Trainees also receive feedback related to specific events that occur during training. Successful simulation-based training programs provide opportunities for evaluating team members on multiple levels. History taking, making an inventory of the skills and competencies available within the team, and

The effectiveness of didactic classroom team training

One study on the effectiveness of the MedTeams program in reducing errors in the emergency room reported a statistically significant improvement in behaviors between control and experimental groups. The clinical error rate decreased significantly from 30.9% to 4.4% in the experimental group exposed to the MedTeams principle of formal teamwork training. However, the investigators did not report that the raters were blinded to the group to which the caregivers belong nor were these institutions

Simulation versus didactic classroom-based team training

Does simulation add anything at all to didactic teamwork training? Pratt and Sachs [60] argue against simulation. The expenditure involved in buying or building a simulator [61], plus the costs of running it, and the resources spent freeing up staff to attend the simulator do not justify any purported advantages. In the same journal, Gaba argues that simulation need not be ruinously expensive and that simulation can be staged in real-life settings [62]. Gaba argues that only simulation can

Future direction of team training

Although there may never be a randomized controlled blinded study comparing the team training process to other traditional methods of working in high-acuity situations, most experts agree that teaching teamwork has value [18]. This is not to say a scientifically rigorous study evaluating team training is not possible. Indeed, such a study should be an objective worth striving for. Many team training programs draw heavily from crew resource management techniques developed in aviation. While crew

Summary

The Institutes of Medicine report on patient safety conditions inside America's health care organizations has given impetus to a number of initiatives, most notably programs to train medical teams. Crew resource management principles borrowed from aviation have been applied to the development of programs, both simulator-based and nonsimulator-based, to train medical teams with the eventual goal of attaining the status of an HRO. High-acuity environments, such as the operating room, the

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    Stephen Pratt is a consultant to Team Performance Plus, a division of Risk Management Foundation of the Harvard Medical Institutions Inc. and shareholder of Patient Safety Training Group LLC. Other authors of this paper have no financial interests in the subject of this article.

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