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

Jessica R Parsons, Amanda Crichlow, Srikala Ponnuru, Patricia A Shewokis, Varsha Goswami, Sharon Griswold, Jessica R Parsons, Amanda Crichlow, Srikala Ponnuru, Patricia A Shewokis, Varsha Goswami, Sharon Griswold

Abstract

Introduction: In 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.

Methods: The 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.

Results: The 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.

Conclusion: This 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.

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

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Crisis Reseorce Management team performance during simulation scenarios

References

    1. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53(2):143–51.
    1. Ziesmann MT, Widder S, Park J, et al. S.T.A.R.T.T.: development of a national, multidisciplinary trauma crisis resource management curriculum-results from the pilot course. J Trauma Acute Care Surg. 2013;75(5):753–8.
    1. Boet S, Bould MD, Fung L, et al. Transfer of learning and patient outcome in simulated crisis resource management: a systematic review. Can J Anaesth. 2014;61(6):571–82.
    1. Capella J, Smith S, Philp A, et al. Teamwork training improves the clinical care of trauma patients. J Surg Educ. 2010;67(6):439–43.
    1. Risser DT, Rice MM, Salisbury ML, et al. The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium. Ann Emerg Med. 1999;34(3):373–83.
    1. Chapman DM, Hayden S, Sanders AB, et al. Integrating the Accreditation Council for Graduate Medical Education Core Compe tencies into the Model of the Clinical Practice of Emergency Medicine. Ann Emerg Med. 2004;43(6):756–69.
    1. Bearman M, O’Brien R, Anthony A, et al. Learning surgical communication, leadership and teamwork through simulation. J Surg Educ. 2012;69(2):201–7.
    1. Morey JC, Simon R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res. 2002;37(6):1553–81.
    1. Clancy CM, Tornberg DN. Teamstepps: assuring optimal teamwork in clinical settings. Am J Med Qual. 2007;22(3):214–7.
    1. Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care. 2004;13(Suppl 1):i80–84.
    1. Flowerdew L, Brown R, Vincent C, et al. Identifying nontechnical skills associated with safety in the emergency department: a scoping review of the literature. Ann Emerg Med. 2012;59(5):386–94.
    1. Small SD, Wuerz RC, Simon R, et al. Demonstration of high-fidelity simulation team training for emergency medicine. Acad Emerg Med. 1999;6(4):312–23.
    1. Reznek M, Smith-Coggins R, Howard S, et al. Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. Acad Emerg Med. 2003;10(4):386–9.
    1. Shapiro MJ, Morey JC, Small SD, et al. Simulation-based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Qual Saf Health Care. 2004;13(6):417–21.
    1. Clarke S, Horeczko T, Carlisle M, et al. Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study. Med Educ Online. 2014;19:25771.
    1. Fernandez R, Vozenilek JA, Hegarty CB, et al. Developing expert medical teams: toward an evidence-based approach. Acad Emerg Med. 2008;15(11):1025–36.
    1. Lai A, Haligua A, Dylan Bould M, et al. Learning crisis resource management: Practicing versus an observational role in simulation training – a randomized controlled trial. Anaesth Crit Care Pain Med. 2016;35(4):275–81.
    1. Kim J, Neilipovitz D, Cardinal P, et al. A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Crit Care Med. 2006;34(8):2167–74.
    1. Kim J, Neilipovitz D, Cardinal P, et al. A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as “CRM simulator study IB”) Simul Healthc. 2009;4(1):6–16.
    1. Hintze J. NCSS 9. Kaysville, Utah, USA: NCSS, LLC; 2013.
    1. Bland JM, Altman DJ. Multiple significance tests: The Bonferroni method. BMJ. 1995;310(21):170.
    1. Pallant J. SPSS Survival Manual. 3rd Edition. NY, NY: McGraw Hill Open University Press; 2007.
    1. Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70(4):213–20.

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