Crisis Resource Management Training in Medical Simulation

Excerpt

Healthcare is a high-stakes industry that is prone to crises; this is especially true for acute care specialties such as anesthesiology and emergency medicine, in which healthcare practitioners must treat critically ill patients while facing diagnostic ambiguity, resource limitations, and numerous disruptions in chaotic work environments. To deliver safe and effective patient care, medical professionals must execute highly coordinated team-based strategies. Crisis resource management (CRM) refers to a set of principles dealing with cognitive and interpersonal behaviors that contribute to optimal team performance.

Crisis resource management has its origins in the aviation industry. In the 1970s, the National Transportation Safety Board found that human error contributed to over 70% of aviation accidents. More in-depth investigations revealed that the majority of errors were related to teamwork failures rather than deficiencies in knowledge or technical skills. This critical recognition led to the development of simulation-based “crew resource management” training programs that focused on core teamwork behaviors such as leadership, communication, situational awareness, and resource utilization. Crew resource management training has been a global standard in aviation since the 1990s and is now a mandatory component of aircrew training.

In healthcare, anesthesiology was the first specialty to incorporate CRM principles into the training of its clinicians. In the late 1980s, David Gaba and his colleagues recognized that, like aviation, traditional training in anesthesiology focused on the technical aspects of patient management and not on the behavioral aspects of team performance. To address this, they developed and implemented Anesthesia Crisis Resource Management (ACRM), a simulation-based course that focused on crucial teamwork skills such as dynamic decision-making, interpersonal communication, and team leadership. ACRM has been well-received and widely adopted by anesthesiologists around the world.

Following their success in aviation and anesthesiology, simulation-based CRM training programs were soon developed in other high-risk, high-acuity medical specialties, including emergency medicine, critical care, and neonatology. Today, CRM courses can be found in almost every medical specialty as well as in other healthcare professions, including nursing, pharmacy, and emergency medical services.