Crew (or crisis) resource management…a must for medicine

While CRM (or crew resource management) is well described in the aviation literature, it’s not nearly as well known within medicine. Interestingly, it applies extremely well since we (medical professionals) work in teams and often in high-stress situations where decisions involve life and death.

Graphic illustrating that pilot responsibilities increase near landing and subsequent reduction in the safety margin. Similar patterns occur in medicine when we approach critical events…though without CRM training, these high risk periods may not be managed as effectively as possible

This past week I completed a CRM course with fellow physicians, paramedics and pilots through the ARHT. I wanted to share with you a recent publication by one of my supervisors here in Auckland, and a staff physician I work with back home in Toronto.

Chris Hicks and Chris Denny recently published their findings from a study of CRM instruction implementation among emergency medicine residents. It’s difficult to believe that we continue to train and do simulation without some emphasis on CRM. It’s well documented (as I’ve mentioned in a previous post) that stress affects decision making (often negatively) and also adversely affects team communication. So why don’t we train to improve this?

This study examined EM residents in their clinical & team leadership performance before and after a CRM training day. Findings suggest that participant attitudes were positive towards the impact of CRM on team work and error reduction. In addition, while it didn’t reach statistical significance, post course nontechnical skills (leadership, communication, problem solving, etc.) improved after well designed CRM instruction. ¬†Further study is required to assess what impact such training has on trainee performance but the findings are important. As trainees/staff become more experienced, the likelihood that they’ll make one serious error is less likely, but serious errors still occur. Most often, these errors occur as a result of multiple smaller (“less significant”) errors that compound and subsequently affected by poor communication, leadership and team work. As educators, we need to work help trainees understand where teams break down under stress and plan to correct this.

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