Crisis resource management (CRM) training was developed to improve management of complex and dynamic situations involving high cognitive demands and teamwork coordination. CRM teaching focuses on principles of individual behavioral skills and teamwork regarding issues such as communication among team members and delegation of tasks critical for optimal patient outcome. CRM principles were first adopted into medicine and taught in Anesthesiology in the late eighties in what is called Anesthesia Crisis Resource Management or ACRM training. [1] Since then, CRM principles were adopted for training in other dynamic medical domains such as Neonatology, Intensive Care, and Emergency Medicine. [2] [3] [4] In this abstract we describe a 3-level CRM-based training curriculum for Emergency Medicine (EM) residents.
METHODSCRM principles were adapted to management of patient emergencies in Emergency Medicine. Adopted principles were then integrated in a highly realistic simulation training program called Emergency Medicine Crisis Resource Management (EMCRM). EMCRM training includes 3 separate courses, one for each year of the 3-year EM residency training, called EMCRM 1, 2, and 3. During EMCRM 1, EM residents and a nurse participate in a half-day course. First, they are introduced to CRM skills and EMCRM principles using didactic exercises and a trigger video from a real trauma case. The residents and nurse next are familiarized with the simulator and the simulation facility. Then they participate in 4-5 simulation sessions each followed by a debriefing session. During each simulation session, 2-3 residents and the nurse apply EMCRM principles while managing a single (during EMCRM 1) or multiple (during EMCRM 2 and 3) simulated patient emergency situations. Each resident have the opportunity to direct or lead, assist, and observe simulation scenarios. The MedSim-Eagle (MedSim-Eagle V2.41) and SimMan (Laerdal Medical Corporation) simulators and a patient actor are used to simulate simultaneous patient emergency situations. Participants actions and decision making during the simulator sessions are captured on video. Recorded sessions are replayed during debriefing sessions and participants performance is critiqued by the group to elicit good and bad CRM behaviors.
DISCUSSIONEMCRM training and principles have been described in detail. [5] EMCRM 3 curriculum was developed first and offered to PGY3 residents to pilot EMCRM training in the residency program. The following year, EMCRM 1 and 2 courses were developed but only EMCRM 3 was taught to PGY2 and 3 residents. EMCRM 1 was also taught to PGY1 residents during the second year. Each EMCRM training course was over 5 hours. Course participants filled out evaluation questionnaires at the end of the course. All 3-level EMCRM courses will be offered this year.
Similar to other intense simulator training programs, faculty and instructor time requirements are extensive for EMCRM development and ongoing EMCRM teaching. The development of EMCRMs 3-level curriculum occurred over two years and involved efforts from 3 residents, two EM faculty members, an EM nurse, and a simulation engineer. Scheduling of EM faculty and residents for EMCRM training is also challenging and for that reason, EMCRM courses were scheduled during days dedicated by the residency program for didactic lectures. Participants commented positively about the applicability and value of EMCRM and the use of simulators in EM training. A limitation in past EMCRM courses was that simulation sessions were held in a simulation facility originally designed as an Operating Room. Upcoming EMCRM simulator courses will be at a new simulation facility designed to mimic an Emergency Department.
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