A meta-analysis of the effectiveness of crew resource management training in acute care domains

Abstract

The healthcare industry has seen an increase in the adoption of team training, such as crew resource management (CRM), to improve teamwork and coordination within acute care medical teams. A meta-analysis was carried out in order to quantify the effects of CRM training on reactions, learning, behaviour and clinical care outcomes. Biases in the research evidence are identified and recommendations for training development and evaluation are presented. PUBMED, EMBASE and PsychInfo were systematically searched for all relevant papers. Peer reviewed papers published in English between January 1985 and September 2013, which present empirically based studies focusing on interventions to improve team effectiveness in acute health care domains, were included. A total of 20 CRM-type team training evaluation studies were found to fulfil the a priori criteria for inclusion in the meta-analysis. Overall, CRM trained participants responded positively to CRM (mean score 4.25 out of a maximum of 5), the training had large effects on participants' knowledge (d=1.05), a small effect on attitudes (d=0.22) and a large effect on behaviours (d=1.25). There was insufficient evidence to support an effect on clinical care outcomes or long term impacts. The findings support the premise that CRM training can positively impact teamwork in healthcare and provide estimates of the expected effects of training. However, there is a need for greater precision in outcome assessment, improved standardisation of methods and measures, and more robust research design. Stronger evidence of effectiveness will require multi-level, multicentre, multispecialty and longitudinal studies.

The Effectiveness of Teamwork Training on Teamwork Behaviors and Team Performance: A Systematic Review and Meta-Analysis of Controlled Interventions

“…However, these reviews were delimited based on various sample and/or intervention characteristics. For example, some reviews included studies that were only conducted with certain team types (e.g., intact teams [23]) or within a particular context (e.g., sports [24]; medical teams [25]). Others were delimited to specific training programs/strategies that were restricted to a narrow range of teamwork strategies (e.g., [23, 25–29]).…”

“…For example, some reviews included studies that were only conducted with certain team types (e.g., intact teams [23]) or within a particular context (e.g., sports [24]; medical teams [25]). Others were delimited to specific training programs/strategies that were restricted to a narrow range of teamwork strategies (e.g., [23, 25–29]). Finally, studies that used a combination of teamwork and taskwork intervention components have been systematically reviewed [30]; however, these types of interventions result in a limited ability to determine the extent to which the resulting effects were due to teamwork training versus taskwork training.…”

Is there a role for the use of aviation assessment instruments in surgical training preparation? A feasibility study

“…As part of team resource management training to enhance patient safety,15 surgical teams from a large teaching hospital in the Netherlands participated in flight simulator sessions at a flight school 16. During the sessions, a multidisciplinary group of senior surgeons and pilots exchanged views on the importance of certain competences in both industries.…”

How Did Crew Resource Management Take-Off Outside of the Cockpit? A Systematic Review of How Crew Resource Management Training Is Conceptualised and Evaluated for Non-Pilots

“…Industries such as fire-fighting and railway were left out because of the low number of publications. We also excluded military CRM and healthcare CRM because these industries have already been thoroughly and recently reviewed [2,[10][11][12][13][14].…”