Simulation-Based Training in Anesthesia Crisis Resource Management (ACRM): A Decade of Experience

Abstract

Several gaps exist in the training of clinicians in health care domains, such as anesthesiology, that have the cognitive profile of complexity and dynamism. These features are shared with other industries such as commercial aviation. Training for cockpit crews on Crew Resource Management (CRM) emphasizes decision-making and teamwork principles. The authors created a simulation-based curriculum (ACRM) for anesthesiology based on principles of CRM in aviation. The training philosophy adapted to health care is one of training single-discipline crews to work in teams. The ACRM curriculum involves highly realistic simulation scenarios requiring complex decision making and interaction with multiple personnel. Scenarios are each followed by a detailed debriefing using videotapes of the simulation session. ACRM has been adopted at major health care institutions around the world. Special training for instructors is provided, especially concerning debriefing. The ACRM approach has been extended to a wide variety of other health care domains that involve complexity and dynamism, such as emergency and trauma medicine, intensive care, and cardiac arrest response teams. Simulation-based training based on CRM principles is expected to become routine in many health care settings in the coming decade.

Helping fluid teams work: A research agenda for effective team adaptation in healthcare

“…Furthermore, team training within medical domains emphasizes the importance of information sharing. Work that began with Gaba and colleagues [44,45] emphasizes the importance of sharing information. Indeed, a lack of information sharing has been cited as a major contributing factor to medical mishaps [46].…”

Review article: Simulation in anesthesia: state of the science and looking forward

“…Patterned after the Crew Resource Management system from the field of aviation, ACRM is currently the predominant model for training anesthesiologists and trainees to manage operative and perioperative crises. 19 The ACRM curriculum developed by Gaba et al consisted primarily of highly realistic simulation scenarios in which participants managed acute events. These events were followed by detailed video-assisted debriefing sessions during which the medical and technical elements and the principles of crisis management (leadership, teamwork, workload distribution, resource utilization, re-evaluation, and communication) were covered.…”

“…16,20 Crisis management training and related approaches, generally described as team or non-technical skills training for high acuity events, spread rapidly across North America and Europe and now represent the bulk of anesthesia simulation-based training. 8,19,21,22 More recently, the use of simulation in anesthesia has broadened to include the acquisition of technical skills (e.g., fibreoptic oral intubations and cricothyroidotomies), [23][24][25][26] the study of performance-shaping factors and performance gaps, 27-34 the evaluation of new equipment, 35 and modelling patient flow in clinical settings. 36,37 Simulation for training: state of the science…”

The potential impact of 3d telepresence technology on task performance in emergency trauma care

“…To develop a grading protocol, we researched medical education literature [e.g., 2,10,28] and previous research on performance assessment in simulated medical scenarios [e.g., 9,16,20,39]. The most common performance aspects to measure include combinations of: time for problem solving and decision making; technical, cognitive and behavioral skills; and number of appropriate/inappropriate procedures.…”