Original Publication
Open Access

Crisis Resource Management for Third Year Medical Students: A Simulation Curriculum

Published: November 25, 2014 | 10.15766/mep_2374-8265.9951

Included in this publication:

  • CRM Resource.docx
  • CRM Lecture slides.pptx
  • Teaching Resident Simulation Case Scenario Handbook.docx
  • Medical Student CRM Curriculum Pre and Post-Test.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Introduction: Effective communication is critical to crisis situations. Crisis resource management (CRM) has been an established part of the anesthesiology curriculum for close to 20 years and in emergency departments for the better part of the decade. However, it has yet to find a place in pediatrics training. Pediatric crises occur less often than in other specialties and are different from adult crises, and they are uniquely stressful. Because of their rare occurrence, students and residents are often ill-prepared when they arise. In response to this, we designed a 90-minute simulation module to introduce third-year medical students to the principles of CRM on a high-fidelity simulator during their pediatric clerkship. Methods: This module has been written with a focus on discussing improvements that could have been made during each simulation activity. A debriefing session directly follows each simulation activity at which time the observers provide feedback to the participating student. Included in this submission are a guide to the module, a synopsis of both respiratory-to-cardiac-arrest simulation cases, CRM lecture slides, a bag-valve-mask skills workshop, and a student evaluation. Results: One hundred thirty-eight medical students participated in our module during their pediatric clerkship. A subjective assessment showed statistically significant improvement in attitudes and confidence of medical students immediately after participating in the simulation session. Specifically, students reported that they felt more comfortable in a pediatric resuscitation (p < .001, 35% change in those who agreed) after participating in this module. They also reported feeling better able to communicate well in a pediatric resuscitation (p < .001, 41% change in those who agreed) and better at understanding what their role was during a pediatric resuscitation (p < .001, 62% change in those who agreed). Discussion: Although this module may be completed in a 60-minute time slot, we recommend at least 90 minutes if including the manual bag-valve mask skills component, in order to have time for a more thorough debriefing. We limited our evaluations to manual bag-valve mask skills and CRM skills. Similar modules may be used several times during a student’s pediatric rotation in order to focus on additional manual and communication skills. In the future, we hope to implement a multi-institutional study using these materials as the basis of future research.


Educational Objectives

By the end of this session, learners will be able to:

  1. Describe crisis resource management.
  2. Define specific roles of team members during a crisis.
  3. Discuss the importance of effective communication.
  4. Understand the role of a medical student in a code.

Author Information

  • Ilana Harwayne-Gidansky, MD: New York Presbyterian Hospital
  • Alexandra Leader, MD: Icahn School of Medicine at Mount Sinai
  • Sheemon Zackai, MD: Icahn School of Medicine at Mount Sinai
  • Christopher Strother, MD: Icahn School of Medicine at Mount Sinai

Disclosures
None to report.

Funding/Support
None to report.


References

  1. Brett-Fleegler MB, Vinci RJ, Weiner DL, Harris SK, Shih M-C, Kleinman ME. A simulator-based tool that assesses pediatric resident resuscitation competency. Pediatrics 2008;121(3):e597–603. http://dx.doi.org/10.1542/peds.2005-1259
  2. Hollingworth RW, McLoughlin C. Developing science students' metacognitive problem solving skills online. Australian Journal of Educational Technology 2010;17(1):50–63.
  3. Schmidt RA. A Schema Theory of Discrete Motor Skill Learning. PSYCHOLOGICAL REVIEW 1975;82(4). http://dx.doi.org/10.1037/h0076770
  4. Cundiff GW. Analysis of the effectiveness of an endoscopy education program in improving residents' laparoscopic skills. Obstetrics & Gynecology 1997;90(5):854–9. http://dx.doi.org/10.1016/S0029-7844(97)00428-6
  5. Spencer J. Learning and teaching in the clinical environment. BMJ 2003;326(7389):591–4. http://dx.doi.org/10.1136/bmj.326.7389.591
  6. Gaba D, Howard S, Fish K, Smith B. Simulation-based training in anesthesia crisis resource management (ACRM): a decade of experience. Simulation & … 2001; http://dx.doi.org/10.1177/104687810103200206
  7. Reznek M, Smith-Coggins R, Howard S, et al. Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. Acad Emerg Med 2003;10(4):386–9. http://dx.doi.org/10.1111/j.1553-2712.2003.tb01354.x
  8. Bradley P. The history of simulation in medical education and possible future directions. Med Educ. 2006;40:254-62. http://dx.doi.org/10.1111/j.1365-2929.2006.02394.x
  9. Issenberg SB, McGaghie WC, Petrusa ER, et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27:10-28. http://dx.doi.org/10.1080/01421590500046924


Citation

Harwayne-Gidansky I, Leader A, Zackai S, Strother C. Crisis resource management for third year medical students: a simulation curriculum. MedEdPORTAL. 2014;10:9951. https://doi.org/10.15766/mep_2374-8265.9951