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Application of Crisis Resource Management (CRM) Principles in the Clinical Environment: A Follow-Up Study after CRM Training
W. Bosseau Murray, MB, ChB, Sarah J. Rudy, R.N., Robert J. Marine, A.M., Jody L. Henry, B.S., Karin Underberg, RN, BSN, CNOR.
Simulation Development and Cognitive Science Laboratory, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States.

Up to 96,000 hospital deaths occur each year in the United States due to health care provider errors (Kohn 1999). To minimize these errors, simulation has been suggested as a tool to educate health care providers. Simulation education includes Crisis Resource Management (CRM) training. The CRM course objective is to teach concepts of team and resource management using computerized full human simulators and various “crisis” scenarios.

We were interested if the participants of our training courses had used the principles of CRM during a crisis in their clinical practice following the training session. We developed a questionnaire to explore this question.


Since 1998, we have trained over 200 healthcare workers in the principles of CRM. A typical two hour session includes several nurses, residents (anesthesia, surgery, internal medicine, pediatrics, cardiology, etc.), and medical students. (Murray 1999)

Following institutional (IRB) approval, we mailed a questionnaire to participants of our CRM sessions to determine whether the training had had an impact on their practice behaviors since their CRM training. We asked CRM trainees if they had been involved in a medical crisis since their CRM training. If so, we asked them to describe a specific crisis and to what extent the CRM training had had an effect on their behavior during the crisis.


Fifty-three of 149 (36%) questionnaires were returned. Most of the participants had been involved in one or more crises since their CRM training. Forty-one participants (77%) responded that their behavior during crises changed because of their CRM training, either somewhat (43%), moderately (25%), or significantly (9%).Discussion:

According to our respondents, the CRM principles were implemented in their clinical practice during a crisis following Crisis Resource Management training. This encourages us to believe that CRM training will help to alleviate some of the causes of poor outcomes and inhibit the multi-factorial chain of events that often results in disaster.

Based on our data, our CRM training was deemed to be effective in increasing self-reported improvements in feelings of competence, assertiveness and teamwork. Our follow-up study shows that participants perceive themselves as better health care providers due to CRM training.


Kohn L. To Err is Human. Washington: National Academy Press, 1999

Murray WB, et al: Increasing the “hot seats” for CRM training: planned sequential participant entry. Anesthesia Education 1999; 17(2) 6.

Anesthesiology 2003; 99: A1330
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