Six steps from head to hand: A simulator based transfer oriented psychological training to improve patient safety

doi:10.1016/j.resuscitation.2006.08.011

Resuscitation

Volume 73, Issue 1, April 2007, Pages 137-143

https://doi.org/10.1016/j.resuscitation.2006.08.011 Get rights and content

Summary

The incidence of human errors in the field of medicine is high. Two strategies to increase patient safety are simulator training and crew resource management (CRM) seminars, psychological courses on human performance and error management.

Aim

To establish a CRM course combining psychological training on human error with simulator training.

Methods

Evaluation of a new 1-day training approach targeting physicians, nurses, and paramedics.

The course was divided into four modules focusing on situation awareness, task management, teamwork, and decision-making. Each of the modules was set up according to a new six-step approach. The course started with an introduction into good CRM behaviour and an instructor demonstration of a simulator scenario. The participants had to debrief the instructors regarding their human performance. Step 2 was a lecture about the psychological background, and the third step consisted of psychological exercises related to the topic of the module. A psychological exercise in a medical context (MiniSim) made up step 4, which involved a patient simulator. The last two steps were a simulator scenario and a debriefing, as in other simulator courses. A psychologist and a physician were the facilitators in all steps. Two pilot courses were evaluated.

Results

Seventeen evaluation questionnaires were received. All participants rated the course as good (10) and very good (7). The psychological exercises were highly valued (good, 5; very good, 11 participants). Thirteen participants agreed that the course content was related to their work.

Conclusion

We established the first course curriculum combining psychological teaching with simulator training for healthcare professionals in emergency medicine. Similar concepts using the six-step approach can be applied to other medical specialties.

Introduction

Ten years ago epidemiological studies revealed that nearly 10,000 deaths and more than 1 million injuries per year are caused by mistakes in hospitals in the United States alone.¹ As a result, improving patient safety has become a priority.² The incidence of adverse events leading to iatrogenic injury in a hospital setting has been found to be between 3.7 and 11.7%,3, 4 and two-thirds of adverse events are considered to be preventable.⁵

Two major approaches to increase patient safety and to reduce the incidence of adverse events have been established: simulator training and crew resource management (CRM). Patient simulators have been used for educational purposes for many years, especially in anaesthesia⁶ and Howard et al. developed crisis resource management courses concentrating on human error.⁷ Nevertheless, the focus has always been set on non-technical skills, similar to crew resource management courses in aviation, and does not involve psychologists and include psychological exercises.

CRM seminars focus on improvement of training strategies, team relationship, and staff and resource management. Pizzi et al. conclude that the use of CRM, as has been in use for many years in aviation, has tremendous potential.⁸ Although CRM seminars for healthcare professionals have been published,⁹ they have not become a standard teaching instrument in undergraduate or postgraduate medical education.

In this paper we describe a course curriculum developed by physicians and psychologists that combines the two strategies of simulator training and CRM and we report the evaluation results of the first two pilot courses. This course included psychological exercises on error management as well as practical training with a patient simulator.

Section snippets

Course development and course concept

The emergency crisis resource management (ECRM) course was developed by the Department of Anesthesiology at the University Hospital, Dresden and the Dresden University of Technology Institute for Methods in Psychology, focusing on healthcare professionals in the field of emergency medicine. The ECRM training session took place on 1 day in the Dresden Simulation Centre and lasted 8 h. One physician, one psychologist, and two paramedics conducted the training. All participants gave informed

Results

Seventeen participants took part in the first two pilot courses, nine in the first and eight in the second. Nine of the participants were physicians, seven were emergency medical technicians, and one was a nurse. None of the participants had previously taken part in any simulator and/or CRM course. We received 17 evaluation questionnaires. Ten participants rated the course as good and seven as very good. The initial demonstration of good CRM behavior in a scenario with the instructors as actors

Discussion

In the field of medicine, the first simulator-based courses focusing on non-technical skills were established in the early 1990s.⁷ In these well-evaluated courses the participants had to manage a simulated crisis in a fully realistic working environment. During the video-assisted debriefing they obtained feedback with a focus on the non-technical skills. In some simulator-based CRM courses, case reports in which human factor errors were made are discussed; in others, aircraft accident videos

Conclusion

CRM seminars and simulator training are both well-evaluated courses to increase patient safety in the field of medicine. We describe the first curriculum combining both strategies in one course. Based on this concept, future investigations should study the influence on outcome data, such as incidence of errors associated with human factors.

Conflict of interest statement

None of the authors has any financial or personal relationship with people or organisations that could influence our work inappropriately.

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^☆: A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.08.011.

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Training and educational paperSix steps from head to hand: A simulator based transfer oriented psychological training to improve patient safety☆

Summary

Aim

Methods

Results

Conclusion

Introduction

Section snippets

Course development and course concept

Results

Discussion

Conclusion

Conflict of interest statement

QRB

To err is human: building a safer health system

What practices will most improve safety? Evidence-based medicine meets patient safety

JAMA

Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard medical practice study I

N Engl J Med

Adverse events in British hospitals: preliminary retrospective record review

BMJ

A comprehensive anesthesia simulation environment: re-creating the operating room for research and training

Anesthesiology

Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents

Aviat Space Environ Med

Training and educational paper
Six steps from head to hand: A simulator based transfer oriented psychological training to improve patient safety☆