title: Effect of crew resource management training in a multidisciplinary obstetrical setting.
abstract: OBJECTIVE
  To assess the effect of a Crew Resource Management (CRM) intervention specifically designed to improve teamwork and communication skills in a multidisciplinary obstetrical setting.
  
  
  METHODS
  Design--A before-and-after cross-sectional study designed to assess participants' satisfaction, learning and change in behaviour, according to Kirkpatrick's evaluation framework for training programmes. Setting--Labour and delivery units of a large university-affiliated hospital. Participants--Two hundred and thirty nine midwives, nurses, physicians and technicians from the department of anaesthesia, obstetrics and paediatrics. Intervention--All participants took part in a CRM-based training programme specifically designed to improve teamwork and communication skills. Principal measures of outcome-We assessed participants' satisfaction by means of a 10-item standardized questionnaire. A 36-item survey was administered before and after the course to assess participants' learning. Behavioural change was assessed by a 57-item safety attitude questionnaire measuring staff's change in attitude to safety over 1 year of programme implementation.
  
  
  RESULTS
  Most participants valued the experience highly and 63-90% rated their level of satisfaction as being very high. Except for seven items, the 36-item survey testing participants' learning demonstrated a significant change (P<0.05) towards better knowledge of teamwork and shared decision making after the training programme. Over the year of observation, there was a positive change in the team and safety climate in the hospital [odds ratio (OR) 2.9, 95% confidence interval (CI) (1.3-6.3) to OR 4.7, 95% CI (1.2-17.2)]. **There was also improved stress recognition [OR 2.4, 95% CI (1.2-4.8) to OR 3.0, 95% CI (1.0-8.8)].
  
  
  CONCLUSIONS
  The implementation of a training programme based on CRM in a multidisciplinary obstetrical setting is well accepted and contributes to a significant improvement in interprofessional teamwork.
authors.affiliation: Quality of Care Unit and Department of Anaesthesia and Intensive care, Geneva University Hospital, 24, rue Micheli-du-Crest, Geneva, Switzerland. guy.haller@hcuge.ch
authors.forename: Guy
authors.initials: G
authors.lastname: Haller
authors.forename: Philippe
authors.initials: P
authors.lastname: Garnerin
authors.forename: Michel-Ange
authors.initials: MA
authors.lastname: Morales
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pfister
authors.forename: Michel
authors.initials: M
authors.lastname: Berner
authors.forename: Olivier
authors.initials: O
authors.lastname: Irion
authors.forename: François
authors.initials: F
authors.lastname: Clergue
authors.forename: Christian
authors.initials: C
authors.lastname: Kern
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000379:methods; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000193:education* / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D011247:Pregnancy; D017751:Safety Management / Q000379:methods; D055815:Young Adult