title: Positive impact of crisis resource management training on no-flow time and team member verbalisations during simulated cardiopulmonary resuscitation: a randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the impact of video-based interactive crisis resource management (CRM) training on no-flow time (NFT) and on proportions of team member verbalisations (TMV) during simulated cardiopulmonary resuscitation (CPR). Further, to investigate the link between team leader verbalisation accuracy and NFT.
  
  
  METHODS
  The randomised controlled study was embedded in the obligatory advanced life support (ALS) course for final-year medical students. Students (176; 25.35±1.03 years, 63% female) were alphabetically assigned to 44 four-person teams that were then randomly (computer-generated) assigned to either CRM intervention (n=26), receiving interactive video-based CRM-training, or to control intervention (n=18), receiving an additional ALS-training. Primary outcomes were NFT and proportions of TMV, which were subdivided into eight categories: four team leader verbalisations (TLV) with different accuracy levels and four follower verbalisation categories (FV). Measurements were made of all groups administering simulated adult CPR.
  
  
  RESULTS
  NFT rates were significantly lower in the CRM-training group (31.4±6.1% vs. 36.3±6.6%, p=0.014). Proportions of all TLV categories were higher in the CRM-training group (p<0.001). Differences in FV were only found for one category (unsolicited information) (p=0.012). The highest correlation with NFT was found for high accuracy TLV (direct orders) (p=0.06).
  
  
  CONCLUSIONS
  The inclusion of CRM training in undergraduate medical education reduces NFT in simulated CPR and improves TLV proportions during simulated CPR. Further research will test how these results translate into clinical performance and patient outcome.
authors.affiliation: Department of Social and Communication Psychology, Georg-August-University Göttingen, Gosslerstrasse 14, Germany. e.fernandezcastelao@uni-goettingen.de
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Fernandez Castelao
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Russo
authors.forename: Stephan
authors.initials: S
authors.lastname: Cremer
authors.forename: Micha
authors.initials: M
authors.lastname: Strack
authors.forename: Lea
authors.initials: L
authors.lastname: Kaminski
authors.forename: Christoph
authors.initials: C
authors.lastname: Eich
authors.forename: Arnd
authors.initials: A
authors.lastname: Timmermann
authors.forename: Margarete
authors.initials: M
authors.lastname: Boos
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000592:standards*; D004501:Education, Medical / Q000379:methods; D005260:Female; D006801:Humans; D007857:Leadership; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D016544:Patient Simulation; D013997:Time Factors; D014705:Verbal Behavior; D014741:Video Recording