title: Transfer of learning and patient outcome in simulated crisis resource management: a systematic review.
abstract: OBJECTIVE
  Simulation-based learning is increasingly used by healthcare professionals as a safe method to learn and practice non-technical skills, such as communication and leadership, required for effective crisis resource management (CRM). This systematic review was conducted to gain a better understanding of the impact of simulation-based CRM teaching on transfer of learning to the workplace and subsequent changes in patient outcomes.
  
  
  METHODS
  Studies on CRM, crisis management, crew resource management, teamwork, and simulation published up to September 2012 were searched in MEDLINE(®), EMBASE™, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC. All studies that used simulation-based CRM teaching with outcomes measured at Kirkpatrick Level 3 (transfer of learning to the workplace) or 4 (patient outcome) were included. Studies measuring only learners' reactions or simple learning (Kirkpatrick Level 1 or 2, respectively) were excluded. Two authors independently reviewed all identified titles and abstracts for eligibility.
  
  
  RESULTS
  Nine articles were identified as meeting the inclusion criteria. Four studies measured transfer of simulation-based CRM learning into the clinical setting (Kirkpatrick Level 3). In three of these studies, simulation-enhanced CRM training was found significantly more effective than no intervention or didactic teaching. Five studies measured patient outcomes (Kirkpatrick Level 4). Only one of these studies found that simulation-based CRM training made a clearly significant impact on patient mortality.
  
  
  CONCLUSIONS
  Based on a small number of studies, this systematic review found that CRM skills learned at the simulation centre are transferred to clinical settings, and the acquired CRM skills may translate to improved patient outcomes, including a decrease in mortality.
authors.affiliation: Department of Anesthesiology, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, ON, Canada, sboet@toh.on.ca.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
authors.forename: M Dylan
authors.initials: MD
authors.lastname: Bould
authors.forename: Lillia
authors.initials: L
authors.lastname: Fung
authors.forename: Haytham
authors.initials: H
authors.lastname: Qosa
authors.forename: Laure
authors.initials: L
authors.lastname: Perrier
authors.forename: Walter
authors.initials: W
authors.lastname: Tavares
authors.forename: Scott
authors.initials: S
authors.lastname: Reeves
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003198:Computer Simulation; D006282:Health Personnel / Q000193:education*; D006801:Humans; D010348:Patient Care Team / Q000592:standards; D063868:Patient Outcome Assessment; D014163:Transfer, Psychology