title: Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study.
abstract: BACKGROUND
  Simulation has been identified as a means of assessing resident physicians' mastery of technical skills, but there is a lack of evidence for its utility in longitudinal assessments of residents' non-technical clinical abilities. We evaluated the growth of crisis resource management (CRM) skills in the simulation setting using a validated tool, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). We hypothesized that the Ottawa GRS would reflect progressive growth of CRM ability throughout residency.
  
  
  METHODS
  Forty-five emergency medicine residents were tracked with annual simulation assessments between 2006 and 2011. We used mixed-methods repeated-measures regression analyses to evaluate elements of the Ottawa GRS by level of training to predict performance growth throughout a 3-year residency.
  
  
  RESULTS
  Ottawa GRS scores increased over time, and the domains of leadership, problem solving, and resource utilization, in particular, were predictive of overall performance. There was a significant gain in all Ottawa GRS components between postgraduate years 1 and 2, but no significant difference in GRS performance between years 2 and 3.
  
  
  CONCLUSIONS
  In summary, CRM skills are progressive abilities, and simulation is a useful modality for tracking their development. Modification of this tool may be needed to assess advanced learners' gains in performance.
authors.affiliation: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, USA; samuel.clarke@ucdmc.ucdavis.edu.
authors.forename: Samuel
authors.initials: S
authors.lastname: Clarke
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Horeczko
authors.affiliation: Office of Medical Education, LSU Health Sciences Center, New Orleans, LA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Carlisle
authors.affiliation: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Barton
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ, USA.
authors.forename: Vivienne
authors.initials: V
authors.lastname: Ng
authors.affiliation: Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Sameerah
authors.initials: S
authors.lastname: Al-Somali
authors.affiliation: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Bair
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002140:California; D004503:Education, Medical, Graduate; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006295:Health Resources / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D008137:Longitudinal Studies; D008297:Male; D011361:Professional Competence / Q000592:standards*
keywords: assessment; crisis resource management; simulation