title: Learning crisis resource management: Practicing versus an observational role in simulation training - a randomized controlled trial.
abstract: OBJECTIVE
  Simulation training has been shown to be an effective way to teach crisis resource management (CRM) skills. Deliberate practice theory states that learners need to actively practice so that learning is effective. However, many residency programs have limited opportunities for learners to be "active" participants in simulation exercises. This study compares the effectiveness of learning CRM skills when being an active participant versus being an observer participant in simulation followed by a debriefing.
  
  
  METHODS
  Participants were randomized to two groups: active or observer. Active participants managed a simulated crisis scenario (pre-test) while paired observer participants viewed the scenario via video transmission. Then, a trained instructor debriefed participants on CRM principles. On the same day, each participant individually managed another simulated crisis scenario (post-test) and completed a post-test questionnaire. Two independent, blinded raters evaluated all videos using the Ottawa Global Rating Scale (GRS).
  
  
  RESULTS
  Thirty-nine residents were included in the analysis. Normally distributed data were analyzed using paired and unpaired t-tests. Inter-rater reliability was 0.64. Active participants significantly improved from pre-test to post-test (P=0.015). There was no significant difference between the post-test performance of active participants compared to observer participants (P=0.12).
  
  
  CONCLUSIONS
  We found that learning CRM principles was not superior when learners were active participants compared to being observers followed by debriefing. These findings challenge the deliberate practice theory claiming that learning requires active practice. Assigning residents as observers in simulation training and involving them in debriefing is still beneficial.
authors.affiliation: Department of Emergency Medicine, Alberta Health Services, University of Calgary, Room C231, 1403-29 Street, NW Calgary, AB, T2N 2T9, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Lai
authors.affiliation: Department of Emergency Medicine, The Montfort Hospital, University of Ottawa, 713, Montreal Road Ottawa, K1K 0T2, ON, Canada.
authors.forename: Alexis
authors.initials: A
authors.lastname: Haligua
authors.affiliation: The Department of Innovation in Medical Education of the Faculty of Medicine, University of Ottawa, Roger Guidon Hall Room 2211, 451 Smyth Rd, Ottawa, ON, K1H 85M, Canada; Department of Anesthesiology, The Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Dylan Bould
authors.affiliation: Department of Anesthesiology, The Hospital for Sick Children, University of Toronto, Room 2303, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
authors.forename: Tobias
authors.initials: T
authors.lastname: Everett
authors.affiliation: Department of Anesthesiology, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Gale
authors.affiliation: Department of Anesthesiology, The Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, ON K1H 8L6, Canada.
authors.forename: Ashlee-Ann
authors.initials: AA
authors.lastname: Pigford
authors.affiliation: The Department of Innovation in Medical Education of the Faculty of Medicine, University of Ottawa, Roger Guidon Hall Room 2211, 451 Smyth Rd, Ottawa, ON, K1H 85M, Canada; Department of Anesthesiology, The Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, ON K1H 8L6, Canada. Electronic address: sboet@toh.on.ca.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D000776:Anesthesiology / Q000193:education; D002983:Clinical Competence; D003419:Crisis Intervention / Q000193:education; D004521:Educational Measurement; D007396:Internship and Residency; D007858:Learning; D008348:Manikins; D019370:Observation; D040841:Resource Allocation; D000066908:Simulation Training
keywords: Communication; Crisis resource management; Debriefing; Dyad learning; Inter-professional care; Teamwork