title: Early crisis nontechnical skill teaching in residency leads to long-term skill retention and improved performance during crises: A prospective, nonrandomized controlled study.
abstract: Medical error is common in crises, and the majority of observed errors are nontechnical in nature. The long-term impact of teaching crisis nontechnical skills to residents has not been evaluated. The objective of this study was to determine the effect of simulation-based teaching of crisis nontechnical skills compared to controls one year after initial teaching.
  
  
  
  This was a prospective study using both historical controls and a before-and-after methodology to evaluate the effect of a high-fidelity simulation curriculum that used crisis resource management principles to teach nontechnical skills. Postgraduate year 2 and 3 residents were invited to take part in a prospective training course over 2 years. The primary outcome was leader performance evaluated by expert raters using the previously validated 7-point Ottawa Global Rating Scale.
  
  
  
  Overall, 23 residents performed 30 simulations over the 2 years with the intervention group of 7 residents being assessed in both years. After adjustment, the postgraduate year 3 intervention group who received training the previous year had significantly higher overall performance scores than all postgraduate year 2 scores (1.09 95% confidence interval 0.70-1.47, P < .001) and the historical postgraduate year 3 cohort who received no prior training (1.20, 95% confidence interval 0.37-2.03, P = .005). There was no decay of skills noted over the course of the study.
  
  
  
  Postgraduate year 3 residents who had prior training had significantly improved crisis performance compared to historical postgraduate year 3 controls and untrained postgraduate year 2 residents. There were no significant differences between the crisis performance of postgraduate year 2 residents and the untrained postgraduate year 3 controls. This confirms the beneficial effect and long-term retention after crisis nontechnical skill training.
authors.affiliation: Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Aristithes G
authors.initials: AG
authors.lastname: Doumouras
authors.affiliation: Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, McMaster University, Hamilton, Ontario, Canada. Electronic address: engelsp@mcmaster.ca.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Engels
mesh_terms: D002983:Clinical Competence; D065187:Controlled Before-After Studies; D003419:Crisis Intervention / Q000193:education*; D003479:Curriculum; D013502:General Surgery / Q000193:education*; D000070856:High Fidelity Simulation Training; D006801:Humans; D007396:Internship and Residency; D007857:Leadership; D011446:Prospective Studies; D012153:Retention, Psychology