Using medical simulation to teach crisis resource management and decision-making skills to otolaryngology housestaff

Develop a course to use in situ high-fidelity medical simulation (HFS) in an actual operating room (OR) to (1) teach teamwork and crisis resource management (CRM) skills simultaneously to otolaryngology and anesthesia trainees and OR nurses and (2) provide decision-making experience to ear, nose, and throat residents and OR teams in simulated high-risk, low-frequency airway emergencies.

A simulation-based, in situ CRM course was developed to teach airway management and CRM in the OR. Upon completion of each course, the participants were surveyed using questions with (1-5) scale answers.

The simulated clinical scenarios took place in the intensive care unit and OR at Children's Hospital Boston.

The participants consisted of pediatric otolaryngology fellows, otolaryngology residents, anesthesiology residents, fellows, and certified registered nurse anesthetists as well as OR nurses. Fifty-nine individuals participated in 9 simulation-based courses given between October 2008 and May 2010. The team members participated together in 3 simulated medical crises that centered on airway and anesthesia issues. Each simulated crisis was followed by a structured debriefing session conducted by trained debriefers. Embedded within the course were didactics on CRM principles.

The participants' responses on the survey included General Course Organization, Realism, Debriefing, and Relevance to Future Practice. Ninety percent of the responses were favorable or very favorable.

Using a newly developed, in situ HFS-based course, clinical decision-making skills and teamwork can be effectively taught concurrently to members of an OR team.