Enhancing Observer Engagement During Undergraduate Critical Care Simulation Using Crisis Resource Management...

Observers in simulation-based education often lack structured roles, leading to disengagement and reduced learning. Crisis resource management (CRM) principles, focusing on nontechnical skills like communication and situational awareness, offer a potential framework to enhance observer engagement.

We conducted a prospective cohort study with senior-cycle medical students in critical care simulations. In the intervention group (n = 44), observers were oriented to CRM principles and assigned domains such as leadership, communication, or situational awareness. Using structured checklists, they documented behaviors and contributed findings during debriefs. A control cohort (n = 56) completed standard simulations without structured roles. Postsimulation questionnaires assessed engagement, focus, confidence, and perceived educational value. Data were analyzed using nonparametric tests (Mann-Whitney U, χ2, or Fisher's exact test where appropriate), with statistical significance defined as P < 0.05.

Observers in the intervention group reported significantly higher confidence in identifying key actions and decisions compared with the control group (odds ratio = 2.50, 95% confidence interval [1.12-5.91], P = 0.037; Mann-Whitney U = 778, P = 0.0007). 95.5% of students reported improved focus during scenarios, and 93% endorsed continued CRM use. Prior simulation experience did not differ significantly between groups (χ2(1, N = 100) = 0.7959, P = 0.3723). Free-text feedback highlighted increased interactivity and deeper understanding of team dynamics. The CRM-based approach proved adaptable across a range of simulation scenarios, suggesting potential for widespread application.

Structured observer engagement through CRM principles improves learning outcomes, enhances critical thinking, and builds confidence in evaluating teamwork and communication skills. Integrating CRM principles provides observers with a clear analytical focus and promotes meaningful participation. This structured, low-cost approach offers a scalable method to improve the educational experience for simulation observers in undergraduate medical education.