Academic journal article American Journal of Pharmaceutical Education

Simulation-Based Crisis Resource Management in Pharmacy Education

Academic journal article American Journal of Pharmaceutical Education

Simulation-Based Crisis Resource Management in Pharmacy Education

Article excerpt


Crisis resource management (CRM) in health care is the articulation of individual and team behaviors in routine and crisis situations that focuses on dynamic decision-making skills, interpersonal skills, and team management. (1,2) The purpose of CRM is to train crews to collaborate effectively and adopt behaviors promoting patient safety. Since its beginnings in the 1990s, simulation-based CRM has grown in health professions education across multiple domains. Numerous studies have reported positive results in the implementation of team-oriented and CRM programs; however, most of these studies were conducted with a small sample size, using a one-time training of short duration. (3-5) Larger studies with rigorous performance assessments are needed to measure the true impact of CRM training in health care.

Team work is central to safety in health care and team performance is directly linked with the quality of interactions between workers. (6,7) Pharmacy programs throughout the world have established learning outcomes fostering intra- and inter professional collaboration. (8) Even in the simplest situations, pharmacists have to communicate effectively with their teams and maintain effective workload distribution to ensure that patients will receive the appropriate medications and professional services. It is therefore imperative that pharmacy students be educated on CRM principles.

Over the past five years, second- and third-year undergraduate pharmacy students at Laval University in Canada have experienced collaborative simulation-based team training with pharmacy technician students targeting CRM basic principles (eg, team management, resource allocation, environmental awareness, and dynamic decision-making). To our knowledge, Laval University is the first institution to have integrated an interdisciplinary CRM activity in their Doctor of Pharmacy program (PharmD) curriculum. This education brief describes strategies for a successful implementation of simulation-based CRM in pharmacy education and presents students' appreciation of the activity.


The key concepts of CRM are organized in four broad categories that interact and overlap. These key concepts are team management, resource allocation, awareness of environment and dynamic decision-making. (9) Team management involves the establishment of a team leader who prioritizes and distributes tasks among team members. Roles and responsibilities of team members must be clear, understood and enacted. Effective communication within the team is crucial to establish a shared mental model, which might require asking for clarification when needed or requesting timely help. Resource allocation and environmental awareness pertain to knowing one's environment to help anticipate and plan for all eventualities and allocate resources where they are most needed. Decision-making in crisis situations can be extremely challenging because the information is constantly changing, which contributes to clinical uncertainty. Strategies to avoid fixation errors and continuous reassessment of situations help promote patient safety behaviors.

The first step to designing simulation-based CRM training for undergraduate pharmacy students is to establish clear learning objectives and associate CRM principles to possible scenarios to be simulated. Typically, high-acuity situations are included in CRM training because the dynamic nature of such situations and the highly complex environment can lead to critical incidents that best illustrate the key CRM principles. (9) Although it might be tempting to incorporate multiple stressors and information in the scenario, task complexity should be adapted to account for the learner's expertise level to maximize the learning outcomes. (10) Given the stress and complexity associated with these activities, the scenarios should be sequenced from simple to complex to help learners familiarize themselves with the environment and with other team members before facing more complex situations. …

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