TEAM-ORIENTED MEDICAL SIMULATION

In 1994, a simulator-based, CRM-oriented curriculum was developed independently by Helmreich, Schaefer, and colleagues at the University of Basel (Robert Helmreich is a social psychologist who has long investigated aerospace crew performance issues and is one of the originators of CRM in aviation).^[61] Although both ACRM and team-oriented medical simulation (TOMS) share many features and both derive from the model of CRM in aviation, the TOMS approach has somewhat more emphasis on the social psychology of team interactions in the OR, whereas ACRM has somewhat more emphasis on the cognitive psychology of the anesthesiologist in the context of team interactions. Using the Wilhelm Tell variant of the Sophus simulator (in which perfused animal organs are provided to allow laparoscopic surgery), the TOMS group conducted true combined team training of complete OR teams. An OR team of surgeons, nurses, anesthetists, and orderlies is assigned to the TOMS OR on a given day instead of their normal OR, and routine operative patient care of the simulated patient is conducted just as they would for actual patients. During surgery, one or more adverse events may be triggered by the instructors. As in ACRM, a debriefing session using videotapes of the simulation follows. The TOMS approach emphasizes self-debriefing by the entire OR team and exploration of team communication and interaction issues. All subgroups of the OR team rated the simulations and debriefing sessions as highly realistic and valuable, which suggested to the investigators that "all groups benefited equally from training."^[61] The group in Basel and Texas is still active and continues to work to improve overall teamwork performance.^{[26] [27] [62]}