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Arch Surg. 2009 Dec;144(12):1133-7. doi: 10.1001/archsurg.2009.207.

Can aviation-based team training elicit sustainable behavioral change?

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Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906, USA.



To quantify effects of aviation-based crew resource management training on patient safety-related behaviors and perceived personal empowerment.


Prospective study of checklist use, error self-reporting, and a 10-point safety empowerment survey after participation in a crew resource management training intervention.


Seven hundred twenty-two-bed university hospital; 247-bed affiliated community hospital.


There were 857 participants, the majority of whom were nurses (50%), followed by ancillary personnel (28%) and physicians (22%).


Preoperative checklist use over time; number and type of entries on a Web-based incident reporting system; and measurement of degree of empowerment (1-5 scale) on a 10-point survey of safety attitudes and actions given prior to, immediately after, and a minimum of 2 months after training.


Since 2003, 10 courses trained 857 participants in multiple disciplines. Preoperative checklist use rose (75% in 2003, 86% in 2004, 94% in 2005, 98% in 2006, and 100% in 2007). Self-initiated reports increased from 709 per quarter in 2002 to 1481 per quarter in 2008. The percentage of reports related to environment as opposed to actual events increased from 15.9% prior to training to 20.3% subsequently (P < .01). Perceived self-empowerment, creating a culture of safety, rose by an average of 0.5 point in all 10 realms immediately posttraining (mean [SD] rating, 3.0 [0.07] vs 3.5 [0.05]; P < .05). This was maintained after a minimum of 2 months. There was a trend toward a hierarchical effect with participants less comfortable confronting incompetence in a physician (mean [SD] rating, 3.1 [0.8]) than in nurses or technicians (mean [SD] rating, 3.4 [0.7] for both) (P>.05).


Crew resource management programs can influence personal behaviors and empowerment. Effects may take years to be ingrained into the culture.

[Indexed for MEDLINE]

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