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Br J Anaesth. 2013 Feb;110(2):299-304. doi: 10.1093/bja/aes351. Epub 2012 Oct 3.

Does warm-up using mental practice improve crisis resource management performance? A simulation study.

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Department of Anesthesiology and the Li Ka Shing Knowledge Institute, Allan Waters Family Simulation Center, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.



Mental practice (MP) is defined as the 'symbolic rehearsal of a physical activity in the absence of any gross-muscular movements' and has been used in sport and music to enhance performance. In healthcare, MP has been demonstrated to improve technical skill performance of surgical residents. However, its effect on crisis resource management (CRM) skills has yet to be determined. We aimed to investigate the effect of warm-up with MP on CRM skill performance during a simulated crisis scenario.


Following ethics board approval, 40 anaesthesia residents were randomized. The intervention group performed 20 min of MP of a script based on CRM principles. The control group received a 20 min didactic teaching session on an unrelated topic. Each subject then managed a simulated cardiac arrest. Two CRM experts rated the video recordings of each performance using the previously validated Ottawa GRS. The time to start chest compressions, administer epinephrine, and give blood was recorded.


There was no significant difference between the intervention and control groups: total Ottawa GRS score was 24.50 (18.63-28.88 [6.50-34.50]) (median (inter-quartile range [range]) vs 20.50 (13.00-29.13 [6.50-34.50]) (P=0.53); the time to start chest compressions 146.0 s (138.0-231.0 [115.0-323.0]) vs 162.5 s (138.0-231.0 [100.0-460.0]) (P=0.27), the time to epinephrine administration 163.0 s (151.0-187.0 [111.0-337.0]) vs 187.0 s (164.0-244.0 [115.0-310.0]) (P=0.09), and the time to blood administration 220.5 s (130.8-309.0 [92.0-485.0]) vs 252.5 (174.5-398.8 [65.0-527.0]) (P=0.48).


Unlike technical skills, warm-up with MP does not seem to improve CRM skills in simulated crisis scenarios.

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