Table 1

Patient safety curriculum elements and order of delivery

Curriculum elementDelivery methodContent
Prework (advance organiser)
Mandatory completion by participants prior to attending course
Intranet-based and interactiveScope and type of medical errors
Paediatric ED as a high risk environment
A systems approach to error
Development of CRM and its impact in aviation
CRM concepts and techniques
Definition of teams, communication techniques and foundations of teamwork
Day 1: Introduction to courseInstructor presentedStandard orientation to simulation environment, simulator(s) and behavioural expectations including confidentiality
Initial simulation and debriefing (baseline)SimulationCritical trauma patient. Team's initial exposure to simulation and video assisted debriefing with emphasis on teamwork and communication
ED as a high risk environmentMini-lectureScope and magnitude of error, ED as a high risk environment, types of errors, systems approach to error
Aviation case study video and facilitated discussionVideo simulation of Tenerife disasterParticipant analysis of the factors that led to this disaster.
Discussion linking high risk elements of this situation to the ED
CRM principlesMini-lecture including videoCRM principles, teamwork and communication techniques, videos illustrating CRM techniques
Simulation and debriefingSimulationCritical medical patient presenting with shock and experiencing iatrogenic adverse drug event
Situational awareness and obstacles to teamworkMini-lecture and interactive video exerciseVideo exercise demonstrates the difficulty of maintaining situation awareness in face of multiple competing demands for attention.
Situation awareness deficit in video exercise linked to complex and competing demands in ED
Simulation and debriefingSimulationCritical medical patient with infrequently seen condition requiring rapid stabilisation. Entire team needs to actively participate to complete successfully
Day 1: Summary and evaluationInstructor facilitatedDebriefing of day's activities, questions, summary
Day 2: Introduction and summary of day 1 activitiesInstructor facilitatedBrief summary of key CRM concepts and behavioural expectations. Day 2 activities emphasise utilisation of the techniques and tools presented during day 1
Simulation and debriefing
Three scenarios presented and debriefed consecutively
SimulationCritical trauma patient requiring rapid stabilisation. Scripted authority gradient and team leader's actions result in severe complications if not addressed by team. Authority gradient, assertive statements and ‘pinch’ addressed
Critical medical patient. An equipment malfunction prevents delivery of adequate tidal volume to patient. Team members need to identify the cause and address the patient's deteriorating condition
Critical medical patient with confusing presentation. Team needs to identify alternative aetiologies of presentation as well as address iatrogenic complications of therapy
Day 2: Summary and evaluationInstructor facilitatedDebriefing, summary, course evaluation, knowledge test and SAQ completion
  • Simulation denotes manikin-based simulation and video assisted debriefing.

  • CRM, crew resource management; ED, emergency department; SAQ, Safety Attitudes Questionnaire.