Comparing the effectiveness of a hybrid simulation/lecture session versus simulation alone in teaching crew resource management (CRM) skills: a randomised controlled trial.

IntroductionVarious methods have been used to teach crew resource management (CRM) skills, including high-fidelity patient simulation. It is unclear whether a didactic lecture added on to a simulation-based curriculum can augment a learner's education.MethodsUsing an already existing simulation-based curriculum for interdisciplinary teams composed of both residents and nurses, teams were randomised to an intervention or control arm. The intervention arm had a 10 min didactic lecture after the first of three simulation scenarios, while the control arm did all three simulation scenarios without any didactic component. The CRM skills of teams were then scored, and improvement was compared between the two arms using general estimating equations.ResultsThe differences in mean teamwork scores between the intervention and control arms in scenarios 2 and 3 were not statistically significant. Mean scores in the intervention arm were lower than in the control arm (-0.57, p=0.78 for scenario 2; -3.12, p=0.13 for scenario 3), and the increase in scores from scenario 2 to 3 was lower in the intervention arm than in the control arm (difference in differences: -2.55, p=0.73).ConclusionsAdding a didactic lecture to a simulation-based curriculum geared at teaching CRM skills to interdisciplinary teams did not lead to significantly improved teamwork

A 77-Year-Old Woman With Capillary Hypoxia and Perioral Cyanosis

Case presentationA 77-year-old woman with asthma, hypothyroidism, irritable bowel syndrome, overactive bladder, and multiple rheumatologic conditions was sent from the clinic to the ED for evaluation of hypoxia. In the clinic, she reported dizziness without shortness of breath and was noted to have perioral cyanosis with an oxygen saturation measured by pulse oximetry (Spo2) of 80%. She was given a nonrebreather mask delivering oxygen at 8 L/min, but the Spo2 remained at 77% to 82%. In the ED, the patient reported intermittent shortness of breath, 2 to 3 days of mild left lower extremity swelling, and a brief episode of lightheadedness earlier in the day that had since resolved. She denied fevers/chills, upper respiratory symptoms, and chest pain. She had been referred to the pulmonology clinic 3 years earlier to evaluate mild hypoxia with Spo2 readings in the low 90% range, but pulmonary function testing failed to identify an etiology. There was no history of VTE. Her rheumatologic conditions included osteoarthritis, rheumatoid arthritis, Sjögren's syndrome, and fibromyalgia