VA PA Sim Center

Criteria for ACRM - like Training


Adapted by The Working Group for Crisis Management Training in Health Care: March, 1998

Anesthesia residents watch and analyze an airplane accident


The universe of possible training activities using realistic simulation is very wide. Each Simulation Center and each faculty member should be free to develop different curricula and styles of training. Nonetheless, the profession will be served by achieving a balance between curricular growth and adaptation to local conditions, and standardizing training experiences and their expected impact. This will facilitate proper understanding of publications, presentations, discussions, and advertisements. To that end we propose the following criteria to be met by a training course to properly be described as Anesthesia Crisis Resource Management (ACRM) or equivalent thereof. These equivalents are not limited to anesthesiology or perioperative management, but may also extend into other health care domains, including intensive care, emergency medicine, neonatology, etc. In this document all of these equivalents and extensions will be referred to as ACRM-like training.


The objectives of ACRM-like training are to:

Required Core Characteristics of ACRM-like Training

1. At least 50% of the emphasis of the course is on crisis resource management behaviors (or crew resource management behaviors) as opposed to the medical and technical aspects of managing the specific situations presented during simulation.

2. The bulk of the training course consists of realistic simulations followed by detailed debriefings. Simulation training may be supplemented by additional modalities including such activities as assigned readings, didactic presentations, analysis of videotapes, role-playing, or group discussions.

3. Simulations strive for a high degree of realism. Simulations are conducted with personnel to individually represent those personnel found in the typical work environment of the participant, including nurses, surgeons, technicians. Simulation scenarios require participants to engage in appropriate interactions with these individuals.

4. The scenarios include situations in which the primary participant can request and receive help from other participants. Participants may rotate between different roles during different scenarios so as to gain different perspectives. In addition to the course participants, additional observers may observe directly or by remote connection. Observation only, without rotating through the roles in the simulations, is not equivalent to actual participation in the course.

5. Debriefings are led by one or more instructors with special training or experience (equivalent to an ACRM Instructor Course). Debriefings are performed with the whole group of participants together, using audio/video recordings of the simulation sessions. As per Core Characteristic 1, the primary emphasis in debriefing is on exploring aspects of behavior. Debriefings emphasize constructive critique in which the participants are given the greatest opportunity possible to speak and to critique and learn from each other.

6. The training is intense and involves a high involvement of faculty with the participants and a low participant to faculty ratio. It is difficult at this time to prescribe a specific number of hours per course. However, given the requirement for complex simulations followed by detailed debriefings, supplemented by other training modalities, it is difficult to imagine conducting a satisfactory ACRM-like training experience in less than half a day. Most ACRM-like training workshops conducted to date have typically lasted 7-10 hours and have involved 4 - 6 participants.

Continuing Medical Education in Anesthesia Crisis Resource Management

The components of the ACRM CME course are well described in the ACRM pages of this Web Site.

The VA Palo Alto Health Care System Simulation Center for Crisis Management Training in Health Care offers ACRM CME sessions on selected weekends and on an as needed basis.

For further information about ACRM CME, contact us

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