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Show Notes

CRM definitions (From TC Approved Check Pilot Manual): 

  • Situational Awareness: an ability to accurately perceive what is taking place inside and outside the aircraft
    • System Awareness
    • Environmental Awareness
    • Awareness of time and anticipation of future events
  • Cooperation
    • Team building and maintaining
    • Consideration of others
    • Support of others
    • Resolving conflicts
  • Decision Making
    • Problem diagnosis
    • Option generation
    • Risk assessment
    • Option selection
    • Outcome review
  • Leadership and Managerial Skills
  • Use of authority and assertiveness
  • Providing and maintaining standards
  • Planning and coordination
  • Workload management

CRM has evolved in aviation

  • CRM started as a pilot-led and evidence-driven response to aviation accidents in the 1970s and 80s where team performance led to accidents, rather than mechanical failure
  • See Episode 3 Show Notes

Evaluating pilots-in-training in both their technical and CRM skills is structured and formalized. 

  • In every pilot license, there is a ground school, a written exam, flying lessons, and a flight test as well as minimum flight hours and experience. They are evaluated on their technical and non-technical skills. 
  • Flight tests include scenario-based oral exams similar to physician board exams.
  • Currently pilot training programs in Canada are starting to shift from modular or block-style training (private license, adding night and instrument ratings, etc.) to a more integrated philosophy to train multi-crew airline pilots from day one. 
  • A Pilot Proficiency Check (PPC) acts as a type rating that is added onto an existing pilot license for a specific type of airplane. This happens roughly every six months and reviews both normal procedures and emergency procedures. 
  • Given the basics of CRM described above, pilots are marked based on four global points (effective, acceptable, poor, unacceptable) while examiners think about possible CRM elements including: 
    • Did they anticipate the threat? 
    • Do they make inquiries for more information? 
    • Do they consider downstream consequences
    • How was the situational awareness? 
    • Did they communicate appropriately?
    • How did they manage their workload?
    • How did they get rid of distractions?
    • Was the aim achieved?
  • Errors are deemed as “critical," "major," or "minor," each with their own repercussions on the outcome of the flight test. 
  • The CRM framework allows us to trace back errors observed and trace back why they might have occurred.
  • In aviation the Pilot Proficiency Check is a check on a specific aircraft where a line check is run by the airline to determine the safety and effectiveness of company-specific policies and procedures. 

Situational Awareness

  • “We all have our own mental models about a certain situation, and if it is accurate, this means that we have good situational awareness."
  • We may have fixation-induced loss of situational awareness through task saturation (e.g. intubation, troubleshooting landing gear)
  • Captain Schuster imagines workload management in three buckets: information can be perceived, processed, and then acted upon. Each must be balanced to function well. 

Cooperation

  • Cooperation: the ability to work effectively as a team. 
  • Cooperation begins in the formation of the team and considers the skills and attitudes of individual members. 
  • Basic conflict resolution techniques can aid in examining the root cause of errors. 
  • A debrief of the exercise is just as important as completing the full exercise in examining the components of CRM that failed and that were successful.

Decision-making

  • Decision-making includes identifying the problem, generating options for action, assessment of the risk, willingness to reassess the plan, and analysis of the outcome.
  • Decision-making in aviation is most often evaluated in the debrief, where the examiner and the trainee discuss the thought processes of the trainee and hypothetical cases.  
  • “The event in the simulator is the practice, the learning takes place in the debrief.”

Leadership, Managerial Skills (and followship)

  • Designated leadership (e.g. Captain) versus functional leadership (context-specific, depending on who has the most relevant experience)
  • Followership: giving appropriate feedback at the appropriate time, asking questions if unsure, suggesting alternate courses of action (which requires good situational awareness).
  • Authority gradient: if too steep, people will not speak up when necessary. If too flat or out of balance, there is a risk of failure of leadership.
  • Good leaders use functional leadership to achieve goals. (e.g., the First Officer has more experience at a particular airport).
  • Good followers will use graduated assertiveness when necessary (e.g., the Probing, Alerting, Challenge, Emergency (PACE) model described in Episodes 3 & 4).
  • Leadership on the flight deck incorporates planning and coordination. 
    • For example, in November, Captain Schuster will ask his First Officer, “Have you needed to de-ice yet this season? Have you had a chance to look over the checklist in advance so there aren’t any surprises?” 
  • Workload management is also a part of leadership, where the leader assesses the situation and then delegates appropriate tasks with clear communication while ensuring they are not task saturated.

Appropriate feedback to trainees and to their training unit allows both individual and system-wide deficits to be studied and improved on. 


CRM in medicine

  • The concept of a Pilot/Physician Proficiency Check (PPC) where a physician must recertify their proficiency at normal and emergency procedures, exists in certification courses such as ACLS, ATLS, and NRP. We do not have specialty or institution-wide proficiency checks after the specialty exams.
  • Medicine remains very individual-focused as opposed to team-focused (e.g. one doctor runs the code and must think of the next steps of action, whereas in a flight emergency the captain often gives control of the aircraft to the first officer, leaving them free to think about next steps). 
  • Medicine has started to recognize the importance of debriefing after resuscitation or critical events.

Other Resources

  • TC Approved Check Pilot Manual. 
  • Re-enactment of a check flight and assessment of CRM (YouTube 19 mins). The issue starts in the briefing where the First Officer lacks trust due to the Captain’s apparent lack of knowledge. This leads to an in-flight emergency that results from a poorly managed abnormal event: an electrical problem. During the running of the checklist, no one is flying the airplane (monitoring the airspeed, which was previously too fast and the thrust levers retarded), the stick shaker activates, indicating an aerodynamic stall is imminent and the crew recovers from the Undesired Aircraft State (UAS). During the debrief, we see the learning take place.

Safety Intervention Worth Mentioning:


Who can do what tomorrow? 

  • Policy Level: Read the TEM paper linked above to see what can be done to improve training and evaluation of non-technical skills in medicine. 
  • Hospital CEO/Department Level: Consider how improving non-technical skills can improve working conditions and team satisfaction. 
  • Practitioner Level: Read the TEM paper.


Random Recommendations

Thanks to Carter Ponce at VoV Media and our intern, Dr. Sam Seshadri for help with post-production.

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