Intended for healthcare professionals

Rapid response to:

Education And Debate

On error management: lessons from aviation

BMJ 2000; 320 doi: (Published 18 March 2000) Cite this as: BMJ 2000;320:781

Rapid Response:

Should crew resource management training be mandatory in anaesthesia?

Editor- I was interested to read the recent papers in the BMJ by both
Helmreich and Gaba concerning the similarities between anaesthesia and
aviation in terms of performance standards of personnel. [1,2] Having
attended both anaesthesia crew resource management simulator training and
aviation crew resource management training in the UK and Australia I can
confirm that the models are indeed very similar.
Furthermore having taken the training into the operating theatre and also
into the air (as part of an aeromedical rescue team) I can also testify as
to the value of such
training, in its application to the working environment for which it is

The recognition that errors occur and the need to move away from a culture
of blame has been highlighted before in anaesthesia. [3] The confidential
critical incident
reporting system set up by the Royal College of Anaesthetists has gone
someway to recognise the need to mirror such systems in the aviation
However it has also been noted that extensive professional training, as
undertaken by doctors and experience on the job generally ensure that
errors caused by failures of
understanding are rare and that task overload is not at the root of
mistakes. This is achieved by making some processes relatively automatic
and unconscious. As such most mishaps are caused by errors in carrying out
rather simple tasks that would normally demand little attention. An
implication of this, is that the more experienced operator is more likely
to make such errors.[4]

With the advent of re-certification for hospital doctors and the obvious
implications on clinical governance and given the availability of
anaethesia simulators in Stirling,
Bristol and London surely it is sensible that all anaesthetic staff
regularly undergo this training, as is expected of our counterparts in
the aviation industry.


[1] Helmreich RL. On error management: lessons from aviation. BMJ
2000; 320: 781-785.

[2] Gaba DM. Anaesthesiology as a model for patient safety in health
care. BMJ 2000; 320: 785-788.

[3] Allnutt MF. Human factors in accidents. Br J Anaesth 1987; 59:

[4] Chappelow J. The psychology of safety. Br J Clin Psychology 1988;
2: 108-125.

Peter J Shirley

Senior Specialist Registrar

Department of Anaesthesia,
Aberdeen Royal Infirmary,
AB25 2ZN

Competing interests: No competing interests

22 March 2000
Peter J Shirley