Enhancing Observer Engagement During Undergraduate Critical Care Simulation Using Crisis Resource Management Principles: A Structured, Scalable Approach

INTRODUCTION: Observers in simulation-based education often lack structured roles, leading to disengagement and reduced learning. Crisis resource management (CRM) principles, focusing on nontechnical skills like communication and situational awareness, offer a potential framework to enhance observer engagement. METHODS: We conducted a prospective cohort study with senior-cycle medical students in critical care simulations. In the intervention group (n = 44), observers were oriented to CRM principles and assigned domains such as leadership, communication, or situational awareness. Using structured checklists, they documented behaviors and contributed findings during debriefs. A control cohort (n = 56) completed standard simulations without structured roles. Postsimulation questionnaires assessed engagement, focus, confidence, and perceived educational value. Data were analyzed using nonparametric tests (Mann-Whitney U, χ2, or Fisher's exact test where appropriate), with statistical significance defined as P < 0.05. RESULTS: Observers in the intervention group reported significantly higher confidence in identifying key actions and decisions compared with the control group (odds ratio = 2.50, 95% confidence interval [1.12-5.91], P = 0.037; Mann-Whitney U = 778, P = 0.0007). 95.5% of students reported improved focus during scenarios, and 93% endorsed continued CRM use. Prior simulation experience did not differ significantly between groups (χ2(1, N = 100) = 0.7959, P = 0.3723). Free-text feedback highlighted increased interactivity and deeper understanding of team dynamics. The CRM-based approach proved adaptable across a range of simulation scenarios, suggesting potential for widespread application. CONCLUSIONS: Structured observer engagement through CRM principles improves learning outcomes, enhances critical thinking, and builds confidence in evaluating teamwork and communication skills. Integrating CRM principles provides observers with a clear analytical focus and promotes meaningful participation. This structured, low-cost approach offers a scalable method to improve the educational experience for simulation observers in undergraduate medical education.