Extent and types of gender-based discrimination against female medical students and physicians at five university hospitals in Germany - results of an online survey.

Objective: There is a gap in research on gender-based discrimination (GBD) in medical education and practice in Germany. This study therefore examines the extent and forms of GBD among female medical students and physicians in Germany. Causes, consequences and possible interventions of GBD are discussed. Methods: Female medical students (n=235) and female physicians (n=157) from five university hospitals in northern Germany were asked about their personal experiences with GBD in an online survey on self-efficacy expectations and individual perceptions of the "glass ceiling effect" using an open-ended question regarding their own experiences with GBD. The answers were analyzed by content analysis using inductive category formation and relative category frequencies. Results: From both interviewed groups, approximately 75% each reported having experienced GBD. Their experiences fell into five main categories: sexual harassment with subcategories of verbal and physical, discrimination based on existing/possible motherhood with subcategories of structural and verbal, direct preference for men, direct neglect of women, and derogatory treatment based on gender. Conclusion: The study contributes to filling the aforementioned research gap. At the hospitals studied, GBD is a common phenomenon among both female medical students and physicians, manifesting itself in multiple forms. Transferability of the results beyond the hospitals studied to all of Germany seems plausible. Much is known about the causes, consequences and effective countermeasures against GBD. Those responsible for training and employers in hospitals should fulfill their responsibility by implementing measures from the set of empirically evaluated interventions.

How to enrich team research in healthcare by considering five theoretical perspectives.

The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.

Effects of the Noise Reduction and Communication Management Headset System SLOS on Noise and Stress of Medical Laboratory Workers.

OBJECTIVE: To investigate the effects of the Silent Laboratory Optimization System (SLOS), a technical-noise reduction and communication-management system, on noise load and stress among medical-laboratory workers. METHODS: We conducted a quasiexperimental field study (20 days with SLOS as the experimental condition, and 20 days without SLOS as the control condition) in a within-subjects design. Survey data from 13 workers were collected before and after the shift. Also, a survey was conducted after the control and experimental conditions, respectively. Noise was measured in dBA and as a subjective assessment. Stress was operationalized via a stress composite score (STAI and Perkhofer Stress Scale), the Perceived Stress Scale (PSS), an exhaustion score (Leipziger StimmungsBogen in German [LSB]), and salivary cortisol values in µg/L. RESULTS: SLOS users perceived significantly less noise (V = 76.5; P =.003). Multilevel models revealed a stress reduction with the SLOS on the composite score, compared with a stress increase in the control condition (F[1, 506.99] = 6.00; P = .01). A lower PSS score (F[1,13] = 4.67; P = .05) and a lower exhaustion level (F[1, 508.72] = 9.057; P = .003) in the experimental condition were found, whereas no differences in cortisol (F[1,812.58.6] = 0.093; P = .76) were revealed. CONCLUSION: The workers showed reduced noise perception and stress across all criteria except cortisol when using SLOS.

Job demands at the patient's bedside and their effects on stress and satisfaction of nurses.

AIM: The study aimed to assess job demands at the patient's bedside and to evaluate the contribution of this central workplace to the stress and satisfaction of nurses. DESIGN: In this cross-sectional survey study, a questionnaire was compiled and all registered nurses from intensive, general and intermediate care wards at a large German hospital were invited to participate. METHODS: The questionnaire used a list of care activities to assess nurses' workload at the patient's bed. The German Copenhagen Psychosocial Questionnaire and an adapted version of the German Perceived Stress Scale were used to measure nurses' stress and burn-out, and single items to assess health status, organisational commitment, job satisfaction, and satisfaction with the quality of care. The questionnaire was returned by 389 nurses. RESULTS: Expected correlations of workload at the patient's bed with stress, burn-out and satisfaction of the nurses were shown. A moderating effect of organisational commitment was non-existent but was shown for the self-assessed health on the correlation between workload and satisfaction with the quality of care. Organisational commitment correlated negatively with stress and burn-out and positively with satisfaction. The study provides evidence that rates of burn-out and stress do not differ based on the work area of nurses. Because job demands at the patient's bed correlated with all outcomes, measures to improve this specific workspace are sensible.

In no uncertain terms: Group cohesion did not affect exploration and group decision making under low uncertainty.

Group decision making under uncertainty often requires groups to balance exploration of their environment with exploitation of the seemingly best option. In order to succeed at this collective induction, groups need to merge the knowledge of all group members and combine goal-oriented and social motivations (i.e., group cohesion). This paper presents three studies that investigate whether more cohesive groups perform worse at collective induction tasks as they spend less time exploring possible options. Study 1 simulates group decision making with the ε-greedy algorithm in order to identify suitable manipulations of group cohesion and investigate how differing exploration lengths can affect outcomes of group decisions. Study 2 (N = 108, 18 groups á 6 participants) used an experimental manipulation of group cohesion in a simple card choice task to investigate how group cohesion might affect group decision making when only limited social information is available. Study 3 (N = 96, 16 groups á 6 participants) experimentally manipulated group cohesion and used the HoneyComb paradigm, a movement-based group experiment platform, to investigate which group processes would emerge during decision making and how these processes would affect the relationships between group cohesion, exploration length, and group decision making. Study 1 found that multiplicative cohesion rewards have detrimental effects on group decision making, while additive group rewards could ameliorate negative effects of the cohesion reward, especially when reported separately from task rewards. Additionally, exploration length was found to profoundly affect decision quality. Studies 2 and 3 showed that groups could identify the best reward option successfully, regardless of group cohesion manipulation. This effect is interpreted as a ceiling effect as the decision task was likely too easy to solve. Study 3 identified that spatial group cohesion on the playing field correlated with self-reported entitativity and leader-/followership emerged spontaneously in most groups and correlated with self-reported perceptions of leader-/followership in the game. We discuss advantages of simulation studies, possible adaptations to the ε-greedy algorithm, and methodological aspects of measuring behavioral group cohesion and leadership to inform empirical studies investigating group decision making under uncertainty.

The Collective Trust Game: An Online Group Adaptation of the Trust Game Based on the HoneyComb Paradigm.

The need to understand trust in groups holistically has led to a surge in new approaches to measuring collective trust. However, this construct is often not fully captured in its emergent qualities by the available research methods. In this paper, the Collective Trust Game (CTG) is presented, a computer-based, multi-agent trust game based on the HoneyComb paradigm, which enables researchers to assess the emergence of collective trust. The CTG builds on previous research on interpersonal trust and adapts the widely known Trust Game to a group setting in the HoneyComb paradigm. Participants take on the role of either an investor or trustee; both roles can be played by groups. Initially, investors and trustees are endowed with a sum of money. Then, the investors need to decide how much, if any, of their endowment they want to send to the trustees. They communicate their tendencies as well as their final decision by moving back and forth on a playfield displaying possible investment amounts. At the end of their decision time, the amount the investors have agreed upon is multiplied and sent to the trustees. The trustees have to communicate how much of that investment, if any, they want to return to the investors. Again, they do so by moving on the playfield. This procedure is repeated for multiple rounds so that collective trust can emerge as a shared construct through repeated interactions. With this procedure, the CTG provides the opportunity to follow the emergence of collective trust in real time through the recording of movement data. The CTG is highly customizable to specific research questions and can be run as an online experiment with little, low cost equipment. This paper shows that the CTG combines the richness of group interaction data with the high internal validity and time-effectiveness of economic games.

Climate policy support as a tool to control others' (but not own) environmental behavior?

Drastic reductions in greenhouse gas emissions are necessary to successfully mitigate climate change. Individual environmental behavior is central to this change. Given that environmental behavior necessitates 1) effortful individual self-control and 2) cooperation by others, public policy may constitute an attractive instrument for regulating one's own as well as others' environmental behavior. Framing climate change mitigation as a cooperative self-control problem, we explore the incremental predictive power of self-control and beliefs surrounding others' cooperation beyond established predictors of policy support in study 1 using machine-learning (N = 610). In study 2, we systematically test and confirm the effects of self-control and beliefs surrounding others' cooperation (N = 270). Both studies showed that personal importance of climate change mitigation and perceived insufficiency of others' environmental behavior predict policy support, while there was no strong evidence for a negative association between own-self control success and policy support. These results emerge beyond the effects of established predictors, such as environmental attitudes and beliefs, risk perception (study 1), and social norms (study 2). Results are discussed in terms of leveraging policy as a behavioral enactment constraint to control others' but not own environmental behavior.

Effects of a Technical Solution on Stress of Surgical Staff in Operating Theatres.

BACKGROUND: Noise in operating theaters (OT) exceeds safety standards with detrimental effects on the health and performance of OT crews as well as patient safety. One of the reasons for these effects is the stress response to noise, which could be minimized by the Silent Operating Theater Optimisation System (SOTOS), a noise-reductive headset solution. METHODS: This study evaluates the effects of the SOTOS on the stress perceived by OT crew members, operationalized through stress level and exhaustion. Twenty-one heart surgeries and 32 robot-assisted prostatectomies at the University Medical Center Goettingen, Germany were examined. Twenty-six surgeries were conducted with and 27 without the SOTOS. The SOTOS-effect is defined as a more beneficial stress course from before to after surgery, when comparing the experimental group with and control group without SOTOS. FINDINGS: Eighty-one OT workers were investigated. The linear multilevel models revealed significant interactions between treatment and time of measurement on stress level (F[1, 406.66] = 3.62, p = 0.029) and exhaustion (F[1, 397.62] = 13.12, p = 0.00017). Nevertheless, there was no a significant main effect of surgery type on stress level (F[1, 82.69] = 1.00, p = 0.32) or on exhaustion (F[1, 80.61] = 0.58, p = 0.45). Additionally, no significant three-way interaction including surgery type, for stress level (F[1, 406.66] = 0.32, p = 0.29) or exhaustion (F[1, 397.62] = 0.03, p = 0.43), was found. INTERPRETATION: An SOTOS-effect was confirmed: the development of stress over the course of an operation was beneficially modified by the SOTOS. Both surgery types are perceived as similarly stressful, and the staff benefits equally strongly from the intervention in both settings.

How collective reward structure impedes group decision making: An experimental study using the HoneyComb paradigm.

This study investigates if and under which conditions humans are able to identify and follow the most advantageous leader who will them provide with the most resources. In an iterated economic game with the aim of earning monetary reward, 150 participants were asked to repeatedly choose one out of four leaders. Unbeknownst to participants, the leaders were computer-controlled and programmed to yield different expected payout values that participants had to infer from repeated interaction over 30 rounds. Additionally, participants were randomly assigned to one of three conditions: single, independent, or cohesion. The conditions were designed to investigate the ideal circumstances that lead to identifying the most advantageous leader: when participants are alone (single condition), in a group that lets individuals sample information about leaders independently (independent condition), or in a group that is rewarded for cohesive behavior (cohesion condition). Our results show that participants are generally able to identify the most advantageous leader. However, participants who were incentivized to act cohesively in a group were more likely to settle on a less advantageous leader. This suggests that cohesion might have a detrimental effect on group decision making. To test the validity of this finding, we explore possible explanations for this pattern, such as the length of exploration and exploitation phases, and present techniques to check for confounding factors in group experiments in order to identify or exclude them as alternative explanations. Finally, we show that the chosen reward structure of the game strongly affects the observed following behavior in the group and possibly occludes other effects. We conclude with a recommendation to carefully choose reward structures and evaluate possible alternative explanations in experimental group research that should further pursue the study of exploration/exploitation phases and the influence of group cohesion on group decision making as promising topics for further research.

The Silent Operation Theatre Optimisation System (SOTOS©) to reduce noise pollution during da Vinci robot-assisted laparoscopic radical prostatectomy.

To reduce noise pollution and consequently stress during robot-assisted laparoscopic radical prostatectomy (RALP) the aim of our study was to evaluate the silent operation theatre optimisation system (SOTOS) in its effectiveness. In the operating room (OR) the noise level is between 80 and 85 decibel (dB). Noise corresponds to a major stress factor for surgical teams and especially surgeons. The use of the da Vinci surgical system entails an additional aspect of noise in the OR. The SOTOS surgical team used wired or wireless headphone/microphone combinations to communicate. We measured sound pressure levels in two different locations in the OR and the heart rate of every surgical team member as an indicator of the stress level. We further captured subjective acceptance of SOTOS as well as perioperative data such as surgical time. We prospectively randomised 32 RALP patients into two study arms. Sixteen surgeries were performed using SOTOS and 16 without (control). Overall, the mean sound pressure level in the SOTOS group was 3.6 dB lower compared to the control (p < 0.001). The highest sound pressure level measured was 96 dB in the control group. Mean heart rates were 81.3 beats/min for surgeons and 90.8 beats/min for circulating nurses. SOTOS had no statistically significant effect on mean heart rates of the operating team. Subjective acceptance of SOTO was high. Our prospective evaluation of SOTOS in RALP could show a significant noise reduction in the OR and a high acceptance by the surgical stuff.

[Ethical decision-making in the face of increasing economization of hospitals : A study on ethical mistrust in decisions taken on the length of hospital stay among students and doctors]. / Ethische Entscheidungen in zunehmend ökonomisierten Krankenhäusern : Eine Untersuchung zum ethischen Misstrauen in Verweildauerentscheidungen bei Studierenden und ÄrztInnen unterschiedlicher Positionen.

Are medical values receding in importance because of economization of the German health system? Within the frame of a vignette study, a case is presented based on prolongation of the hospitalization of an elderly and not entirely recovered patient. All respondents of the questionnaire predicted the relevance of decision criteria, such as medical accuracy, empathy towards the patient, and identification with the hospital. Participants (N = 1,239) believe that decision-makers view medical accuracy as the most important criterion, followed by empathy. The more the respondent had universalistic values, the more likely the person was to favor an extended hospitalization. The more security-oriented and less pro-social the respondent, the more likely the person was to support an early discharge. It can be concluded that in the course of their training doctors acquire their grounded deontological-ethical decision-making autonomy, which may in some cases contradict existing regulations.

Laborious but Elaborate: The Benefits of Really Studying Team Dynamics.

In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.

The HoneyComb Paradigm for Research on Collective Human Behavior.

Collective human behavior such as group movement frequently shows surprising patterns and regularities, such as the emergence of leadership. Recent literature has revealed that these patterns, often visible at the global level of the group, are based on self-organized, individual behaviors that follow several simple local parameters. Understanding the dynamics of human collective behavior can help to improve coordination and leadership in group and crowd scenarios, such as identifying the ideal placement and number of emergency exits in buildings. In this article, we present the experimental paradigm HoneyComb, which can be used to systematically investigate conditions and effects of human collective behavior. This paradigm uses a computer-based multi-user platform, providing a setting that can be shaped and adapted to various types of research questions. Situational conditions (e.g., cost-benefit ratios for specific behavior, monetary incentives and resources, various degrees of uncertainty) can be set by experimenters, depending on the research question. Each participant's motions are recorded by the server as hexagonal coordinates with timestamps at an accuracy of 50 ms and with individual IDs. Thus, a metric can be defined on the playfield, and movement parameters (e.g., distances, velocity, clustering, etc.) of participants can be measured over time. Movement data can in turn be combined with non-computerized data from questionnaires garnered within the same experiment setup. The HoneyComb paradigm is paving the way for new types of human movement experiments. We demonstrate here that these experiments can render results with sufficient internal validity to meaningfully deepen our understanding of human collective behavior.

Competition in human groups-Impact on group cohesion, perceived stress and outcome satisfaction.

This study on competition in human groups was performed within the context of the competitive outcome interdependence concept: the degree to which personal outcomes among group members are affected by the consequences of task performance of others, e.g. when one group member gains a high reward for a task, this lowers the available reward for other group members. Our computer-based multi-participant game empirically assessed how competitive versus neutral conditions influenced the reward-maximising behaviour of 200 undergraduate students functioning in ten-person groups - each playing two games (1 neutral and 1 competitive), their perceived pay satisfaction as well as perceived stress levels and sense of calmness within the games' task to search for coins. Participants were represented by black dots moving on a virtual playground. Results showed that competition led to reward-maximising but fellow group member disadvantaging behaviour, and all participants experienced lower pay satisfaction, higher stress levels and less calmness. We conclude that short-term behavioural consequences of positive individual competitive behaviour were gained at the above-mentioned potential long-term negative costs for all group members. This implies group paradigms aimed at sustainability should avoid introducing competitive factors that at best result in short-lived gains and at worst cause widespread dissatisfaction, stress and a pervasive lack of calmness.

Effect of CRM team leader training on team performance and leadership behavior in simulated cardiac arrest scenarios: a prospective, randomized, controlled study.

BACKGROUND: Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization. METHODS: Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV). RESULTS: CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95% CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95% CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95% CI -0.2, -0.01), p = 0.023). CONCLUSION: Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.

Leadership in moving human groups.

How is movement of individuals coordinated as a group? This is a fundamental question of social behaviour, encompassing phenomena such as bird flocking, fish schooling, and the innumerable activities in human groups that require people to synchronise their actions. We have developed an experimental paradigm, the HoneyComb computer-based multi-client game, to empirically investigate human movement coordination and leadership. Using economic games as a model, we set monetary incentives to motivate players on a virtual playfield to reach goals via players' movements. We asked whether (I) humans coordinate their movements when information is limited to an individual group member's observation of adjacent group member motion, (II) whether an informed group minority can lead an uninformed group majority to the minority's goal, and if so, (III) how this minority exerts its influence. We showed that in a human group--on the basis of movement alone--a minority can successfully lead a majority. Minorities lead successfully when (a) their members choose similar initial steps towards their goal field and (b) they are among the first in the whole group to make a move. Using our approach, we empirically demonstrate that the rules of swarming behaviour apply to humans. Even complex human behaviour, such as leadership and directed group movement, follow simple rules that are based on visual perception of local movement.

Effects of team coordination during cardiopulmonary resuscitation: a systematic review of the literature.

PURPOSE: The purpose of this study is to identify and evaluate to what extent the literature on team coordination during cardiopulmonary resuscitation (CPR) empirically confirms its positive effect on clinically relevant medical outcome. MATERIAL AND METHODS: A systematic literature search in PubMed, MEDLINE, PsycINFO and CENTRAL databases was performed for articles published in the last 30 years. RESULTS: A total of 63 articles were included in the review. Planning, leadership, and communication as the three main interlinked coordination mechanisms were found to have effect on several CPR performance markers. A psychological theory-based integrative model was expanded upon to explain linkages between the three coordination mechanisms. CONCLUSIONS: Planning is an essential element of leadership behavior and is primarily accomplished by a designated team leader. Communication affects medical performance, serving as the vehicle for the transmission of information and directions between team members. Our findings also suggest teams providing CPR must continuously verbalize their coordination plan in order to effectively structure allocation of subtasks and optimize success.

Spontaneous flocking in human groups.

Flocking behaviour, as a type of self-organised collective behaviour, is described as the spatial formation of groups without global control and explicit inter-individual recruitment signals. It can be observed in many animals, such as bird flocks, shoals or herds of ungulates. Spatial attraction between humans as the central component of flocking behaviour has been simulated in a number of seminal models but it has not been detected experimentally in human groups so far. The two other sub-processes of this self-organised collective movement - collision avoidance and alignment - are excluded or held constant respectively in this study. We created a computer-based, multi-agent game where human players, represented as black dots, moved on a virtual playground. The participants were deprived of social cues about each other and could neither communicate verbally nor nonverbally. They played two games: (1) Single Game, where other players were invisible, and (2) Joint Game, where each player could see players' positions in a local radius around himself/herself. We found that individuals approached their neighbours spontaneously if their positions were visible, leading to less spatial dispersion of the whole group compared to moving alone. We conclude that human groups show the basic component of flocking behaviour without being explicitly instructed or rewarded to do so.

Positive impact of crisis resource management training on no-flow time and team member verbalisations during simulated cardiopulmonary resuscitation: a randomised controlled trial.

OBJECTIVES: To evaluate the impact of video-based interactive crisis resource management (CRM) training on no-flow time (NFT) and on proportions of team member verbalisations (TMV) during simulated cardiopulmonary resuscitation (CPR). Further, to investigate the link between team leader verbalisation accuracy and NFT. METHODS: The randomised controlled study was embedded in the obligatory advanced life support (ALS) course for final-year medical students. Students (176; 25.35±1.03 years, 63% female) were alphabetically assigned to 44 four-person teams that were then randomly (computer-generated) assigned to either CRM intervention (n=26), receiving interactive video-based CRM-training, or to control intervention (n=18), receiving an additional ALS-training. Primary outcomes were NFT and proportions of TMV, which were subdivided into eight categories: four team leader verbalisations (TLV) with different accuracy levels and four follower verbalisation categories (FV). Measurements were made of all groups administering simulated adult CPR. RESULTS: NFT rates were significantly lower in the CRM-training group (31.4±6.1% vs. 36.3±6.6%, p=0.014). Proportions of all TLV categories were higher in the CRM-training group (p<0.001). Differences in FV were only found for one category (unsolicited information) (p=0.012). The highest correlation with NFT was found for high accuracy TLV (direct orders) (p=0.06). CONCLUSIONS: The inclusion of CRM training in undergraduate medical education reduces NFT in simulated CPR and improves TLV proportions during simulated CPR. Further research will test how these results translate into clinical performance and patient outcome.