Labor & Delivery Crisis Resource Management Course
The Center for Medical Simulation
65 Landsdowne St., Cambridge, MA 02139; 617-768-8900
Patient safety is an integral component of healthcare and many efforts are underway to
reduce medical errors and the injuries and malpractice claims that result from them.
Obstetrical and surgical adverse events often involve failures of team performance. The
increasingly high cost of obstetrical malpractice claims has made patient safety and error
reduction priorities for loss prevention interventions, with a focus on interventions that
improve teamwork and communication.
Simulation based training has been used by Anesthesia, Emergency Medicine and
Neonatology for several years to refine teamwork and procedural skills. The Anesthesia
Departments of Harvard Medical School (HMS) has been working with the Center for
Medical Simulation (CMS) since 1994, teaching skills such as leadership,
communication, and resource and support management techniques necessary for effective
team performance during critical events. All Anesthesia faculty of Harvard-affiliated
hospitals actively participate in simulation-based training and receive malpractice
insurance premium discounts.
The Center for Medical Simulation and Risk Management Foundation of the Harvard
Medical Institutions (RMF) offers a Labor and Delivery Crisis Resource Management
(CRM) course specifically for Obstetrical nurses, Obstetricians, and Anesthesiologists.
This Labor and Delivery CRM course qualifies as one of the required elements that
RMF’s Controlled Risk Insurance Company (CRICO) insured Obstetricians must
complete to take advantage of a 10% per year discount of annual malpractice premiums
for three years. Full requirements that obstetricians need to qualify for rate reduction of
CRICO insurance premiums are available through RMF’s website at
The fee, payable by cash, check, or money order, for the Labor & Delivery course is:
CRICO Insured Obstetricians: $950;
Obstetrical nurses: $150
We apologize for any inconvenience, but we are unable to accept credit card payments.
Learning Teamwork and Crisis Resource Management for Labor and Delivery
Physicians and Nurses is an experiential six hour program focusing on event
management during simulated clinical practice. Participants include Obstetricians,
Obstetrical Nurses and Obstetrical Anesthesiologists who collaborate and work in teams
during simulated obstetrical events.
The Center for Medical Simulation (CMS) provides a realistic medical setting, equipped
with all the supplies and devices normally found in Labor and Delivery, where simulated
clinical scenarios and obstetrical procedures are conducted using computerized
mannequins and fetal heart rate simulator equipment. Some obstetrical procedures that
cannot be easily simulated will require the participant to play-act. Simulated events will
be videotaped so that teammates can view their performance in structured group
debriefings facilitated by trained CMS instructors. Practice and supportive feedback will
be provided to improve teamwork skills that can enhance error prevention, recognition
and management in actual clinical settings.
The course curriculum is derived from review of obstetrical claims data, consultation
with obstetrical leadership, experiences with Anesthesia CRM courses, and feedback
from L&D CRM programs that have been held over the past two years:
Labor & Delivery Crisis Resource Management
I. Factors degrading long-term vigilance in Labor & Delivery
A. Work overload.
C. Production pressures.
D. Fixation-sticking with mental models that seem rational but aren't.
E. Tolerance and accommodation.
II. Communication strategies
A. Sharing information with all team members.
B. Closed-loop communications.
C. Knowing your and your teammates roles, knowledge, skills and abilities.
D. Calling for help.
E. Assertiveness techniques.
III. Strategies for managing and disclosing medical errors
A. Being accountable as a team member.
B. Talking about error with your teammates.
C. Apologizing without assigning blame.
D. Talking about error with patients and their family members.
IV. Developing a culture of communication
C. Surgical Pause.