CREW RESOURCE MANAGEMENT (CRM): WHAT AVIATION
CAN LEARN FROM THE APPLICATION OF CRM IN OTHER
Camilo Jimenez Karissa Kasper Javier Rivera Andrew B. Talone Florian Jentsch
Institute for Simulation and Training, University of Central Florida
Crew Resource Management (CRM) was implemented into the aviation training curriculum over three
decades ago in an effort to optimize flight deck management, safety, and improve flightcrew team
performance. Since the mid-1990s, other industries have shown considerable interest in adapting and
implementing CRM training to train their personnel in non-technical skills. This paper reviews the
implementation of CRM in healthcare, the military, and the maritime industry. A comparison of different
training methods and training assessment techniques, as well as gaps in the assessment of CRM training
effectiveness are discussed. Lastly, a discussion of CRM training techniques and evaluation methods
developed in other industries are presented for the consideration of the aviation community.
Crew Resource Management (CRM) is a method that has
been used now for over 35 years to train pilots in the non-
technical skills desired in flightcrews for the safe operation of
an aircraft. The need to train pilots on non-technical skills
originated from an analysis of accidents and incidents which,
among other factors, showed that the advancements in
aerospace technology resulted in an increase of flight deck
complexity. As aircraft complexity increased, the importance
of the interactions among and between crewmembers
increased as well, and the aviation community was challenged
by the rising number of accidents related to poor team
coordination and decision-making. Crew coordination and
decision making thus became the focus of organizations such
as the National Aeronautics and Space Administration
(NASA), the Federal Aviation Administration (FAA), and
major air carriers in the US.
In 1979, NASA conducted a study to examine the causes
of accidents that were not related to technical or engineering
issues (Cooper, White, & Lauber, 1980). The study showed
that 66% of air transport, 79% of commuter, and 88% of
general aviation (GA) accidents were related to poor decision-
making, loss or degradation of situation awareness, and lack of
leadership. These statistics prompted air carriers and aviation
authorities to develop and implement training programs to
help pilots develop better leadership, communication, and
group decision-making skills, and to teach pilots strategies to
identify and mitigate threats. The first programs were
implemented by US carriers in the 1980s, and shortly after,
other air carriers in Europe and then in the rest of the world
followed. Initially, the program was named Cockpit Resource
Management, but later, it was acknowledged that the
principles applied not only to pilots and flight engineers but
the entire crew, and Cockpit Resource Management evolved
into what became known as Crew Resource Management
(CRM). Today, CRM involves not only all flight crew
members, but also air traffic controllers (ATCs), dispatchers,
flight attendants, and maintenance personnel (Helmreich,
Merritt, & Wilhelm, 1999). Finally, CRM transitioned from
the aviation community to other fields, such as healthcare, the
military, and the maritime industry.
The purpose of the study reported here was to examine
the current state of CRM in the fields of healthcare, the
military, and maritime operations. As part of the process, it
was important to identify similarities and differences between
aviation and other industries in CRM training and training
effectiveness assessment. This approach allowed for, not only
the identification of similarities and differences among
industries, but also, existing gaps in training and assessment
generally found across industries.
We first conducted a review of the CRM literature that
covered the period of 1999-2014. The review included peer-
reviewed research papers as well as technical reports, and best
practice guides by national and international regulatory
agencies. The search included the term aviation CRM and also
terms derived from CRM, such as crisis resource management,
bridge resource management (BRM), and maritime resource
management (MRM). In total, 226 sources were reviewed and
classified by industry. Information related to training
techniques, effectiveness of training assessment methods, and
history of CRM implementation was then used to classify each
source. The information from industries other than aviation
was then compared against current CRM practices in aviation,
in order to identify techniques and methods applied in other
industries that are not currently used in aviation.
An overview of the state-of-the-art CRM practices in
aviation is shown in this section in order to understand how
other industries’ approaches differentiate from methods and
techniques currently used in aviation.
CRM in Aviation
In aviation, topics covered during CRM training usually
include communication processes, judgment and decision
making and behavior, and team building and maintenance.
Some methods suggested by the FAA (2004) to deliver
training include readings, lectures, role-plays, case studies,
Proceedings of the Human Factors and Ergonomics Society 59th Annual Meeting - 2015 946
Not subject to U.S. copyright restrictions. DOI 10.1177/1541931215591274
and simulations. Several aviation regulatory agencies across
the world (e.g., International Civil Aviation Organization
[ICAO], Civil Aviation Authority [CAA]) take a similar
approach in suggesting CRM training methods and topics,
rather than creating strict regulations for CRM training.
CRM training length, intervals, and topics. The length of
training and the intervals between training sessions vary
greatly. O’Connor et al. (2008) pointed out, for example, that
initial training usually lasts between two and three days,
whereas refresher training ranges from a few hours to one day.
During typical refresher training, not all topics are covered,
and only a few of them are covered in the course of each
refresher session. Refresher training is usually part of a large
training syllabus that also contains many topics related to
technical, or “stick and rudder,” skills. The reason that
regulatory entities refrain from implementing strict regulations
is typically that air carriers need flexibility to develop
programs that best fit their operations, aircraft, and standard
operation procedures (CAA, 2003).
CRM evaluation. The evaluation of CRM training is
usually done by assessing training at the first two levels of
Kirkpatrick’s (1976) (see Table 1) four-level model of training
evaluation. These levels involve (a) attitudes towards CRM
(first level) concepts and value of CRM training (the most
common evaluation method), and (b) knowledge tests (second
level). Where possible, CRM training is also assessed as part
of job-related simulations (e.g., via Line-Operational
Simulations [LOS] in a Flight Simulator). Although LOS
assesses not just knowledge, but also behavior, the assessment
is still done in a training environment. LOS thus cannot assess
what the trainees “typically” do in the operational setting;
therefore, LOS assessments fall somewhere between Levels 2
and 3 of Kirkpatrick’s (1976) framework. LOS assessments
are therefore augmented with line checks conducted by senior
pilots and line safety audits conducted during actual flights.
Kirkpatrick’s Training Evaluation Hierarchy (after Kirkpatrick,
Hierarchy Level Description
Level 1: Reactions Participants’ reactions to training
Level 2: Learning Knowledge gained from training
Level 3: Behavior Change Application of knowledge to operational
Level 4: Organizational Impact Evidence of training influence on the
organization (e.g., increased safety)
Tools such as NOTECHS were developed to standardize the
evaluation of flight crews CRM skills across European air
carriers. Another popular tool to evaluate flight crews’
attitudes towards CRM is the cockpit management attitudes
questionnaire (CMAQ) (O’Connor, 2008). CMAQ is a 25-
item scale that measure attitudes related to CRM at the
conceptual or empirical level. The purpose of CMAQ is to
provide an objective evaluation of crewmembers attitudes pre
and post training and identify CRM topics that need further
reinforcement (Gregorich, Helmreich, & Wilhelm, 1990).
CRM in Healthcare
CRM began the transition from aviation to healthcare
through the subfield of anesthesia in the early 1990s.
Originators initially renamed CRM to Anesthesia Crisis
Resource Management (ACRM), to better relate to the field of
anesthesia (Gaba, Howard, Fish, Smith, & Sowb, 2001).
A number of similarities exist between the domains of
aviation and healthcare. The main objective in both domains
is to increase safety by providing effective training approaches
to optimize performance. The utilization of a team concept is
also common in both domains. For example, in aviation, the
team consists of the flightcrew, flight attendants, and air traffic
controllers. In healthcare, doctors, nurses, anesthesiologists,
and assistants form part of a cohesive unit. Therefore, the
topics of improving teamwork and communication are
paramount within the CRM training provided in both domains.
CRM training topics such as briefing/debriefing, leadership
and followership, and situational awareness in healthcare are
similar to those in aviation CRM (Doucette, 2006; Hunt &
Callaghan, 2008; Leonard, Graham, & Bonacum, 2004).
Training aspects such as length, who is involved, topics
discussed, intended goals, and assessment measures appear to
be inconsistent in healthcare. For instance, CRM training
programs may last as little as an hour to as long as a few days
(Gaba et al., 2001; Guerlain, Turrentine, Bauer, Calland, &
Adams, 2008). Most healthcare CRM training sessions seem
to include a lecture portion, and some include a simulation
portion. The simulation aspect is predominant in the majority
of the studies we considered for review, and has been shown
to be accepted and beneficial by healthcare professionals
(Blum et al., 2004; France et al., 2005). Simulations usually
involve using differing levels of technologically advanced
mannequins to role-play a pre-determined crisis scenario,
while practicing the skills learned during the lecture portion of
training. Typically, the role-playing is done in groups and
includes a debriefing session with senior physicians. Of the
reviewed studies, the majority of participants preferred to take
part in more simulation training and role-playing exercises.
While most of the reviewed studies surveyed trainees
immediately following completion of the CRM training,
several studies have evaluated training using longitudinal
methods. Nine out of the 28 studies considered produced
longitudinal results based on the percentages of errors that
occurred before and after the training, as well as changes in
behaviors. For example, in Awad et al. (2005), participants
attended a training session that included both a lecture and a
role-playing session about the CRM concept of effective
communication through the means of briefing. Upon re-
evaluation, the experimenters found that there was a 64%
increase in preoperative briefings one month after CRM
training, and an increase of 100% four months after.
Clay-Williams, Greenfield, Stone, and Braithwaite (2014)
found that the typical full day training session for CRM did
not fit well with the 12-hour rotating shift schedule that
healthcare workers typically have. To work around this, the
researchers created a modular training based on two sets of
two-hour workshops in which participants could self-schedule
and complete the modules they felt were relevant to their work
Proceedings of the Human Factors and Ergonomics Society 59th Annual Meeting - 2015 947
environment on their own time. Overall, participants found the
modules to be educational (Clay-Williams et al., 2014).
CRM in the Military
Literature describing the implementation of CRM within
the military domain tends to be focused on military aviation or
healthcare, with a few sources also describing team training in
other parts of the military, such as shipboard crews (see also
“CRM in the Maritime Industry” below). There is no
information within the public domain concerning how CRM
has been applied to other areas within the military (e.g.,
ground-based combat teams). Despite this, useful CRM
insights and applications can be derived from literature
describing team research within the military domain.
Recent research has focused on expanding upon related
CRM characteristics in military training. Briefing and
debriefing have been found to improve work dynamics and
communication within military health operations (Vashdi,
Bamberger, Erez, & Weiss-Melik, 2007). Briefing helps
ensure that goals, roles, etc. are established beforehand while
debriefing is useful for assessing areas in need of
improvement. Dalenberg, Vogelaar, and Beersma, (2009)
found that teams who were instructed to spend 10 minutes
developing a strategy (prior to beginning a mission) developed
a better shared mental model, had more productive team
behaviors, were more coordinated, and had better performance
in comparison to teams that were given no instruction.
MacMillan, Entin, Morley, and Bennett (2013) developed
the Scenario-based Performance Observation Tool for
Learning In Team Environments (SPOTLITE) method as a
potential military tool to measure teams in complex
environments. Using teams of US Air Force (USAF) F-16
pilots, MacMillan et al. assessed the SPOTLITE method in
terms of sensitivity, reliability, and validity. They found that it
was a reliable and valid measure of team performance. One
benefit of using this method is that observers can rate
individual and team performance in real-time. This allows the
observers to provide diagnostic feedback that identifies
performance detriments specific to a mission phase (e.g.,
performance while engaging enemy aircraft) or type of action
(e.g., performance while maneuvering the aircraft). By using
the SPOTLITE method, observers can give individual team
members positive or negative “check marks” for performance
that is significantly above or below the rest of the team.
Alonso et al. (2006) developed the Team Strategies and
Tools to Enhance Performance and Patient Safety
(TeamSTEPPS) program to be used within the military
domain by healthcare personnel. TeamSTEPPS was created to
serve as a standardized program that all healthcare military
personnel can take to enhance their ability to work effectively
within a healthcare team. The course consists of a 45-minute
introductory module followed by four modules that focus on a
major teamwork skill (e.g., leadership, situation monitoring,
mutual support, or communication). Methods used during
training include: question-and-answer sessions, role-play
exercises, and videos demonstrating desired behaviors for
each of these skills.
One unique aspect of TeamSTEPPS is that a three-phase
process is used to implement the training program. The first
phase involves analysis of the site to be used and the staff to
be trained. The second phase involves a three-day train-the-
trainer program that all future on-site trainers must complete.
The final phase involves continued post-training support of
leadership and the head trainers. The TeamSTEPPS training
program also includes multiple measures of training
evaluation. Reactions are measured both before and after
training while knowledge is measured immediately after
training and once every 3 months following completion of the
training. Coaches are responsible for evaluating whether there
have been any changes in behavior. This form of evaluation is
conducted by using a behavioral observation checklist. It is the
goal of the TeamSTEPPS program to also evaluate whether
the training reduces errors; however, this has proven to be
difficult given that it is rare for people to report “near misses”
or errors unless they are major. TeamSTEPPS measures
training effectiveness at all four levels of Kirkpatrick’s Four-
Level Model of training evaluation (Kirkpatrick, 1976).
CRM in the Maritime Industry
The maritime industry began to show interest in CRM
principles, in part, because of major shipping accidents that
involved the ineffective use of non-technical skills (Barnett,
Gatfield, & Pekcan, 2003). The Scandinavian Airlines System
(SAS) Flight Academy, The Swedish Club (a mutual maritime
insurance company), and six other major maritime
organizations came together in 1993 to develop a Bridge
Resource Management (BRM) training course that could help
reduce accidents caused by poor team coordination/decision
making (The Swedish Club Academy, n.d.). In 2003, those
organizations responsible for BRM training delivery decided
to rebrand the courses to what they called Maritime Resource
Management (MRM). MRM training requirements were
recently revised in the form of “The Manila amendments to
the STCW Convention and Code” (International Maritime
Organization, 2010). One of the major changes resulting from
these amendments is that MRM training is now mandatory
(The Swedish Club Academy, 2011). MRM training courses
today are provided by a number of different entities including
maritime universities and training centers (The Swedish Club
Academy, 2012). These courses are intended for ship officers,
engineers, maritime pilots, and shore-based personnel.
The Swedish Club Academy’s MRM course typically
lasts four days and includes computer-based training (CBT),
lectures, and workshops (The Swedish Club Academy, 2012).
The course consists of a maximum of 16 modules. Each
module includes one workshop that is preceded by CBT.
The effectiveness of MRM training is typically assessed
immediately following training by administering a subjective
questionnaire asking participants questions regarding their
perceived value of MRM training (ALL Academy, n.d.).
Empirical research assessing the effectiveness of
BRM/MRM courses is scarce. Byrdorf (1998) reported that
BRM training caused a substantial reduction in nautical
causalities as well as a 15% reduction in insurance premiums.
Fonne and Fredriksen (1995) found positive reactions and
Proceedings of the Human Factors and Ergonomics Society 59th Annual Meeting - 2015 948
positive attitude changes following a 2-day BRM training
course. Brun et al. (2000) evaluated a 3-day BRM training
course that covered the following topics: coping in critical
situations, communication and decision making, and
teamwork. The primary goal of this course was to increase
trainees’ shared mental models. Although the course received
positive reactions, no significant differences were found on a
shared mental models questionnaire.
Many training courses assess training effectiveness by
administering subjective questionnaires to assess trainees’
attitudes towards CRM topics. Röttger, Vetter, and Kowalski
(2012) created an adaption of the Crew Resource Management
Attitudes Questionnaire (CRMAQ; a measure used to assess
an individual’s CRM-related attitudes) called the Ship
Management Attitudes Questionnaire-German Navy (SMAQ-
GN). This measure was used to investigate the CRM-related
attitudes of two samples from the German Navy: one
consisting of over 100 active seafarers and the other consisting
of over 100 junior officers. The major goal of this study was to
replicate the finding that there is a positive correlation
between CRM-related attitudes and performance (Helmreich,
Foushee, Benson, & Russini, 1986). Röttger et al., however,
did not find a consistent positive correlation between attitudes
and behavior/performance. They found a negative correlation
between attitudes and performance for those with attitudinal
scores in the low to middle score range. In other words, low
attitudinal scores were associated with worse
behavior/performance and performance was higher for
individuals with scores in the middle score range.
Based on the review of the current state of CRM in other
domains, we concluded that aviation continues to be the point
of reference for other industries for the development and
application of CRM training. While industries, such as
healthcare, have actively developed and implemented CRM
training to best fit their needs, most of their methods and
techniques are derived from those first implemented by
aviation more than three decades ago. However, even though
aviation is at the forefront of the application of CRM across
industries, there are some lessons that can be learned from the
experience gained in this realm by other industries. Although
some of the training techniques used in aviation to train for
CRM non-technical skills include simulation sessions such as
line-oriented flight training (LOFT) and LOS, these simulation
exercises are currently primarily targeted to train flightcrews.
Specifically, LOFT is ideal to train for technical skills and
perhaps non-technical, but these exercises leave almost no
room for integrating other types of crews (e.g., cabin crews,
air traffic controllers, etc.) to allow for intergroup training. In
contrast, integrative CRM training is one of the aspects that
have been widely used in healthcare for the training of
surgical teams. As it was discussed in this paper, healthcare
personnel have shown a preference for integrative training, as
it resembles the interactions that healthcare professionals
usually find in their operational environment (Blum et al.,
2004; France et al., 2005). Another interesting strategy we
found in one of the research studies in healthcare CRM is the
use of modularized training. During modularized training
participants could self-schedule to accommodate training to
their work schedule (Clay-Williams et al, 2014). This
technique could be beneficial for flight and cabincrews
because of their non-conventional work schedules. One
difference between healthcare and aviation is that aviation
personnel are non-stationary. In order to account for this
factor, air carriers and CRM training administrators should
consider the use of CBT and e-learning to supplement CRM
refresher training sessions. Ritzman, Kluge, and Hagemann
(2011) surveyed pilots and asked them about their willingness
to use e-learning to receive training. The pilots answered
favorably; as this technology supports the needs of the modern
The military also embraced CRM training techniques that
were developed in aviation. Both aviation and the military
make extensive use of briefings and debriefings. Another
interesting finding of this review was that other fields have
developed their own training methods and assessment
techniques to measure CRM training effectiveness. In this
aspect, military healthcare developed TeamSTEPPS, which
centers on (a) the standardization of training for trainers and
(b) the assessment of training effectiveness by exploring all of
Kirkpatrick’s (1976) four-level model of training
effectiveness. Most of the studies reviewed for this study
explored Kirkpatrick’s levels one (attitude towards training)
and two (declarative knowledge of CRM concepts).
TeamSTEPPS assesses training effectiveness at all levels by
assessing trainees’ reactions (measured before and after
training) and knowledge (measured immediately after training
and once every 3 months after training). Coaches also evaluate
changes in behavior in the operational context by using
checklists. TeamSTEPPS also expects to evaluate
organizational impact by looking at error reduction; however,
this has been difficult given that it is rare for people to report
“near misses” or errors unless they are major.
In healthcare, some studies have explored training
effectiveness by implementing longitudinal observations.
Techniques used include tracking the percentages of errors
that occurred before and after the training as well as changes
in behaviors (see Awad et al. 2005).
One of the major points that can be highlighted from the
experiences of CRM implementation in the maritime domain
is the standardization of training. Aviation entities (both
governmental and private) may be more effective if they
agreed upon training methods and assessment techniques,
trainers’ certification, and the involvement of third parties that
provide CRM training services for air carriers and others
interested in improving non-technical skills.
One of the main gaps found across industries is the
difficulty assessing CRM training influence in the operational
context and its influence at the organizational level.
Evaluating aircrews’ attitudes towards CRM and knowledge
right after CRM training does not completely help to
understand the real impact that CRM training has on trainees.
Even though aviation has developed tools such as NOTECHS
and CMAQ, it’s important to develop and validate assessment
tools that help the aviation community understand how
Proceedings of the Human Factors and Ergonomics Society 59th Annual Meeting - 2015 949
training is being applied during line operations and its impact
on the organizational culture.
Future research should focus on assessing CRM training
at Kirkpatrick’s level three and four of his training evaluation
model. The aviation community should further evaluate how
the use of CBT and e-learning can benefit aircrews’
understanding and implementation of CRM concepts in line
operations. Future research should also focus on asking
aircrews about their training needs, preferences, and concerns.
All stakeholders in the aviation community should also look
into developing standardized CRM training effectiveness
assessment methods that go beyond surveying trainees about
their attitudes and knowledge right after training.
This research was supported by the FAA Human Factors
Division (ANG-C1) collaborative research agreement 14-G-
005. The views and opinions expressed in this paper are those
of the authors and do not necessarily represent those of the
Federal Aviation Administration (FAA) or of the institutions
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