Par 9 Page 13 types or behavioral styles, individual differences, and how they affect the way people perceive information and communicate with one another.
(3) How Will You Structure Your Presentation? Presentation material should be structured so each individual gains knowledge from the training. It has been found that individual learners have three sensory preferences for learning that must be considered when developing instructional material. Various personality types require different communication skills. These are:
(a) Visual learners prefer to see and observe,
(b) Auditory learners prefer to hear and listen, and
(c) Kinesthetic learners prefer to do rather than see or listen.
(4) How Will You Create Impact? Adults want training that focuses on real-life problems and tasks rather than academic material only. They should be given an opportunity for active participation in an instructional setting that is safe, welcoming, comfortable, and where they are permitted to be a contributor.
(5) How Will You Design and Display Visual Aids? Course media, used as aids in understanding the material, provides impact and must be relevant to the course content and the learning objectives that are to be achieved. Since media interacts directly with instructional methods, all instructional modules should include some type of live instructor/trainee interaction.
Audio-visual aids help keep attention/focus.
(6) How Will You Stage Your Presentation? The physical environment is important and should provide for a relaxed and comfortable setting that promotes interactivity.
b. Initial Indoctrination/Awareness.
(1) The initial indoctrination/awareness component of AMRM training consists of classroom presentations that focus on interpersonal relations, including team building and communication skills, and the coordination involved in the decision making process. Emphasis on learning to assert oneself and maintaining the situation should also be included. It further provides a common terminology and conceptual framework for identifying coordination problems. Initial indoctrination may be accomplished by a combination of methods including lectures, group discussions, interactive play, videos, and role-playing exercises. It is advantageous to have interactive participation of all air medical team members and any other members operating in their environment.
(2) Indoctrination/awareness training modules for experienced air medical team members are not the only way AMRM training components can be provided. AMRM concepts should be addressed in air medical team member’s initial qualification training for new team members (new hires).
(3) Curriculum development should continuously address AMRM skills that have been demonstrated to influence air medical team member performance.
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c. Recurrent Practice and Feedback. AMRM training should be included as a regular part of recurrent training. Recurrent AMRM training should include refresher practice and feedback exercises. Advanced AMRM components may be introduced as the air medical team grows and develops comprehensive use of AMRM principles. Recurrent training allows participants to practice newly improved skills in communication and interpersonal relationships and to receive feedback on their effectiveness. Feedback has its greatest impact when it comes by way of self-critique and peer review. Feedback in a debriefing environment should focus on “the action” not “the individual.” Guidance from a facilitator with special training in assessment and debriefing techniques completes an effective practice/feedback process.
d. Continuing Reinforcement. AMRM concepts should be carried into every other type of training including technical and interdepartmental training so that those concepts are reinforced continuously. Dissimilar groups should all be brought together for joint AMRM training. The objective is to improve the effectiveness and safety of the entire operations team (cross-pollination) as a working system. This is accomplished through:
(1) Technical Training. For example, initial and recurrent training, which includes:
(a) Simulation. Simulation training provides all team members a better opportunity to understand other team member’s responsibilities and job function. Simulations that could be used for training could include a mock air medical flight to emergency room staff and dispatchers or providing training on the helicopter emergency systems and procedures to the medical flightcrew members. This could be something as simple as how to turn off the battery or operate the radios in cases where the pilot was incapacitated and could not perform these functions. Pilots could receive training on the procedures for deactivating the medical equipment installed on board.
(b) Case Studies. Most medical personnel receive training on lessons learned from previous medical cases. For air ambulance crewmember accident training, accident reports from the National Transportation Safety Board (NTSB), Aviation Safety Reporting System (ASRS), and the National Aviation Safety Data Analysis Center (NASDAC) are great training aids to be used for determining how and why an accident happened and how to prevent a reoccurrence of the accident.
(2) Interdepartmental Training. For example, symposiums and seminars:
(a) Problem Solving. A problem solving method that could be used for resolution consists of four basic steps. First, find out what the problem is and determine if you have seen a similar problem before. Second, determine what strategies are available then choose one that seems as if it will work. Third, solve it by using the strategy you selected and work the problem.
Fourth, look back and reread the question, did you answer the question, is your solution correct, and does it seem reasonable.
(b) Stress Awareness. Stress is individual, variable, and cumulative. When stress exceeds our capacity to resist or cope, there is likely to be a collapse. Identifying the causes of stress is of the utmost importance. Causes could include lifestyle stressors, mind stressors, body stressors, work stressors, and change stressors.
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(c) Role Reversal. In order to better understand the other team member’s position, their real needs must be understood. This can easily be accomplished by understanding:
1. What is the value or sense of the other position?
2. What might the other team member want or need?
3. How are our needs/interests the same?
4. What can I do to focus on our areas of agreement?
5. What can I do to meet their needs?
(d) Inquiry/Advocacy/Assertion. Training in the potential benefits of team members’ advocating the course of action that they feel is best, even though it may involve conflict with others. This can be accomplished by confronting complex and diverse issues by stimulating reflective thinking and increased awareness. There is a need to tap the insights of others to motivate fresh thinking by empowering others. Sticking with a topic longer could lead to a broader understanding of underlying problems by evoking more questions with a deeper meaning.
(e) Conflict Resolution. Conflict is healthy when effectively managed and viewed as an opportunity for discussion and managing problems, which are inevitable in human relations.
Quality of decision making can be improved by allowing all points of view to be examined.
Steps to managing team conflict are:
1. Clarify the issues,
2. Set goals for resolution,
3. Consider options,
4. Remove barriers,
5. Make agreements, and
6. Acknowledge the solutions.
NOTE: Effective AMRM skills are not gained by passively listening to classroom lectures but by active participation and recurrent practice.
10. THE CRITICAL ROLE OF THE DEVELOPER/FACILITATOR. The effectiveness of any training curriculum is directly related to the expertise of the developers and facilitators.
Ideally, developers and facilitators should be current, qualified members of the air medical team who have additional training in the following AMRM topics:
• Listening and communicating.
• Role-playing, simulations, and group discussions.
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• Team building.
• Debriefing and feedback.
11. ASSESMENT IN AMRM TRAINING PROGRAMS. AMRM is a dynamic process that works most effectively when it is continually assessed to determine if the training is achieving its goals. Each organization should have a systematic assessment process that tracks the effects of the training program so that critical topics for recurrent training may be identified and continuous improvements may be made in all other respects. Experience has shown that AMRM training works most effectively if it is continually refreshed by subject matter that is timely, relevant, and usable. Assessment of the training program should include observation and feedback by program administrators and self-reports by participants using standard survey methods.
Developers/facilitators should use every available opportunity to highlight the importance of AMRM skills and techniques. One of the best learning opportunities occurs when air medical team members examine their own behavior and performance with the assistance of a trained facilitator. The facilitator points out both positive and negative aspects of AMRM performance.
Whenever highly effective performance is observed, it is vital that the underlying behaviors are discussed and reinforced.
a. The emphasis in this assessment process should be on all team members’ performance.
The essential areas of AMRM-related assessment include communications, decision-making, team building and maintenance, workload management, and situational awareness, always in balance with traditional technical proficiency. An additional assessment is to determine the impact of the AMRM training on organization-wide trends in team member performance.
b. For optimal assessment, data on team members’ attitudes and behavior should be collected before AMRM indoctrination and again at intervals after the last component of AMRM training, to determine both initial and enduring effects of the program. The goal should be to obtain an accurate picture of the organization’s significant corporate personality traits before formal adoption of AMRM training and to continue to monitor those traits after implementation.
c. Reinforcement and feedback are essential to effective AMRM training. Team members must receive continual reinforcement to sustain AMRM concepts. Effective reinforcement depends upon usable feedback to crewmembers on their AMRM practices and on their job function performance.
d. Usable feedback requires constant assessment. Team members and those involved in training and evaluation should be able to recognize effective and ineffective AMRM behaviors.
AMRM concepts should be critiqued during the briefing and debriefing phases of all training and checking events.
e. Summarizing the assessment process should include measurement and tracking of the organization’s corporate culture as it is reflected in attitudes and operational norms, identifying topics needing emphasis within the AMRM program, and ensuring that all team members are well prepared and standardized.
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12. SUMMARY. More and more operators in the air medical community are discovering the value of extending resource management training across organizational lines of business.
Effective AMRM begins with training the trainers. It is implemented through initial training and strengthened by recurrent practice and feedback. Each and every person on the air medical team is a resource to the air medical community. All operators and programs engaged in the provision of AMS are encouraged to include all middle and upper-level managers as well as all support staff in their training. It is sustained by annual continuous reinforcement that is part of the corporate culture and embedded in every element of the air medical team’s training. Their objective is to improve the effectiveness of all the groups within the operator’s team.
ORIGINAL SIGNED BY /s/ James J. Ballough Director, Flight Standards Service