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Practice : Fall 2008
the patient while providing a balance between independent thinking, responsibility, didactic education, and super vision for each phase of classroom and experiential learning. How does the individual at each of the levels of training--- medical school, internship, residency and fellowship---learn from peers and superiors, while teaching those at the levels below? Instruction is vertical; typically, residents, fellows and practicing physicians in multiple disciplines collaborate in the ongoing care of the patient. Dr. Fuller went on to describe key responsibilities of practitioners who teach future doctors. ese included providing increased opportunities to exercise independent judgment and supply constructive feedback, fostering critical thinking and the ability to anticipate the unexpected; and encouraging collaboration with peers in other disciplines. Effective Communication and Managing Risk in the Airlines Industry Crew Resource Management has been widely used to improve the operation of ight crews. e concept originated in in response to a NASA workshop that examined the role that human error plays in air crashes. CRM empha- sizes the role of human factors in high-stress, high-risk environments. It encompasses team training, as well as simulation, interactive group debrie ngs, and measure- ment and improvement of air crew performance. With more than years in aviation, spent teaching CRM courses around the globe, Norm Komich understands what it takes to muster e ective teamwork. "When collaboration breaks down and there is failure," Norm began, "more likely than not it has to do with serious gaps in commu- nication. You need only look at the wall of books at Borders to know that communication is not simply something that happens on its own. Time and again I have found that in order for e ective communica- tion to occur, it needs to be formally introduced and then reinforced on an almost constant basis until such time that it is imbedded in the culture as a normal, expected routine. What continues to surprise me is that being a good communicator is more an art than science." Aviation and medicine certainly have a great deal to learn from each other when it comes to managing risk. One could also argue that the AEC industry stands to learn from their example as well. "Flying in and of itself is calculated risk; risk is a normal aspect of everyday operations," said Komich. "We manage risk by creating a comprehensive checklist of factors that are likely to impact safety and clear communications between the crew and then try to anticipate and talk through steps that need to be taken to insure smooth operations. ese factors range from the weather, terrain or even fatigue that is likely to take hold. e keys are anticipa- tion, communication and careful planning." "Once you have become used to managing risk, you are able to make the required changes in behavior that are most likely to produce good outcomes." Becoming a Team Player " e 'one rm' business structure goes a long way in keeping everyone's mission and agenda with the same focus and purpose, working not competitively on an individual level Regardless of where you turn, here at the BAC or at almost any design rm within Boston, everyone is being asked to focus on collaborating more e ectively. PRACTICE ] EFFECTIVE COLLABORATION PRACTICE 31