CRCIO is the organization that provides malpractice insurance for all Harvard-affiliated physicians and surgeons. In 2012 they sponsored the development of a series of CRM (Crisis Resource Management) based simulation courses for surgical attendings. Partaking in these courses (which is mandatory for ORL attendings) results in a reduction of malpractice premiums for attending surgeons who participate. The program has. a three-year cycle. Year one is a six-hour in situ OR simulation experience that involves ORL attendings, pediatric ORL fellows, anesthesia attendings and fellows/residents, and OR nurses. This is styled after the NOA simulations for residents and fellows. In year two, the ORL attendings, in conjunction with the anesthesiologist and OR nurses, participate in one hour "Safety Drills." These are rapid simulations and post-op debriefs that focus on a specific safety issue, such as intraoperative fires. During year number three, the ORL attendings participate in a 4-hour "Chairman's Choice" which is a series of simulations geared around a specific, ORL related event or communication problem.