Published: 08/2025
When emergent medical situations occur, there can be several sources of error. These are often categorized as technical, environmental, and team-based. Technical errors stem from the incorrect performance of a skill. Environmental errors include equipment availability, malfunction, or other structural factors that impede optimal care. Lastly, team skills errors occur when a group of highly skilled individuals with adequate resources are unable to efficiently work together toward the desired outcome. Simulations and drills are common ways for medical teams to mitigate these sources of error.
Simulation and drills for technical skills are especially helpful for novice or out-of-practice providers. Both low-fidelity and high-fidelity simulators can be used. While downstream patient outcome data is sparce, simulation has been shown to improve individual surgical performance and reduce operating time.1
Example 1: A resident is preparing for their advanced gynecology rotation and would like to improve their laparoscopic skills. They perform a series of tasks on a laparoscopic trainer in the weeks leading up to the rotation. Immediately before surgery, they also spend 20 minutes warming up on the trainer before starting their first case. They notice their surgical evaluations improve and operating times decrease.
Environmental factors can also significantly impact team performance in emergencies. Simulation, especially when performed in-situ, can identify these improvement opportunities.
Example 2: The Emergency Department team at a local children’s hospital undergoes a birth simulation. During the drill, they identify equipment needs that are not met, specifically enough clamps on the delivery tray. Additionally, there is a lack of knowledge as to where the tray is located. After the simulation, the tray was re-designed, and an in-service was performed to ensure all providers and staff could find the tray with ease.
Even among highly skilled teams, communication and situational awareness can be suboptimal and lead to team-based errors. In many emergency scenarios, training and simulation as a team can improve outcomes.2,3
Example 3: A labor and delivery unit implements a new shoulder dystocia protocol. They ensure every team member participates in the initial training with continued drills every few months. After implementation, they see an improvement in the number of maneuvers required to resolve the dystocia.
Simulations and drills have been shown to significantly improve patient care outcomes in a variety of emergency scenarios. Programs should actively investigate for and mitigate potential sources of technical, environmental, and team-based error when implementing simulations. Effective simulation programs also ensure recurring training occurs to sustain improvements.
References
1. Orejuela FJ, Aschkenazi SO, Howard DL, et al. Gynecologic surgical skill acquisition through simulation with outcomes at the time of surgery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2022 Jul;227(1):29.e1-29.e24.
2. Birnbach DJ and Salas E. Can Medical Simulation and Team Training Reduce Errors in Labor and Delivery? Anesthesiol Clin 26 (2008): 159–168.
3. Preparing for Clinical Emergencies in Obstetrics and Gynecology. ACOG Committee Opinion 590. Published March 2014. Reaffirmed 2018.