Simulation training has taken hold as a key method for safely teaching procedural proficiency. Prior studies have found simulation to be superior to traditional didactics in improving skills and behaviors. This systematic review focused specifically on whether the skill set obtained from simulation is transferable to the operating room. The study was restricted to randomized controlled trials involving novice surgical trainees. The findings demonstrate a positive impact on operating competence, but the metrics used in studies thus far have been limited. The authors advocate for more robust assessment of operative performance. A recent systematic review, published as part of the AHRQ Making Health Care Safer II report, also found evidence that simulation training improved procedural competence and patient care outcomes. An AHRQ WebM&M perspective by Dr. David Cook reviews the literature on health care simulation training.

This review recommends educating surgical trainees about error disclosure, teamwork, and non-technical skills to augment their ability to cope and learn from medical errors.

Standardized feedback resulted in lower error rates for surgery residents completing simulated laparoscopic surgical procedures.

Unprofessional behavior by clinicians poses definite patient safety threats, but most research in this area has focused on identifying and addressing disruptive behavior in the work environment. This randomized study raises the concern that physician behaviors outside of work can impair work performance. Significant worsening of simulated surgical performance was found when subjects (students and attending physicians) drank alcohol until intoxication the night before performing procedures. The authors of this study recommend that consideration be given to establishing formal recommendations for alcohol consumption prior to operating room duties. Lack of sleep prior to performing surgery has also been associated with surgical complications, and in fact, intoxication and sleep deprivation have been shown to have similar detrimental effects on physicians' cognitive performance.

In this randomized trial, surgical residents who underwent simulation training were significantly less likely to commit technical errors during cholecystectomy than residents who received traditional training. A prior AHRQ WebM&M perspective discusses the growing role of simulation training in medical education.