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Simulation-based training: the missing link to lastingly improved patient safety and health?
  1. Lukas P Mileder1,2,
  2. Georg M Schmölzer3,4
  1. 1Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
  2. 2Clinical Skills Center, Medical University of Graz, Graz, Austria
  3. 3Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada
  4. 4Department of Paediatrics, University of Alberta, Edmonton, Canada
  1. Correspondence to Dr Lukas P Mileder, Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 38/1, Graz 8036, Austria; lukas.mileder{at}medunigraz.at

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Introduction

Patient harm resulting from medical care is common, with 25.1 harms per 100 hospital admissions and 10.9% of harms being life threatening and causing or contributing to a patient's death.1 One study found at least 210 000 deaths of hospitalised patients to be associated with preventable harm per year.2 Factors contributing most frequently to patient safety incidents are active failures including cognitive and technical errors as well as deviations from policies, individual factors (eg, inexperience and stress), communication, equipment and supplies, and management of staff and staffing levels.3

As factors contributing to safety incidents are manifold, a multitude of strategies—involving the continuum from individuals to healthcare systems—has to be considered when aiming at improving the quality of healthcare and patient safety. A strategy certainly at the forefront of this process is active improvement of quality and effectiveness in medical education and training.4

Medical education has traditionally relied on on-the-job training. However, the often used ‘see one, do one, teach one’ approach may be detrimental to patient safety and health, as it exposes patients to inexperienced healthcare practitioners.5 In an effort to reduce human errors and improve operational safety, simulation-based training (SBT) has been recognised as an effective methodology.6 It is well documented that aviation, aerospace and nuclear power have developed a remarkable safety culture. Because of the profound safety awareness, these professions represent high-reliability industries and provide a ‘benchmark safety record for medicine to emulate’.7

In hindsight, first initiatives to implement SBT into medical education in the 1960s and 1970s have to be considered as pioneer work. From these initial efforts incorporated mainly by anaesthesiologists, the use of simulation—defined as ‘a technique to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully …

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