At a hospital in Seattle, a newly graduated OB/GYN faced an emergency that would challenge the most seasoned clinicians. Her patient suffered a uterine rupture that rapidly escalated into a postpartum hemorrhage and disseminated intravascular coagulation, leading to cardiac arrest. She knew she had just seconds to act to save mother and baby.
Fortunately, even though she had only been practicing independently for one week, she had seen this scenario before – in a simulation-based training (SBT) session led by Lisbeth McKinnon, MD.
“She literally used those skills from that course,” said Dr. McKinnon, simulation director for Ob Hospitalist Group (OBHG), who told the story during a webinar she co-hosted with OBHG Senior Quality Improvement Specialist Leah Hanson, MSN, RN, a few days later. “She identified the rhythm, performed CPR and managed the hemorrhage.”
Supported by an experienced hospitalist at the bedside, the new OB/GYN and her team quickly stabilized the patient. Six days later, the mother was on her way home with a healthy newborn.
Incidents like these prove the value of SBT for Dr. McKinnon, who, with Hanson, is developing and leading virtual emergency simulations around the country.
“This shows how the ripple effect of our care as hospitalists can impact patients we serve and how simulation training can have a significant impact,” she said.
Simulation is foundational to OB care
Obstetric emergencies are notoriously among the most complex situations in medicine. They’re unpredictable and sudden, requiring multiple clinicians to make simultaneous decisions under intense pressure.
The stakes are especially high in the United States, where maternal mortality is higher than in other high-income countries. In 2022, there were 22.3 maternal deaths for every 100,000 live births in the U.S. Among minority mothers, the rates are even higher.
Before around 2010, structured simulation-based training was considered optional. Today, it’s embedded in many residency programs and continuing education requirements. Accrediting bodies like the American College of Obstetricians and Gynecologists and the Accreditation Council for Graduate Medical Education increasingly link simulation to competency, patient safety and institutional accountability.
“We’re really seeing that this is here to stay,” said Dr. McKinnon. “It’s evolving and expanding.”
And it’s making a measurable difference, she added. In a systematic review of eight studies published between 2014 and 2023 (covering more than 177,000 deliveries) that examined the impact of SBT on maternal and neonatal outcomes, researchers found a significant reduction in adverse outcomes, including postpartum hemorrhage requiring transfusion and neonatal Apgar scores.
Building ‘muscle memory’ for high-risk events
Rare events – like the uterine rupture the new OB/GYN encountered in Seattle – are often the most serious, making it all the more critical that every clinician be prepared for anything, said Dr. McKinnon.
“It’s important to expose ourselves to high-risk scenarios that are infrequently encountered in real life,” she said. “[SBT is] a safe environment to rehearse. There’s no patient harm, no judgment.”
For her part, Hanson saw the benefits of SBT firsthand as a nurse educator at her previous employer’s hospital. A drill she ran on amniotic fluid embolism later helped a physician and nurse take quick action to save the patient’s life.
“That muscle memory of going through the motions for something you hope to never see in your life is really beneficial if you do actually encounter it,” said Hanson – especially for clinicians who cannot afford to hesitate.
Stress-testing systems and communication
It’s far better to uncover problems during a simulation before they show up in a real emergency, as Hanson observed during another drill she ran, this one focusing on an eclamptic seizure.
“We identified that there was a knowledge gap,” she said. “The nurses didn’t know that you could give intramuscular (IM) magnesium, even though it was part of our protocol, and they didn’t know how to administer it.”
That drill also uncovered a systemic gap: The necessary magnesium formulation wasn’t even available in the clinic’s Pyxis medication dispensing system.
“[SBT] could uncover a variety of different things, like missing equipment, unclear protocols or confusion about processes,” said Hanson. “It brings all these things to light and helps you address them before they impact a patient.”
Simulation drills can also reinforce teamwork and communication, helping clinicians function better together under stress and avoid a common obstacle to positive outcomes, Hanson noted.
“We know from the Joint Commission root cause analysis of sentinel events that the number one contributor to adverse events in healthcare is communication failure,” she said. “In those moments, how we communicate translates into the quality of care that the patient receives.
Simulation allows teams to practice:
- Assigning roles in real time
- Establishing clear leadership
- Using structured communication tools
- Maintaining clarity in chaotic environments
Simulations can reveal:
- Missing medications or equipment
- Unclear protocols
- Delays in escalation
- Knowledge gaps across roles
Hospitalists championing readiness
As simulation becomes more embedded in OB care, hospitalists – clinical experts in emergencies who have a continuous presence on the unit – are well positioned to lead them, said McKinnon.
“We are frontline educators and the first ones there,” she said. “We are the champions of standardization, protocols and quality improvement.”
Making simulations virtual, scalable and available
As more hospitals nationwide adopt SBT, standardizing simulations to reflect best practices will be crucial to improving patient outcomes. Virtual platforms can reinforce these best practices widely, particularly in rural and resource-limited settings in need of accessible, scalable and cost-effective SBT solutions.
OBHG is leading the way, focusing on expanding access to standardized simulation-based training through virtual simulations.
A typical virtual simulation would consist of:
- Pre-work/didactic phase: Learners complete online modules or readings beforehand, covering core knowledge related to the scenario.
- Filmed video scenario: Participants watch a recorded scenario, such as a case of postpartum hemorrhage, severe hypertension or cardiac arrest.
- Facilitated virtual session: As participants collectively view the scenario, facilitators intentionally pause at key moments to ask clinical and teamwork questions about the diagnosis, next steps and communication. The interruption points encourage reflection, discussion and collaborative decision-making.
- Teamwide participation: These simulations bring together a broad cross-section of disciplines, including OB/GYN physicians, midwives, nurses, emergency department staff, anesthesiologists, NICU providers, OR technicians and even unit coordinators.
- Learning culture: Participants must feel safe making “wrong” choices, asking for help and discussing alternative strategies. The simulation is a learning space and not a judgment zone.
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