Authors: Putnam E et al.
Anesthesiology 144(4):767–770, April 2026
Summary:
This article argues that simulation-based training in anesthesiology should not stop after residency but instead become a routine part of ongoing professional development. Despite strong evidence that simulation improves team performance, patient outcomes, and reduces malpractice risk, its use among practicing anesthesiologists remains limited.
The authors draw parallels between anesthesiology and other high-reliability industries such as aviation and nuclear power, where continuous simulation and crisis rehearsal are standard regardless of experience level. In contrast, anesthesiology largely abandons structured simulation training once clinicians complete residency, despite working in similarly high-risk, time-sensitive environments.
To address this gap, the authors propose a practical model for integrating simulation into routine clinical practice. Their approach includes aligning simulation sessions with subspecialty teams to ensure relevance, embedding training within existing quality improvement initiatives, and using real-world adverse events to design scenarios. This makes simulation directly applicable to daily practice rather than a theoretical exercise.
They also emphasize the importance of measuring value to sustain institutional support, including improvements in team communication, crisis management, and system-level deficiencies. A key component is fostering a culture of shared learning through regular sessions, multidisciplinary participation, and psychologically safe debriefing environments.
Barriers such as scheduling, cost, and perception of simulation as punitive are acknowledged, but the authors provide practical strategies to overcome them, including integrating simulation into clinical schedules and framing it as professional development rather than remediation.
Ultimately, the article calls on anesthesia leaders to prioritize simulation as a core component of lifelong learning and patient safety, rather than an optional or secondary activity.
Key Points:
- Simulation improves outcomes but is underutilized after residency
- Other high-risk industries use continuous simulation regardless of experience
- Integrating simulation with quality improvement makes it clinically relevant
- Team-based, multidisciplinary training enhances communication and performance
- Institutional support and culture change are critical for sustained adoption
What You Should Know:
We train for rare events early in our careers—and then stop. That makes no sense in a field where crises are infrequent but high stakes. Simulation shouldn’t be optional—it should be part of how we practice. The groups that embrace this will outperform those that don’t.
We would like to thank Anesthesiology for allowing us to summarize and share this article.