Association of Simulation Training With Rates of Medical Malpractice Claims Among Obstetrician-Gynecologists

In the United States, adverse events occur in approximately 2% to 16% of deliveries. Root cause analysis and medical malpractice claims data point to issues in communication as the most common problem in these cases. Simulation training of highacuity events is becoming increasingly popular among residency training programs for improving surgical and teamwork skills. This retrospective analysis aimed to evaluate the association between team-training simulation with malpractice claim rate for OB-GYNs. The study included all OB-GYNs who were insured by a single malpractice carrier and participated in simulation training at the Center for Medical Simulation. The simulation course, held between 2002 and 2019, focused on team training and crisis management in a high-acuity obstetric setting with post-case-facilitated debriefings. The primary study outcome was malpractice claim rates, defined as any written request for compensation for medical injury due to negligence or formal lawsuits, for physicians before and after participation in the training. Malpractice claim rates were expressed as claims per 100 physician coverage years. Three periods were analyzed: the entire study period from 1976 to 2019, the 2 years presimulation and postsimulation training, and 1 year presimulation and postsimulation training. Secondary outcomes analyzed included the association of the number of simulation trainings attended with malpractice claim rates as well as a comparison between the periods before and after simulation training for financial metrics related to the indemnity paid, malpractice claim outcome, and severity of injury. A total of 292 physicians were included, with the majority (55.5%) attending a single simulation and 19.9% attending 3 or more simulations. When examining the entire study period, the rate of claims after simulation was significantly lower than before simulation (5.7 per 100 physician coverage years vs 11.2 per 100 physician coverage years, P < 0.001). When examining 2 years presimulation and postsimulation, the claims rate was likewise significantly lower postsimulation (5.4 per 100 physician coverage years vs 9.2 per 100 physician coverage years, P < 0.043). When examining 1 year presimulation and postsimulation, the difference in claim rate was not statistically significant. The relative risk reduction for the full study period, the 2-year period, and the 1-year period presimulation and postsimulation was 49.5%, 41.2%, and 40.5%, respectively. The postsimulation claim rate for physicians attending 3 or more trainings (1.3 per 100 physician coverage years) or 2 trainings (2.1 per 100 physician coverage years) was significantly lower than that of those attending 1 training (6.3 per 100 physician coverage years) ( P = 0.012). No significant difference in severity of injury, mean, or median indemnity payment amounts, or the percentage of claims resulting in an indemnity payment was observed before and after simulation training. The results of this study show an association between simulation training participation and a significant decrease in medical malpractice claims, warranting consideration of widespread expansion of simulation training in OB-GYN.