One of the challenges with simulation programs is how to measure their efficacy. Simulation training can be expensive to run, so it is important to understand the efficacy of these programs. Here we explore two peer-review studies that leverage medical professional liability (MPL) data to evaluate the benefits of investment in simulation training.

In recognition of Healthcare Simulation week (September 13–19, 2021) we are highlighting two studies that used medical malpractice data to evaluate the benefits and efficacy of health care simulation programs. One analysis evaluated malpractice rates for participating physicians pre- and post-simulation training in obstetrics. The other study looked at the efficacy as well as the cost-effectiveness of a simulation program designed to reduce cast-saw injuries.


A new study published in Obstetrics & Gynecology suggests that obstetrician-gynecologists simulation team training is an effective patient safety intervention. This study leveraged malpractice claim rates for physicians before and after participation in simulation training as its primary outcome measure.

“This study demonstrates how the use of malpractice data can provide rich insights when evaluating the effectiveness of patient safety programs.” Adam C. Schaffer, MD, MPH

When things go wrong in obstetrics-gynecology, in addition to the devastating harm, it can result in costly medical malpractice claims. Data in the Comparative Benchmarking System (Candello) show that, among closed cases with obstetrics-gynecology as the responsible service (2008–2020), 41.4% closed with payment with an average indemnity of $631,300.

Many hospitals and residency programs have implemented ob-gyn simulation training to help mitigate the risk of devastating adverse events that can occur during child birth. CRICO, the captive insurer of the Harvard medical institutions, has established a robust OB Patient Safety program, of which a component is simulation team training.

CRICO’s leadership and the clinical leaders at the insured hospitals have long believed that simulation training contributes to the delivery of safe care. Since 2001, CRICO has supported simulation training at Harvard medical institutions through premium reduction programs for anesthesia, OB (2004), and most recently, OR (2014). Given its deep commitment to simulation training as a risk mitigation strategy, CRICO set out to evaluate the effectiveness of simulation training by evaluating the OB simulation program.

Researchers from CRICO conducted a retrospective analysis to compare claims rates before and after simulation training among obstetrician-gynecologists. All of clinicians were insured by CRICO and attended simulation training between 2002 and 2019. Key findings include:

  • Malpractice claim rates were significantly lower post-simulation training (11.2 vs. 5.7 claims per 100 physician coverage years for the full study period)
  • Participation in more than one simulation session was associated with a greater reduction in claim rates

These favorable effects of simulation training on malpractice claims rates seen in this study should encourage the even wider adoption of simulation team training within obstetrics and gynecology.


In a study published in The Journal of Bone and Join Surgery, researchers from Boston Children’s Hospital endeavored to understand the return on investment of a simulation training program it had implemented to reduce cast-aw burns. While the hospital had data on simulation participation among its residents, it leveraged data from Candello to help determine the true cost of these injuries.

Researchers used hospital billing information to determine costs associated with additional care resulting from a cast-saw burn injury. To understand the complete financial repercussions, researchers also analyzed cases in Candello involving cast-saw burns from 2005 to 2014 that resulted in indemnity payouts and expenses. This provided a comprehensive estimation of the costs of this kind of injury.

Using this methodology, researchers were able to determine a return on investment for the simulation-based training.

"The anticipated savings from averted cast-saw injuries and associated medicolegal payments in the 2.5 years post-simulation was $27,131, representing an 11-to-1 return on investment." —Bae, Donald S., MD Bae, et al

The study concluded that simulation-based training for orthopedic surgical residents was effective in reducing cast-saw injuries and had a high theoretical return on investment.


As demonstrated by these two studies, researchers used medical malpractice data to evaluate the efficacy of two simulation training programs. The first study suggests that simulation training can be a tool to improve patient safety, while the second study determined a potential return on investment.

Interested in learning how you can leverage medical malpractice to make data-informed decisions about your patient safety programs? Contact us today.


Written By
Katy Schuler, MSc
Katy Schuler was the Marketing Manager for CRICO Strategies.
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