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A comprehensive definition of simulation-based training incorporates “information, demonstration, and practice-based learning activities into a systematically designed and delivered a program of instruction.”[1]  Simulation-based medical training is a valid and effective strategy for teaching both technical and non-technical skills to individual providers and teams.[2][3][4][5] The Institute of Medicine (IOM) has promoted medical simulation for its ability to evaluate new technologies, enhance policies, and improve systems for the goal of improving patient safety.[6]  The IOM’s To Err is Human is frequently cited for its conclusion that medical errors are not a result of isolated individual actions but rather faulty systems, processes, and conditions that lead people to make mistakes.[7]  These reports have led to a greater examination of the systems approach to error management.  Research is evolving to examine how organizations and individuals can better approach medical error.  This review will discuss the systems approach for error management as it relates to a latent safety threat (LST), and the process of developing in situ simulation to expose LSTs and subsequently address medical error within organizations and teams.

Poor communication and teamwork inherently represent latent safety conditions. In situ simulation provides opportunities for the deliberate practice among teams and the opportunity for reflection on areas of improvement. Many validated scales are used to assess team performance for evaluation of in situ training.[27][28][26] Almost all the research evaluating in situ simulation report a positive impact on the non-technical skills of leadership, role clarity, decision-making, communication, and task management.[19][13][29][30] Studies also comment on the less tangible impacts of in situ simulation on organizations in the form of culture change. Frequent in situ simulation normalizes it as a training process and promote a culture of safety by engaging participants to identify LSTs as part of developmental team-based exercises.[18][19] The collaborative approach of in situ simulation can strengthen teamwork, and also empower healthcare providers to improve patient safety via a systems paradigm.