Developing a high-fidelity trauma surgery simulation to enhance team performance: Lessons learned from a complex implementation

BACKGROUND: Effective trauma care depends on technical proficiency and teamwork under pressure. While simulation has become integral to trauma education, few reports detail the methodological processes and lessons learned from developing highly complex operative simulations designed to both assess and improve team performance. METHODS: We developed and implemented a high-fidelity trauma surgery simulation to evaluate multidisciplinary intraoperative team performance. Twenty-two surgical teams-each composed of an attending surgeon, resident, anesthesiologist, circulating nurse, and scrub technician-completed two trauma scenarios requiring surgical intervention for a patient presenting in hemorrhagic shock: Scenario 1-liver/iliac injuries; Scenario 2-kidney/spleen injuries. Scenario development incorporated multidisciplinary perspectives, high-fidelity simulators, and iterative pilot testing. A dual-layer performance framework was created to operationalize measurement of taskwork and teamwork, using time-stamped video analysis and validated postsimulation surveys assessing teamwork, psychological safety, and shared mental models. RESULTS: Through iterative refinement, rater calibration, and multidisciplinary collaboration, the team established a feasible framework for delivering complex, realistic, surgical trauma team simulations. Challenges and lessons learned are described. CONCLUSIONS: This methods paper outlines the development and execution of a high-fidelity trauma surgery simulation aimed at enhancing operative team readiness. Lessons learned underscore the importance of deliberate scenario design, planning, and multidisciplinary coordination to optimize outcomes. The framework described provides a reproducible model for institutions seeking to implement simulation-based trauma training and performance assessment programs. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level IV.