Evaluating the impact of operating room simulations on communication skills and patient safety (EIORS-CPS)

ABSTRACT Background: The WHO Surgical Safety Checklist is a cornerstone of perioperative safety, yet its effective implementation hinges on nontechnical skills like communication. High-fidelity simulation (HFS) is a promising tool for training these competencies. This study evaluated the impact of HFS on anesthesiology students’ perceptions of patient safety, specifically examining the mediating role of improved communication through the checklist. A convergent parallel mixed-methods study was conducted with 137 fourth-year medical students specializing in anesthesiology. Participants completed a SimMan3G-based operating room simulation centered on the WHO Checklist. Quantitative data from a postsimulation survey (Likert-scale items on realism, communication, and safety) were analyzed using descriptive statistics, Pearson correlation, and causal mediation analysis via Ordinary Least Squares regression. Qualitative feedback was analyzed thematically. Results: An overwhelming majority of students perceived the checklist as effective for improving communication (86.1%, Mean =4.3 / 5) and enhancing patient safety (85.4%, Mean =4.3 / 5). A strong correlation was found between communication and safety perceptions (r = 0.89, P < 0.001). Mediation analysis revealed a significant total effect of simulation realism on safety perception (β =0.52, P < 0.001). This effect was fully mediated by perceived improvement in communication (indirect effect: β =0.42, 95% Boot CI [0.31, 0.54]; direct effect: β =0.10, P = 0.118). Qualitative analysis reinforced this, identifying ‘Communication is Safety’ as a central theme. Conclusions: HFS using SimMan3G is highly effective in fostering a strong perceived culture of patient safety among anesthesiology students. This effect is primarily driven by the simulation’s ability to demonstrate that the WHO Checklist improves team communication, which students then link to enhanced safety. Educational efforts should maximize realism and explicitly articulate the communication-safety nexus.