Integrating Technical and Nontechnical Skills Under Pressure: A Qualitative Observational Study of Obstetric On-Call Simulation

Introduction: Simulation is widely used in obstetric training; however, there is limited understanding of how early-stage trainees integrate technical and nontechnical skills under realistic clinical pressures. This study explored how early-stage trainees integrated technical and nontechnical skills while managing concurrent clinical demands during a simulated obstetric on-call shift. Methods: A qualitative observational study was conducted in a simulated labor ward during a regional training day. Fourteen obstetrics and gynecology trainees (years 1 to 2) participated in a 40-minute simulated on-call shift involving concurrent management of patients across multiple clinical areas, followed by a facilitated focus group discussion. Some participants were deliberately assigned roles with responsibilities beyond their actual training grade. Data were analyzed thematically, with triangulation across participant observation, field notes, movement-tracking diagrams, simulation transcripts, and focus group data. Results: Trainees completed familiar technical tasks, although some preparatory steps required prompting. Observed hesitation, requests for guidance, and reliance on prompting occurred during complex decision-making, obtaining consent for instrumental birth, and escalation of care. These behaviors occurred while some trainees were undertaking assigned roles with responsibilities beyond their training grade. Coordinated teamwork behaviors were observed alongside communication lapses and disrupted role allocation. Participants described the simulation environment as psychologically safe and valued the opportunity for experiential learning and reflection. Conclusions: The simulated obstetric on-call shift was practicable to deliver within a regional training day and was acceptable to participants as a learning activity. It provided a structured approach for observing the integration of technical and nontechnical skills during concurrent clinical demands. The findings describe behavior within assigned simulated roles and should not be interpreted as an assessment of competence or readiness at the participants’ actual training level.