Integrating technical and non-technical skills under pressure: a qualitative observational study of obstetric on-call simulation

Journal article

Introduction:
Simulation is widely used in obstetric training; however, there is limited understanding ofhow early-stage trainees integrate technical and non-technical skills under realistic clinicalpressures. This study explored how early-stage trainees integrated technical and non-technicalskills while managing concurrent clinical demands during a simulated obstetric on-call shift.
Methods:
A qualitative observational study was conducted in a simulated labour ward during a regionaltraining day. Fourteen obstetrics and gynaecology trainees (years 1-2) participated in a 40-minute simulated on-call shift involving concurrent management of patients across multipleclinical areas, followed by a facilitated focus group discussion. Some participants weredeliberately assigned roles with responsibilities beyond their actual training grade. Data wereanalysed 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 requiredprompting. Observed hesitation, requests for guidance, and reliance on prompting occurredduring complex decision-making, obtaining consent for instrumental birth, and escalation ofcare. These behaviours occurred while some trainees were undertaking assigned roles withresponsibilities beyond their training grade. Coordinated teamwork behaviours were observedalongside communication lapses and disrupted role allocation. Participants described thesimulation environment as psychologically safe and valued the opportunity for experientiallearning 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 non-technical skills during concurrent clinical demands. The findings describe behaviour within assigned simulated roles and should not be interpreted as an assessment of competence or readiness at the participants’ actual training level.

Authors: Siddharth, A; Muspratt Tucker, N; Nambiar, D; Houlden, R; Aitken, D

• Publication status: Accepted
• Peer review status: Peer reviewed
• Publisher: Lippincott, Williams & Wilkins
• Journal: Simulation in Healthcare More from this journal
• Acceptance date: 2026-10-02
• EISSN: 1559-713X
• ISSN: 1559-2332
• Language: English