Unexpected consequences of simulator use in medical education: a cautionary tale

Reform of medical education in Vienna in the early 19th century led to bodies of patients who had died being used as obstetric simulators. It was unpleasant, but it was thought that learning on a cadaver simulator would be superior to learning on phantoms (artificial simulators). Unfortunately, the change was associated with a significant increase in maternal mortality from puerperal fever and thousands of women died before Ignaz Philipp Semmelweis recognized that the condition was transmitted from the cadaver to the parturient and could be prevented by careful hand washing. A hundred fifty years later, the spread of infection on the hands of health care professionals is still a cause for concern. The apparently simple skill of cleaning hands and adherence to hand hygiene guidelines should be included in scenarios. We also need to make sure that current simulation-based training does not have unwanted consequences.