Why India needs a cultural shift to promote simulation in medical learning

India’s healthcare system loses thousands of patients every year not to disease, but to preventable clinical errors – a problem the country rarely admits, but one every doctor encounters. Over the years, in my work in developing high-fidelity medical simulators and observing training behaviour across hospitals, I have seen a quiet shift: institutions are increasingly turning to structured simulation to close this dangerous gap.

For decades, India has lived with a paradox. We routinely perform some of the world’s most complex surgeries, yet routine complications still arise from errors that have little to do with medical knowledge and everything to do with preparedness. Even the most dedicated young clinicians enter intensive care units and emergency rooms without ever having practised high-risk situations outside real patients. This is not a failure of individuals; it is a structural flaw in how we train our healthcare workforce.

Most hospitals continue to rely on apprenticeship-style learning: observe, attempt, and learn on the job. But in disciplines such as trauma care, neonatal emergencies, obstetrics, and critical care, “learning on the job” often means “learning on the patient”. Predictably, hesitation in the first crucial minutes of a crisis, inconsistent procedural steps, and communication breakdowns become routine vulnerabilities of a system that depends on experience rather than rehearsal.

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The shift to simulation

Patient safety can no longer be left to chance. Across the country, clinical leaders are taking a quiet but decisive turn towards simulation-based training – a practice that has long been standard in aviation and defence, and is now becoming central to Indian medicine. This shift is not driven by technology for its own sake, but by the urgent need to standardise how teams respond to high-stakes scenarios.

In simulation development, one sees how repeated drills change behaviour: muscle memory replaces panic. Nursing students who rehearse catheter insertions, neonatal resuscitation, or airway management on lifelike simulators make their early mistakes where they belong – inside the lab, not beside a patient. Simulation allows errors to surface, be examined, and be corrected without harm.

The benefits extend beyond technical skill. Many preventable errors stem from communication – who speaks when, who leads, who anticipates. Simulation reveals these interpersonal fault lines. Teams learn not just how to perform a procedure, but how to function as a coordinated unit. In overcrowded emergency departments, this coordination often determines whether a patient recovers or declines.

Nursing education in transition

Nursing, in particular, is undergoing a profound shift. With India’s nursing workforce being nearly 12 times the size of the pool of MBBS graduates, this segment carries much of the country’s bedside care. Increasingly, nursing colleges are integrating structured simulation modules into their curriculum, allowing students to practise dozens of procedures before entering clinical rotations. This is more than an academic upgrade – it is a public health investment that directly translates into fewer complications and safer wards.

Hospitals, too, are rethinking their safety culture. The idea of “zero-complication pathways”, once aspirational, are becoming operational as teams rehearse full clinical workflows end-to-end. Institutions that once treated complications as statistical inevitabilities now ask: was this preventable? Could a simulated scenario have revealed this earlier?

Scaling across India

The real challenge now is scale. Simulation cannot remain confined to metros. Tier2 and Tier 3 cities, where clinical load is high but access to structured training is scarce, stand to benefit the most. Encouragingly, several medical universities and State health departments are exploring decentralised simulation labs, mobile training units, and blended learning models that combine digital and hands-on practice.

From the development side, the field in India has matured significantly. A focus on accessibility and realism is shaping much of the ongoing work: creating models that reflect not just anatomy, but context -resource constraints, heavy patient loads, and diverse case profiles across regions.

Across the industry, teams working on simulator material science and realistic anatomical modelling are seeing growing demand from institutions outside large urban centres. This signals an encouraging cultural shift: hospitals are acknowledging that preparedness, not improvisation, must define modern clinical training.

A cultural pivot

Ultimately, the shift towards simulation is not merely pedagogical; it is cultural. It acknowledges what the system has long resisted: even the most committed clinicians make errors when they are under-prepared, under-supported, or under-trained. Reducing preventable harm requires humility, accountability, and the courage to rethink old methods.

If India is to build a healthcare system where safety is assured rather than aspirational, rehearsal must become as integral as diagnosis. Every pilot flies hundreds of simulated hours before taking command. Every surgical resident, nurse, and emergency physician deserves — and increasingly demands – the same opportunity to practise before lives depend on them.

Simulation will not eliminate every error. But it prevents the most heartbreaking ones: the errors we already know how to avoid. In a country where avoidable harm has been normalised for too long, that alone marks a significant step forward.

(Dr. Sunil Tomar is clinician and simulation researcher; leads material-science development at Maverick Simulation Solutions. sunil@mavericksimulation.com)

Published – December 03, 2025 10:47 am IST