5 ▁system ic ▁struct ural ▁bar riers ▁to ▁the ▁use ▁of ▁sim ul ators ▁to ▁advance ▁medical ▁training . ▁These ▁are : ▁ ▁Un limited ▁decision - making ▁aut onomy ▁of ▁individual ▁medical ▁staff ; ▁instead , ▁team work ▁and ▁reg ulations ▁should ▁anticip ate ▁problems ▁and ▁processes ▁across ▁depart ments . ▁ ▁Un limited ▁performance ▁of ▁individuals ▁and ▁of ▁the ▁system ; ▁instead , ▁hours ▁of ▁work ▁should ▁be ▁limited ▁and ▁short age ▁of ▁staff ▁addressed ▁because ▁excess ive ▁product ivity - not ▁compet ence , ▁leads ▁to ▁medical ▁errors . ▁ ▁F ocus ▁on ▁status ▁of ▁individual ; ▁instead , ▁standards ▁of ▁excell ence ▁of ▁equivalent ▁actors ▁should ▁be ▁the ▁goal . ▁ ▁Over prote ction ▁against ▁personal ▁li ability ; ▁instead , ▁more ▁consideration ▁should ▁be ▁given ▁to ▁" un int ended ▁consequences ", ▁and ▁to ▁system - level ▁arbitr ation ▁to ▁optimize ▁safety ▁strateg ies . ▁ ▁Over reg ulation ▁and ▁technical ▁complex ities ▁in ▁medicine ; ▁instead , ▁simpl ification ▁of ▁reg ulations ▁is ▁needed . ▁The ▁existence ▁of ▁these ▁bar riers ▁leads ▁to ▁a ▁lower ▁rate ▁of ▁patient ▁safety , ▁and ▁prevent ▁the ▁health ▁industry ▁to ▁come ▁closer ▁to ▁the ▁goal ▁of ▁" ult ras a fe ▁performance ," ▁already ▁achieved ▁by ▁the ▁civil ▁av iation ▁and ▁the ▁nuclear ▁power ▁indust ries ▁ ▁References ▁▁▁ ▁Ald rich , ▁Clark ▁( 2 0 0 3 ). ▁A ▁field ▁guide ▁to ▁educational ▁simulations . ▁Learning ▁Circ uits . ▁American ▁Society ▁for ▁Training ▁and ▁Development . ▁January , ▁ 2