In the United States, upon resident work hour restriction implementation, obstetrics and gynaecology residents’ gynaecologic surgery volume decreased and operative time per caesarean delivery increased. High volume surgeons can have clinically significantly lower complication rates than low volume surgeons, p<0.001. Decreasing surgical volumes and increasing operative time raise the question of procedural patient safety in teaching institutions. Some institutions are turning to international rotations in resource-limited nations to increase residents’ surgery volume, possibly doubling monthly surgical volume. As resource-limited nations need to train and increase their indigenous health care workforce, surgical skills simulation is ethically preferable to training high-resource nation residents in resourcelimited nations. A medical and surgical skills simulation center (SSSC) implementation is a workplace continuous quality improvement (CQI) project that can benefit multiple facility departments and community organizations. Stakeholder preparedness must be evaluated before embarking on a CQI project. Anonymous brainstorming contributes to CQI project selection. There is a preferred strategy for incorporating a SSSC into an obstetrics and gynecology department. Staff, space, systems, supplies, science, success, support, and sustainability will come into play at different stages of SSSC implementation. Once operational, the SSSC must undergo CQI to optimize effectiveness. Continuous quality improvement plan-do-study-act cycles are recommended at least as frequently as equipment upgrades.