Effectiveness of simulation-based training in improving critical decision making and procedural skills among emergency and critical care medicine residents at St. Paul Hospital Millennium Medical College. A mixed method study

Abstract

ABSTRACT Background: Simulation-based training is a relatively new instructional method in the medical education of low-income countries due to too much patient flow and shortages health-care personnel. A little is known about its effectiveness particularly among emergency and critical care medicine (ECCM) residents. Objective: To assess the effectiveness of simulation-based training in improving critical decision making and procedural skills among ECCM residents at St. Paul Hospital Millennium Medical College, 2025, Ethiopia. Methods: A mixed-methods study was conducted from April to September, 2025. All 1st to 3rd year emergency and critical care medicine residents were included for the quantitative and three respondents were selected purposively for the qualitative data. Data were collected using a self administered and interviews questions for quantitative and qualitative parts respectively. Descriptive statistics were used and the data was presented using percentages and frequencies for the quantitative part. Thematic analysis was employed for the qualitative data. Finally, the results obtained from both the quantitative and qualitative data were triangulated. Result: A total of 51 ECCM residents participated in the study. The study evaluated the effectiveness of simulation-based training (SBT) based on clinical decision-making, procedural, and non-technical skills domains. Following simulation-based training, 76.5% [95% CI: (62.79, 88.19)] of ECCM residents demonstrated high overall competency. Specifically, 60.8% showed improvement in clinical decision-making, 64.7% in procedural skills, and 86.3% in non-technical skills. Conclusion and Recommendations: This study evaluated the effectiveness of SBT based on three domains. The result revealed respondents demonstrated relatively higher level of competency in the non-technical followed by procedural skill, and critical decision making skills. Integrating simulation learning in the current curriculum and applying it effectively would improve professional skills of the trainee. For future researchers, longitudinal studies involving randomized control trials would provide a better and strong evidences on simulation-based learning. Key words: simulation based training, critical decision making skills, Procedural skills, and emergency medicine.