SST in Emergency Education (SST)

The Application of Scenario Simulation Teaching and Confidence Behavior Evaluation in Emergency Medicine Teaching

This study looks back at how the investigatorsll two different teaching methods work for training medical and nursing students in CPR (cardiopulmonary resuscitation), a life-saving emergency procedure used when someone's heart stops. the investigators want to find out whether learning through realistic emergency case simulations helps students gain better skills and knowledge than traditional classroom lectures.

The study reviews training records of medical and nursing interns-students in their first hands-on hospital training-who completed CPR training betthe investigatorsen September 2024 and November 2025. the investigators included students who had no prior CPR certification and who attended most of their training sessions.

Because this is a retrospective study, no one needs to take part in any new activities or visits. Researchers will analyze existing training records, test scores, and anonymous survey responses that the investigatorsre already collected during past training sessions. One group of students learned CPR through traditional lectures and instructor demonstrations. The other group learned through hands-on case-based simulations, where they practiced working together as a medical team in realistic emergency scenarios.

This research may help hospitals choose better ways to teach CPR to future doctors and nurses. If case-based simulation proves more effective, more students could receive this type of training, which may help them respond more confidently and effectively in real-life emergencies. Ultimately, better-prepared healthcare professionals may improve care for patients experiencing cardiac arrest.

There are no direct risks to participants. The study only uses existing anonymous teaching records, and no personal identities will be shared in any study reports.

Study Overview

• Status: Completed
• Conditions: Cardiac and Respiratory Arrest
• Intervention / Treatment: Other: case-based scenario simulation teaching

Detailed Description

Clinical clerkship in emergency medicine represents a critical transition period for medical students, bridging the gap from theoretical knowledge to practical application. The traditional "didactic lecture + bedside teaching" model has the investigatorsll-documented limitations, including disconnection betthe investigatorsen theory and practice, passive student engagement, and insufficient training in clinical reasoning.

In recent years, innovative pedagogical models-such as the Flipped Classroom (FC) combined with the SNAPPS structured clinical reasoning framework, and Case-Based Scenario Simulation Teaching (CBSST)-have demonstrated promising outcomes in emergency and critical care medical education. While traditional lecture-based instruction falls short in fostering active learning and critical thinking, case-based scenario simulation immerses learners in highly realistic clinical contexts, enabling interns to experience the urgency of emergency care before actual clinical practice and to master the core elements of team-based resuscitation.

Entrustable Professional Activities, EPAs has gained increasing recognition in healthcare training. Simulation-based collaborative training betthe investigatorsen medical and nursing students improves role clarification, facilitates task coordination, and narrows knowledge-system gaps betthe investigatorsen disciplines. Hothe investigatorsver, existing studies have largely focused on general clinical skills rather than specifically targeting CPR scenarios involving collaborative medical-nursing intern teams. Furthermore, there is a paucity of systematic evaluations regarding the effectiveness of case-based scenario simulation in this specific context.

Previous single-center randomized controlled trials have shown that the FC+SNAPPS model significantly improves interns' theoretical knowledge, Mini-CEX clinical core competencies (history taking, physical examination, clinical assessment, and clinical judgment), and teaching satisfaction. Similarly, CBSST has been shown to simultaneously enhance theoretical scores, procedural skills, clinical judgment, and teamwork among medical and nursing interns during CPR training. Nevertheless, current research remains limited in several aspects:

1. Limited evaluation dimensions: Most studies rely on immediate theoretical examinations and Mini-CEX skill scores as primary outcomes, lacking assessment of whether trainees "can be trusted to perform professional activities independently"-a core competency indicator.
2. Insufficient model comparison: Existing studies predominantly compare a single innovative model against conventional instruction, with little direct comparison betthe investigatorsen different innovative models or exploration of synergistic effects.
3. Limited external validity: Single-center, small-sample designs restrict generalizability.
4. Unknown long-term effects: There is a lack of longitudinal follow-up regarding knowledge retention, skill maintenance, and clinical entrustment decision-making capacity.

Entrustable Professional Activities (EPAs) represent a competency-based core assessment framework in medical education, emphasizing supervising physicians' entrustment decisions regarding whether a learner can independently execute a specific clinical activity. EPA evaluation extends beyond "can they do it" (knowledge and skills) to encompass trust and behavioral competence, aligning closely with the high-risk, practice-intensive nature of emergency medicine. Incorporating EPA as a guiding evaluation tool can compensate for the limitations of traditional Mini-CEX in assessing "independent decision-making and responsibility-bearing," thereby providing more clinically practical evidence for teaching model reform.

• Study Type: Observational
• Enrollment (Actual): 69

Contacts and Locations

Study Locations

• China
  • Hangzhou, China
    • The Second Affiliated Hospital of Zhejiang University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Enrolled 69 medical and nursing interns rotating at our hospital from September 2024 to November 2025.

Description

Inclusion Criteria:

• First-time clinical internship;
• No prior BLS certification;
• Attendance rate ≥ 90%.

Exclusion Criteria:

• Leave of absence ≥10% during the training period;
• Withdrawal from the study for other reasons after enrollment.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
control group; Received conventional lecture-based CPR training.
intervention group; received case-based scenario simulation teaching with interprofessional team training, consisting of five stages	Other: case-based scenario simulation teaching; The intervention group received case-based scenario simulation teaching with interprofessional team training, consisting of five stages

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
theoretical exam	The assessment included a theoretical exam (maximum score: 100 points)	up to 2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mini-CEX Scores	Prior to the study, both assessors participated in a 2-hour calibration session reviewing standardized Mini-CEX rating criteria and benchmark video recordings. Inter-rater reliability was assessed using Cohen's kappa coefficient based on 10 independently scored pilot cases. The kappa value was 0.85 (95% CI: 0.72-0.98), indicating excellent agreement between the two assessors. The Mini-CEX scoring system uses a three-level, 9-point scale, which is categorized as follows: Needs Improvement (1-3 points, indicating very poor, poor, and average), Pass (4-6 points, indicating good, moderate, and fair), and Excellent (7-9 points, indicating excellent, very good, and exceeding expectations). This evaluation system covers four dimensions: knowledge mastery, operational skills, clinical judgment, and team collaboration, with a maximum score of 36 points	up to 2 weeks
Questionnaire Survey	The satisfaction questionnaire was developed based on established dimensions of instructional design and learner engagement identified in health professions education literature[8], and adapted for the specific context of CPR simulation training. Content validity was ensured through review by a panel of three clinical education experts (including BLS instructors and medical educators), who evaluated the relevance, comprehensiveness, and representativeness of the five dimensions (course content, course resources, classroom interaction, teaching methods, and learning burden) and confirmed that all items adequately reflected the constructs of interest in simulation-based CPR education. Prior to formal administration, the questionnaire underwent pilot testing with 10 medical and nursing interns who were not included in the main study sample. The pilot test confirmed the clarity of item wording, logical flow of dimensions, and appropriateness of the 5-point rating scale. Internal consisten	up to 2 weeks

Collaborators and Investigators

• Sponsor: Second Affiliated Hospital, Zhejiang University, School of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2024
• Primary Completion (Actual): November 30, 2025
• Study Completion (Actual): December 30, 2025

Study Registration Dates

• First Submitted: August 25, 2026
• First Submitted That Met QC Criteria: August 31, 2026
• First Posted (Actual): September 4, 2026

Study Record Updates

• Last Update Posted (Actual): September 4, 2026
• Last Update Submitted That Met QC Criteria: August 31, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Scenario simulation teaching; Mini Clinical Evaluation Exercise
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Respiration Disorders; Signs and Symptoms, Respiratory; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Apnea
• Other Study ID Numbers: 2026-0693; 20230242,20240410 (Other Grant/Funding Number: Teaching reform research and cultivation project of The Second Affiliated Hospital of Zhejiang University School of Med)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Due to institutional data privacy policies and the retrospective use of anonymized teaching records, individual participant data cannot be shared outside the research team to protect trainee confidentiality.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No