Enhancing Emergency Clinical Training with SimMan 3G Simulation

Enhancing Emergency Clinical Training with SimMan 3G Simulation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Emergency Clinical Training with SimMan 3G Simulation Qiyuan Wang, Jiqiang Liu, Dengke Wu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6361427/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The predominance of critically ill patients in Chinese emergency departments restricts medical students' clinical exposure, leading to insufficient procedural training and possible reluctance to pursue emergency medicine. This research examines whether SimMan 3G simulation training significantly improves theoretical knowledge retention and practical skill performance in emergency clinical education for medical students. Methods Between January and June 2024, 241 medical students who received internship training in the emergency department were randomly divided into two groups: a control group ( n = 121) that received bedside teaching and a research group ( n = 120) that received SimMan 3G simulation training. The theoretical performance, practical skills, and satisfaction levels of the two groups of students were compared and analyzed. Results The enthusiasm for learning in the control group was 86.77% (105/121), significantly lower ( P < 0.05) than that in the research group (96.67%, 116/120). The scores for theoretical knowledge, practical skills, case analysis, and comprehensive quality were all significantly higher in the study group than in the control group ( P < 0.05). The satisfaction with teaching was significantly lower ( P < 0.05) in the control group (85.12%, 103/121) than in the research group (98.33%, 118/120). Conclusion The SimMan 3G high-fidelity simulator demonstrates significant potential in optimizing emergency medicine training through structured scenario-based learning (SBL) modules. SimMan 3G simulation training emergency department teaching theoretical knowledge hands-on skills Figures Figure 1 Background Emergency medicine operates 24 hours a day and is an indispensable part of the medical system. The emergency department is critical in dealing with all kinds of public health emergencies and is critical to public health and safety [ 1 ]. However, emergency medicine encompasses a wide range of clinical specialties, including internal medicine, surgery, pediatrics, obstetrics and gynecology, and psychiatry. As a result, emergency clinical teaching is inherently complex and challenging due to the vast and multidisciplinary nature of the field [ 2 ]. At present, the lack of a systematic and standardized framework for emergency clinical teaching leads to poor regularity and low interest in learning, which is not conducive to cultivating emergency clinical talent or promoting public health and safety [ 3 ]. This mainly affects critically ill patients, who rely on practitioners with a strong combination of knowledge and skills to care for them. Emergency clinical situations are among the most challenging and high-risk scenarios that medical students face during their training. As a result, there is a pressing need to reevaluate traditional methods of skill acquisition and integrate innovative teaching tools. Thus, it is crucial to shift perspectives, reform teaching strategies, and develop systematic, scientific, and standardized approaches to emergency medical education[ 4 ]. In recent years, simulation-based medical education has developed rapidly and become one of the most popular teaching methods for improving patient safety and care [ 5 ]. Increasing evidence supports the benefits of clinical simulation in teaching basic scientific and clinical knowledge, procedural skills, teamwork, communication, and evaluation at both the undergraduate and graduate levels [ 6 ]. Due to the dynamic, complex, and interdisciplinary nature of the emergency department, simulation training is particularly suitable for training emergency medical personnel. SimMan 3G simulators have been shown to effectively enhance students’ mastery of disease knowledge and clinical skills [ 7 , 8 ]. These simulators have been widely used to bridge theoretical medical knowledge and clinical practice. SimMan 3G simulators can also help students master certain clinical skills and improve their proficiency [ 9 , 10 ]. The SimMan 3G adult patient simulation tool used in this study can simulate real clinical scenarios, different stages and pathological manifestations of diseases, and even reactions to different measures, misdiagnosis, and mistreatment. However, SimMan 3G simulation has some limitations. First, some students may struggle with time management when learning schedules are not prearranged, requiring a high level of self-discipline and the ability to balance competing tasks. Second, the virtual environment may fail to fully engage students due to various factors, including distractions from external stimuli. Additionally, technical issues such as slow hardware performance or connectivity problems may demand extra resources. Finally, integrating simulation-based learning into the already demanding schedules of medical students may further reduce their rest time and negatively affect their personal lives. The integration of SimMan 3G simulation demonstrates the potential to enhance clinical decision-making competencies in emergency medicine education. This initiative seeks to bridge standardization gaps in clinical training protocols while improving learner engagement through immersive scenario-based learning. By implementing this structured simulation pedagogy, we aim to cultivate evidence-based clinical competencies in medical trainees, thereby establishing a replicable training model that is ultimately translatable to public health outcomes through workforce capacity building. Methods A standardized pedagogical framework was developed and implemented following instructor training on simulation-based educational protocols. Sample size estimation was conducted using GPower (version 3.1.9.7) with the following parameters: two-tailed independent t-test design, medium effect size (Cohen's d = 0.5) based on pilot data, α = 0.05, and power (1-β) = 0.80. The calculation yielded a required sample of 102 participants per group, with the final enrollment of 241 undergraduate clinical medical students (January-June 2024) exceeding this threshold to account for potential attrition. Participants were randomly allocated through computer-generated sequencing (Microsoft Excel RAND() function) with concealed allocation to either: Intervention group (n = 120): 71 males, 49 females; mean age = 21.41 ± 0.17 years, Control group (n = 121): 72 males, 48 females; mean age = 21.32 ± 0.18 years. Demographic characteristics showed no statistically significant intergroup differences through independent samples t-tests (age: t = 1.12, p = 0.264) and chi-square analysis (gender: χ²=0.04, p = 0.845), confirming baseline comparability. The control group that received bedside teaching and the research group that received SimMan 3G simulation training. After the training, Following the class, student performance was evaluated across three domains: theoretical knowledge assessment, Emergency Medical Record Writing, and Case Analysis Assessment. The evaluation utilized an objective structured clinical examination (OSCE) for competency-based assessments, complemented by a Class Satisfaction Questionnaire administered via standardized distribution protocols. Additionally, the PORTAAL tool and postclass surveys were employed to triangulate data collection. In the study, the teaching instructors were blinded to the group allocation and taught according to randomly - assigned lesson plans. The students only knew they were participating in the study without being aware of the grouping details. The data statisticians processed data with the group identifiers removed. All three parties were blinded. The trial concluded upon reaching the predetermined sample size. There were no sample dropouts, yet harms or unintended effects were noted in each group. SPSS 25.0 statistical software was used for data analysis. Metric data were expressed as ( x ± s ), and comparisons were performed by t-test. Count data were expressed as [ n (%)] and compared via chi-squared test. P < 0.05 was considered statistically significant. Results Comparison of theoretical knowledge and clinical skill between the two groups of students The research group had significantly higher scores in the theoretical knowledge and clinical skill assessments compared with the control group ( P < 0.05; Table 1 ). The proportion of students achieving "excellent" scores (scores ≥ 90) in both the theoretical knowledge and clinical skill assessments was significantly higher in the research group than in the control group (P < 0.05; Table 2 ). Table 1 Comparison of theory and clinical skills scores between two student groups Group Theoretical Knowledge Examination Clinical Skill Assessment Research group ( n = 120) 91.52 ± 2.50 94.45 ± 2.93 Control group ( n = 121) 84.99 ± 2.41 88.45 ± 2.01 t 20.655 18.553 P < 0.001 < 0.001 The theoretical knowledge and clinical skill assessment scores were compared between the research and control groups. In the theoretical knowledge assessment, the research group (91.52 ± 2.50) scored significantly higher than the control group (84.99 ± 2.41), with a t -value of 20.655 and P < 0.001, indicating significantly better improvement in theoretical knowledge in the research group compared with the control group. Similarly, for the clinical skill assessment, the research group (94.45 ± 2.93) outperformed the control group (88.45 ± 2.01), with a t -value of 18.553 and P < 0.001. Thus, the research group also showed significantly more improvement in clinical skills compared with the control group. Table 2 Comparison of excellent score rates [n(%)] between two student groups in theory and clinical skills Group Theoretical Knowledge Examination Clinical Skill Assessment Research group ( n = 120) 111 (92.50%) 116 (96.67%) Control group ( n = 121) 84 (69.42%) 86 (71.07%) X 2 20.778 29.093 P < 0.001 < 0.001 The rates of “excellent” scores in the theoretical knowledge and clinical skill assessments were compared between the research and control groups. In the assessment of theoretical knowledge, 111 participants (92.50%) in the research group passed, while 84 participants (69.42%) in the control group passed. The chi-square ( X ²) value was 20.778, with P < 0.001, indicating a significant difference between the two groups. In the assessment of clinical skill, 116 participants (96.67%) in the research group passed, compared to 86 participants (71.07%) in the control group ( X ² = 29.093, P < 0.001), indicating a significantly higher success rate in the research group. Comparison of self-directed learning ability between the two groups of students before and after teaching Before teaching, no significant differences were observed between the two groups in the scores for learning motivation, self-management ability, and learning cooperation ability ( P > 0.05). In the control group, no significant differences ( P > 0.05) were found in the various dimensions of self-directed learning ability before and after teaching. In contrast, in the research group, the self-directed learning ability scores in all dimensions were significantly higher after teaching ( P < 0.05). Moreover, after teaching, the self-directed learning ability scores in the research group were significantly higher in all dimensions compared with the control group ( P < 0.05; Table 3 , Fig. 1 ). Table 3 Comparison of abilities between the two groups of students before and after teaching Competence Research Group ( n = 120) Control Group ( n = 121) t P Learning motivation Before teaching 25.76 ± 0.83 25.57 ± 1.50 1.206 0.229 After teaching 31.53 ± 1.52 26.00 ± 1.63 27.201 < 0.001 −35.175 −2.155 < 0.001 0.033 Self-management Before teaching 35.50 ± 1.51 35.66 ± 3.25 −0.495 0.621 After teaching 48.00 ± 0.82 35.16 ± 3.09 44.21 < 0.001 −79.844 1.074 < 0.001 0.285 Clinical thinking Before teaching 19.99 ± 2.21 20.51 ± 2.33 −1.779 0.076 After teaching 26.13 ± 1.99 20.26 ± 2.08 22.403 < 0.001 −22.304 0.935 < 0.001 0.351 Cooperation Before teaching 19.48 ± 2.07 18.72 ± 2.14 2.817 0.005 After teaching 25.14 ± 3.09 19.10 ± 2.12 17.693 < 0.001 −18.576 −1.454 < 0.001 0.149 We evaluated the learning motivation, self-management, clinical thinking, and cooperation of the research and control groups before and after teaching. A) No significant difference in learning motivation was observed between the research group (25.76 ± 0.83) and the control group (25.57 ± 1.50) before teaching ( t = 1.206, P = 0.229). However, after teaching, the research group (31.53 ± 1.52) had significantly greater learning motivation compared with the control group (26.00 ± 1.63; t = 27.201, P < 0.001). B) No significant difference in self-management was observed between the two groups before teaching (research group, 35.50 ± 1.51; control group: 35.66 ± 3.25; t = − 0.495, P = 0.621). However, after teaching, self-management was significantly higher in the research group (48.00 ± 0.82) than in the control group (35.16 ± 3.09; t = 44.21, P < 0.001). Thus, the research group showed a more substantial improvement in self-management than the control group after the teaching intervention. C) The clinical thinking scores were not significantly different between the research group (19.99 ± 2.21) and the control group (20.51 ± 2.33) before teaching ( t = − 1.779, P = 0.076). However, after teaching, the clinical thinking score was significantly higher in the research group (26.13 ± 1.99) than in the control group (20.26 ± 2.08; t = 22.403, P < 0.001). Thus, the research group showed a more substantial improvement in clinical thinking than the control group after the teaching intervention. D) The research group (19.48 ± 2.07) had a significantly higher cooperation score than the control group (18.72 ± 2.14) before teaching ( t = 2.817, P = 0.005). After teaching, the cooperation score of the research group (25.14 ± 3.09) remained significantly higher than that of the control group (19.10 ± 2.12; t = 17.693, P < 0.001); however, the improvement in cooperation score after teaching was not significantly different between groups ( t = − 1.454, P = 0.149), suggesting a similar effect of the teaching intervention in both groups. Comparison of class satisfaction between the two groups of students Compared with the control group, the research group had significantly higher satisfaction scores for teaching form and teaching effect ( P < 0.001; Table 4 ). Table 4 Comparison of class satisfaction between the two groups of students Group Teaching form Teaching effect Research group ( n = 120) 66.48 ± 2.04 71.47 ± 2.26 Control group (n = 121) 51.69 ± 4.71 55.28 ± 4.19 t 31.59 37.379 P < 0.001 < 0.001 The teaching form and teaching effect scores were compared between the research and control groups. The teaching form score was significantly higher in the research group (66.48 ± 2.04) than in the control group (51.69 ± 4.71; t = 31.59, P < 0.001). The teaching effect score was also significantly higher in the research group (71.47 ± 2.26) than in the control group (55.28 ± 4.19; t = 37.379, P < 0.001). Thus, both measures of class satisfaction were significantly higher in the research group than in the control group. Comparison of teaching mode evaluation scores between the two groups of students Compared with the control group, the scores for teaching mode interest, practicality, and applicability were significantly higher in the research group ( P < 0.05; Table 5 ). Table 5 Comparison of student evaluation scores of teaching mode between the two groups [ n (%)] Group Interest Practicality Applicability Research group ( n = 120) 108 (90.00%) 118 (98.33%) 111 (92.50%) Control group ( n = 121) 97 (80.17%) 93 (76.86%) 102 (84.30%) X 2 4.586 25.492 3.948 P 0.032 < 0.001 0.047 The interest, practicality, and applicability of the intervention were compared between the research and control groups. In the research group, 108 participants (90.00%) expressed interest in the teaching mode, whereas 97 participants (80.17%) expressed interest in the control group ( X ² = 4.586, P = 0.032), indicating significantly greater interest in the research group. Regarding practicality, 118 participants (98.33%) in the research group found the intervention practical, compared with 93 participants (76.86%) in the control group. ( X ² = 25.492, P < 0.001); thus, significantly more participants in the research group rated the teaching intervention as practical. In terms of applicability, 111 participants (92.50%) in the research group found the intervention applicable, compared with 102 participants (84.30%) in the control group ( X ² = 3.948, P = 0.047). Thus, significantly more students in the research group perceived the intervention as applicable. Discussion Emergency medicine is a critical branch of medical science characterized by its complexity and urgency, which demands a high level of practical skills and adaptability from medical students [ 11 ]. The SimMan 3G simulator is an advanced tool that has been widely applied in medical education [ 8 , 9 ]. This study demonstrates that SimMan 3G simulation training significantly enhances clinical competence among emergency medicine trainees compared to traditional bedside teaching. The research group exhibited superior performance in theoretical knowledge (91.52 vs. 84.99, p < 0.001), practical skills (94.45 vs. 88.45, p < 0.001), and self-directed learning competencies, including clinical thinking and emergency medical record writing. Additionally, 98.33% of participants in the research group expressed high satisfaction with the teaching model, underscoring its acceptability and potential for broader implementation in medical education. These findings highlight the clinical relevance of structured simulation-based learning (SBL) in bridging the gap between theoretical knowledge and clinical practice, ultimately fostering physicians capable of managing high-risk emergency scenarios [ 9 , 12 ]. Our results align with recent studies emphasizing the efficacy of high-fidelity simulation in medical education. For instance, Rotin et al. (2023) reported that simulation training enhances procedural proficiency and critical thinking by replicating real-world clinical challenges, consistent with our observed improvements in case analysis scores (26.13 vs. 20.26, p < 0.001) [ 5 ]. The SimMan 3G platform’s ability to simulate complex pathologies, such as myocardial infarction and acute poisoning, provides learners with opportunities to practice risk-free clinical decision-making, a feature widely recognized as essential for competency-based training [ 13 , 14 ]. However, our study advances prior work by systematically integrating SBL into emergency medicine curricula. While traditional simulation models often focus on isolated skill acquisition [ 15 , 16 ], our approach emphasizes interdisciplinary collaboration and dynamic scenario adaptation. For example, the simulator’s integration with ECG monitors and ventilators enabled trainees to experience multi-device management, a critical skill in acute care settings. This aligns with recommendations from Motola et al. (2013), who advocate for immersive, technology-enhanced simulations to replicate clinical complexity [ 17 ]. The observed improvements in teamwork (25.14 vs. 19.10, p < 0.001) and learning motivation (31.53 vs. 26.00, p < 0.001) further validate the SimMan 3G’s role in fostering collaborative learning environments-a cornerstone of modern medical education frameworks [ 18 , 19 ]. This study has limitations. First, the single-center design and homogeneous participant pool (undergraduate trainees) may limit generalizability. Larger, multi-center trials involving postgraduate learners are needed to validate these findings across diverse educational contexts. Second, the short follow-up period (one month) precludes assessment of long-term skill retention, a challenge noted in simulation-based research. Third, while the SimMan 3G offers high fidelity, its inability to fully replicate patient-provider emotional interactions may reduce ecological validity [ 20 ]. Nevertheless, rigorous blinding protocols and validated assessment tools (e.g., OSCE, PORTAAL) strengthen internal validity. The absence of attrition and standardized statistical methods (SPSS 25.0) further mitigate confounding risks. Future research should prioritize longitudinal studies to evaluate the durability of competency gains [ 21 ]. Additionally, integrating artificial intelligence (AI) algorithms to personalize simulation scenarios based on learner performance may further optimize training efficiency [ 22 , 23 ]. Qualitative investigations into instructors’ perspectives on balancing simulation fidelity with curricular demands are also warranted [ 24 , 25 ]. Conclusion This work establishes the SimMan 3G as a transformative tool in emergency medicine education. By combining immersive scenario-based learning with interdisciplinary collaboration, this approach not only enhances academic performance but also equips trainees with adaptive clinical judgment essential for high-stakes environments. Its alignment with competency-based paradigms underscores its potential to redefine acute care training globally. Abbreviations structured scenario-based learning (SBL) Declarations Ethics approval and consent to participate All methods were carried out in accordance with relevant guidelines and regulations. The study was approved by Ethics Committee of the Second Xiangya Hospital of Central South University . And informed consent was obtained from all subjects. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Clinical trial number Not applicable. Funding The study was supported in part by a grant from the Changsha Science and Technology Bureau Project [kq2014242], the Natural Science Foundation of Hunan Province of China [2021JJ30959] . Authors' contributions Qiyuan Wang: Data curation (lead); Investigation (lead); Validation (lead); Writing – review & editing (equal). Jiqiang Liu: Formal analysis (equal); Methodology (equal); Resources (equal); Visualization (equal); Writing–review & editing (equal). Dengke Wu: Conceptualization (lead); Funding acquisition (equal); Writing –original draft (lead); Writing – review & editing (equal); Dengke Wu, Xudong Xiang critically reviewed the manuscript. Acknowledgments The authors thank AiMi Academic Services (www.aimieditor.com) for English language editing and review services. References Wittayer M, Sandikci V, Ebert A, Koehler C, Szabo K, Hoyer C. 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Stress responses in high-fidelity simulation and standard simulation training among medical students. BMC Med Educ. 2023;23(1):116. doi:10.1186/s12909-023-04101-x. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6361427","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":455164727,"identity":"e31b5ee4-a027-4264-8b27-92c089a3c54e","order_by":0,"name":"Qiyuan Wang","email":"","orcid":"","institution":"The Second Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Qiyuan","middleName":"","lastName":"Wang","suffix":""},{"id":455164728,"identity":"2d17928e-5030-4fca-b352-6bb4acd584ef","order_by":1,"name":"Jiqiang Liu","email":"","orcid":"","institution":"The Second Xiangya Hospital of Central South University","correspondingAuthor":false,"prefix":"","firstName":"Jiqiang","middleName":"","lastName":"Liu","suffix":""},{"id":455164729,"identity":"c7ecf15d-8b85-485a-bfe9-84effd667774","order_by":2,"name":"Dengke Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYHACY4YPBhI8/BAOM3FaGGdUWMhJNpCihZnnTIWxwQFitRjcSN5swNsmkbj5+PFnEgwV1okN7GcPENCSVpwgCdSy7UyOmQTDmfTEBp68BLxazG7kGB8wBGm5wcMmwdh2OLFBgseAsJZEkMNmsD+TYPxHpJaEA2ckjA0kGMwkGBuI0GJ/5lmxYUOFhJzEmRxji4Rj6cZtPDn4tUi2J2+W/mNQx8PffvzhjQ811rL97Gfwa0EFCUDMRoL6UTAKRsEoGAU4AAC0zENQIstU4AAAAABJRU5ErkJggg==","orcid":"","institution":"The Second Xiangya Hospital of Central South University","correspondingAuthor":true,"prefix":"","firstName":"Dengke","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2025-04-02 12:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6361427/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6361427/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82623818,"identity":"146f77dc-2cc1-42bd-ad96-ff06dcd9c3d0","added_by":"auto","created_at":"2025-05-13 12:45:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33287,"visible":true,"origin":"","legend":"\u003cp\u003eAbilities between two groups of students before and after teaching.\u003c/p\u003e\n\u003cp\u003eNote: * indicates a significant difference between the control and research groups, while # indicates a significant difference before and after teaching for the same group.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6361427/v1/6decc996291a1deae6e269b9.png"},{"id":83340431,"identity":"9376c548-251b-4a57-9947-8ab32eefca0e","added_by":"auto","created_at":"2025-05-23 10:23:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":835677,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6361427/v1/d7f04aaf-42b4-406e-893b-9bad9f378284.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhancing Emergency Clinical Training with SimMan 3G Simulation","fulltext":[{"header":"Background","content":"\u003cp\u003eEmergency medicine operates 24 hours a day and is an indispensable part of the medical system. The emergency department is critical in dealing with all kinds of public health emergencies and is critical to public health and safety [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, emergency medicine encompasses a wide range of clinical specialties, including internal medicine, surgery, pediatrics, obstetrics and gynecology, and psychiatry. As a result, emergency clinical teaching is inherently complex and challenging due to the vast and multidisciplinary nature of the field [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. At present, the lack of a systematic and standardized framework for emergency clinical teaching leads to poor regularity and low interest in learning, which is not conducive to cultivating emergency clinical talent or promoting public health and safety [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This mainly affects critically ill patients, who rely on practitioners with a strong combination of knowledge and skills to care for them. Emergency clinical situations are among the most challenging and high-risk scenarios that medical students face during their training. As a result, there is a pressing need to reevaluate traditional methods of skill acquisition and integrate innovative teaching tools. Thus, it is crucial to shift perspectives, reform teaching strategies, and develop systematic, scientific, and standardized approaches to emergency medical education[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, simulation-based medical education has developed rapidly and become one of the most popular teaching methods for improving patient safety and care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Increasing evidence supports the benefits of clinical simulation in teaching basic scientific and clinical knowledge, procedural skills, teamwork, communication, and evaluation at both the undergraduate and graduate levels [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Due to the dynamic, complex, and interdisciplinary nature of the emergency department, simulation training is particularly suitable for training emergency medical personnel. SimMan 3G simulators have been shown to effectively enhance students\u0026rsquo; mastery of disease knowledge and clinical skills [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These simulators have been widely used to bridge theoretical medical knowledge and clinical practice. SimMan 3G simulators can also help students master certain clinical skills and improve their proficiency [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The SimMan 3G adult patient simulation tool used in this study can simulate real clinical scenarios, different stages and pathological manifestations of diseases, and even reactions to different measures, misdiagnosis, and mistreatment. However, SimMan 3G simulation has some limitations. First, some students may struggle with time management when learning schedules are not prearranged, requiring a high level of self-discipline and the ability to balance competing tasks. Second, the virtual environment may fail to fully engage students due to various factors, including distractions from external stimuli. Additionally, technical issues such as slow hardware performance or connectivity problems may demand extra resources. Finally, integrating simulation-based learning into the already demanding schedules of medical students may further reduce their rest time and negatively affect their personal lives.\u003c/p\u003e \u003cp\u003eThe integration of SimMan 3G simulation demonstrates the potential to enhance clinical decision-making competencies in emergency medicine education. This initiative seeks to bridge standardization gaps in clinical training protocols while improving learner engagement through immersive scenario-based learning. By implementing this structured simulation pedagogy, we aim to cultivate evidence-based clinical competencies in medical trainees, thereby establishing a replicable training model that is ultimately translatable to public health outcomes through workforce capacity building.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA standardized pedagogical framework was developed and implemented following instructor training on simulation-based educational protocols. Sample size estimation was conducted using GPower (version 3.1.9.7) with the following parameters: two-tailed independent t-test design, medium effect size (Cohen's d\u0026thinsp;=\u0026thinsp;0.5) based on pilot data, α\u0026thinsp;=\u0026thinsp;0.05, and power (1-β)\u0026thinsp;=\u0026thinsp;0.80. The calculation yielded a required sample of 102 participants per group, with the final enrollment of 241 undergraduate clinical medical students (January-June 2024) exceeding this threshold to account for potential attrition. Participants were randomly allocated through computer-generated sequencing (Microsoft Excel RAND() function) with concealed allocation to either: Intervention group (n\u0026thinsp;=\u0026thinsp;120): 71 males, 49 females; mean age\u0026thinsp;=\u0026thinsp;21.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17 years, Control group (n\u0026thinsp;=\u0026thinsp;121): 72 males, 48 females; mean age\u0026thinsp;=\u0026thinsp;21.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 years. Demographic characteristics showed no statistically significant intergroup differences through independent samples t-tests (age: t\u0026thinsp;=\u0026thinsp;1.12, p\u0026thinsp;=\u0026thinsp;0.264) and chi-square analysis (gender: χ\u0026sup2;=0.04, p\u0026thinsp;=\u0026thinsp;0.845), confirming baseline comparability.\u003c/p\u003e \u003cp\u003eThe control group that received bedside teaching and the research group that received SimMan 3G simulation training. After the training, Following the class, student performance was evaluated across three domains: theoretical knowledge assessment, Emergency Medical Record Writing, and Case Analysis Assessment. The evaluation utilized an objective structured clinical examination (OSCE) for competency-based assessments, complemented by a Class Satisfaction Questionnaire administered via standardized distribution protocols. Additionally, the PORTAAL tool and postclass surveys were employed to triangulate data collection.\u003c/p\u003e \u003cp\u003eIn the study, the teaching instructors were blinded to the group allocation and taught according to randomly - assigned lesson plans. The students only knew they were participating in the study without being aware of the grouping details. The data statisticians processed data with the group identifiers removed. All three parties were blinded. The trial concluded upon reaching the predetermined sample size. There were no sample dropouts, yet harms or unintended effects were noted in each group.\u003c/p\u003e \u003cp\u003eSPSS 25.0 statistical software was used for data analysis. Metric data were expressed as (\u003cem\u003ex\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e), and comparisons were performed by t-test. Count data were expressed as [\u003cem\u003en\u003c/em\u003e (%)] and compared via chi-squared test. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eComparison of theoretical knowledge and clinical skill between the two groups of students\u003c/h2\u003e \u003cp\u003eThe research group had significantly higher scores in the theoretical knowledge and clinical skill assessments compared with the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The proportion of students achieving \"excellent\" scores (scores\u0026thinsp;\u0026ge;\u0026thinsp;90) in both the theoretical knowledge and clinical skill assessments was significantly higher in the research group than in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of theory and clinical skills scores between two student groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTheoretical Knowledge Examination\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Skill Assessment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe theoretical knowledge and clinical skill assessment scores were compared between the research and control groups. In the theoretical knowledge assessment, the research group (91.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50) scored significantly higher than the control group (84.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41), with a \u003cem\u003et\u003c/em\u003e-value of 20.655 and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, indicating significantly better improvement in theoretical knowledge in the research group compared with the control group. Similarly, for the clinical skill assessment, the research group (94.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93) outperformed the control group (88.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01), with a \u003cem\u003et\u003c/em\u003e-value of 18.553 and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Thus, the research group also showed significantly more improvement in clinical skills compared with the control group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of excellent score rates [n(%)] between two student groups in theory and clinical skills\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTheoretical Knowledge Examination\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Skill Assessment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111 (92.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116 (96.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (69.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (71.07%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe rates of \u0026ldquo;excellent\u0026rdquo; scores in the theoretical knowledge and clinical skill assessments were compared between the research and control groups. In the assessment of theoretical knowledge, 111 participants (92.50%) in the research group passed, while 84 participants (69.42%) in the control group passed. The chi-square (\u003cem\u003eX\u003c/em\u003e\u0026sup2;) value was 20.778, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, indicating a significant difference between the two groups. In the assessment of clinical skill, 116 participants (96.67%) in the research group passed, compared to 86 participants (71.07%) in the control group (\u003cem\u003eX\u003c/em\u003e\u0026sup2; = 29.093, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a significantly higher success rate in the research group.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eComparison of self-directed learning ability between the two groups of students before and after teaching\u003c/h3\u003e\n\u003cp\u003eBefore teaching, no significant differences were observed between the two groups in the scores for learning motivation, self-management ability, and learning cooperation ability (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the control group, no significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) were found in the various dimensions of self-directed learning ability before and after teaching. In contrast, in the research group, the self-directed learning ability scores in all dimensions were significantly higher after teaching (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, after teaching, the self-directed learning ability scores in the research group were significantly higher in all dimensions compared with the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of abilities between the two groups of students before and after teaching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCompetence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResearch Group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl Group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;121)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;35.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;2.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;79.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical thinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;1.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;22.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCooperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17.693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;18.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe evaluated the learning motivation, self-management, clinical thinking, and cooperation of the research and control groups before and after teaching. A) No significant difference in learning motivation was observed between the research group (25.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83) and the control group (25.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50) before teaching (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.206, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.229). However, after teaching, the research group (31.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52) had significantly greater learning motivation compared with the control group (26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27.201, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). B) No significant difference in self-management was observed between the two groups before teaching (research group, 35.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51; control group: 35.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.495, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.621). However, after teaching, self-management was significantly higher in the research group (48.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82) than in the control group (35.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;44.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Thus, the research group showed a more substantial improvement in self-management than the control group after the teaching intervention. C) The clinical thinking scores were not significantly different between the research group (19.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21) and the control group (20.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33) before teaching (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.779, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.076). However, after teaching, the clinical thinking score was significantly higher in the research group (26.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99) than in the control group (20.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22.403, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Thus, the research group showed a more substantial improvement in clinical thinking than the control group after the teaching intervention. D) The research group (19.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07) had a significantly higher cooperation score than the control group (18.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14) before teaching (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.817, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). After teaching, the cooperation score of the research group (25.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09) remained significantly higher than that of the control group (19.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17.693, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); however, the improvement in cooperation score after teaching was not significantly different between groups (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.454, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.149), suggesting a similar effect of the teaching intervention in both groups.\u003c/p\u003e\n\u003ch3\u003eComparison of class satisfaction between the two groups of students\u003c/h3\u003e\n\u003cp\u003eCompared with the control group, the research group had significantly higher satisfaction scores for teaching form and teaching effect (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of class satisfaction between the two groups of students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeaching form\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTeaching effect\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.28\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.379\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe teaching form and teaching effect scores were compared between the research and control groups. The teaching form score was significantly higher in the research group (66.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04) than in the control group (51.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;31.59, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The teaching effect score was also significantly higher in the research group (71.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26) than in the control group (55.28\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;37.379, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Thus, both measures of class satisfaction were significantly higher in the research group than in the control group.\u003c/p\u003e\n\u003ch3\u003eComparison of teaching mode evaluation scores between the two groups of students\u003c/h3\u003e\n\u003cp\u003eCompared with the control group, the scores for teaching mode interest, practicality, and applicability were significantly higher in the research group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of student evaluation scores of teaching mode between the two groups [\u003cem\u003en\u003c/em\u003e (%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePracticality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eApplicability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108 (90.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118 (98.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e111 (92.50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97 (80.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (76.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e102 (84.30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.948\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe interest, practicality, and applicability of the intervention were compared between the research and control groups. In the research group, 108 participants (90.00%) expressed interest in the teaching mode, whereas 97 participants (80.17%) expressed interest in the control group (\u003cem\u003eX\u003c/em\u003e\u0026sup2; = 4.586, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032), indicating significantly greater interest in the research group. Regarding practicality, 118 participants (98.33%) in the research group found the intervention practical, compared with 93 participants (76.86%) in the control group. (\u003cem\u003eX\u003c/em\u003e\u0026sup2; = 25.492, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); thus, significantly more participants in the research group rated the teaching intervention as practical. In terms of applicability, 111 participants (92.50%) in the research group found the intervention applicable, compared with 102 participants (84.30%) in the control group (\u003cem\u003eX\u003c/em\u003e\u0026sup2; = 3.948, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047). Thus, significantly more students in the research group perceived the intervention as applicable.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEmergency medicine is a critical branch of medical science characterized by its complexity and urgency, which demands a high level of practical skills and adaptability from medical students [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The SimMan 3G simulator is an advanced tool that has been widely applied in medical education [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This study demonstrates that SimMan 3G simulation training significantly enhances clinical competence among emergency medicine trainees compared to traditional bedside teaching. The research group exhibited superior performance in theoretical knowledge (91.52 vs. 84.99, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), practical skills (94.45 vs. 88.45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and self-directed learning competencies, including clinical thinking and emergency medical record writing. Additionally, 98.33% of participants in the research group expressed high satisfaction with the teaching model, underscoring its acceptability and potential for broader implementation in medical education. These findings highlight the clinical relevance of structured simulation-based learning (SBL) in bridging the gap between theoretical knowledge and clinical practice, ultimately fostering physicians capable of managing high-risk emergency scenarios [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results align with recent studies emphasizing the efficacy of high-fidelity simulation in medical education. For instance, Rotin et al. (2023) reported that simulation training enhances procedural proficiency and critical thinking by replicating real-world clinical challenges, consistent with our observed improvements in case analysis scores (26.13 vs. 20.26, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The SimMan 3G platform\u0026rsquo;s ability to simulate complex pathologies, such as myocardial infarction and acute poisoning, provides learners with opportunities to practice risk-free clinical decision-making, a feature widely recognized as essential for competency-based training [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, our study advances prior work by systematically integrating SBL into emergency medicine curricula. While traditional simulation models often focus on isolated skill acquisition [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], our approach emphasizes interdisciplinary collaboration and dynamic scenario adaptation. For example, the simulator\u0026rsquo;s integration with ECG monitors and ventilators enabled trainees to experience multi-device management, a critical skill in acute care settings. This aligns with recommendations from Motola et al. (2013), who advocate for immersive, technology-enhanced simulations to replicate clinical complexity [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The observed improvements in teamwork (25.14 vs. 19.10, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and learning motivation (31.53 vs. 26.00, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) further validate the SimMan 3G\u0026rsquo;s role in fostering collaborative learning environments-a cornerstone of modern medical education frameworks [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has limitations. First, the single-center design and homogeneous participant pool (undergraduate trainees) may limit generalizability. Larger, multi-center trials involving postgraduate learners are needed to validate these findings across diverse educational contexts. Second, the short follow-up period (one month) precludes assessment of long-term skill retention, a challenge noted in simulation-based research. Third, while the SimMan 3G offers high fidelity, its inability to fully replicate patient-provider emotional interactions may reduce ecological validity [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Nevertheless, rigorous blinding protocols and validated assessment tools (e.g., OSCE, PORTAAL) strengthen internal validity. The absence of attrition and standardized statistical methods (SPSS 25.0) further mitigate confounding risks.\u003c/p\u003e \u003cp\u003eFuture research should prioritize longitudinal studies to evaluate the durability of competency gains [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Additionally, integrating artificial intelligence (AI) algorithms to personalize simulation scenarios based on learner performance may further optimize training efficiency [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Qualitative investigations into instructors\u0026rsquo; perspectives on balancing simulation fidelity with curricular demands are also warranted [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis work establishes the SimMan 3G as a transformative tool in emergency medicine education. By combining immersive scenario-based learning with interdisciplinary collaboration, this approach not only enhances academic performance but also equips trainees with adaptive clinical judgment essential for high-stakes environments. Its alignment with competency-based paradigms underscores its potential to redefine acute care training globally.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003estructured scenario-based learning (SBL)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp skip=\"true\"\u003eAll methods were carried out in accordance with relevant guidelines and regulations. The study was approved by Ethics Committee of the Second Xiangya Hospital of Central South University . And informed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported in part by a grant from the Changsha Science and Technology Bureau Project [kq2014242], the Natural Science Foundation of Hunan Province of China [2021JJ30959] .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQiyuan Wang: Data curation (lead); Investigation (lead); Validation (lead); Writing \u0026ndash; review \u0026amp; editing (equal). Jiqiang Liu: Formal analysis (equal); Methodology (equal); Resources (equal); Visualization (equal); Writing\u0026ndash;review \u0026amp; editing (equal). Dengke Wu: Conceptualization (lead); Funding acquisition (equal); Writing \u0026ndash;original draft (lead); Writing \u0026ndash; review \u0026amp; editing (equal); Dengke Wu, Xudong Xiang critically reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank AiMi Academic Services (www.aimieditor.com) for English language editing and review services.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWittayer M, Sandikci V, Ebert A, Koehler C, Szabo K, Hoyer C. Epidemiologische Untersuchung zu m\u0026ouml;glichen Auswirkungen \u0026ouml;ffentlicher Kommunikation im Rahmen der COVID-19-Pandemie auf Notfallvorstellungen von Kopfschmerzpatient*innen [Potential Impact of Public Communication on Emergency Presentations due to Headache during the Covid-19 Pandemic]. Gesundheitswesen. 2024;86(3):232-6. doi: 10.1055/a-2146-6286. \u003c/li\u003e\n\u003cli\u003eGosselin M, Mabire C, Pasquier M, Carron PN, Hugli O, Ageron FX, et al. Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study. Intern Emerg Med. 2022;17(6):1803-12. doi: 10.1007/s11739-022-03005-w. \u003c/li\u003e\n\u003cli\u003eDelany C, Kameniar B, Lysk J, Vaughan B. \u0026quot;Starting from a higher place\u0026quot;: linking Habermas to teaching and learning clinical reasoning in the emergency medicine context. 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Emergency Crisis Resource Management de la Sociedad Espa\u0026ntilde;ola de Medicina de Urgencias y Emergencias: curso de gesti\u0026oacute;n en crisis basado en simulaci\u0026oacute;n para estudiantes de ciencias de la salud. Emergencias. 2024;36(1):41-47. doi:10.55633/s3me/010.2023. \u003c/li\u003e\n\u003cli\u003eBarbadoro P, Brunzini A, Dolcini J, Formenti L, Luciani A, Messi D, et al. Stress responses in high-fidelity simulation and standard simulation training among medical students. BMC Med Educ. 2023;23(1):116. doi:10.1186/s12909-023-04101-x.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"SimMan 3G simulation training, emergency department teaching, theoretical knowledge, hands-on skills","lastPublishedDoi":"10.21203/rs.3.rs-6361427/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6361427/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe predominance of critically ill patients in Chinese emergency departments restricts medical students' clinical exposure, leading to insufficient procedural training and possible reluctance to pursue emergency medicine. This research examines whether SimMan 3G simulation training significantly improves theoretical knowledge retention and practical skill performance in emergency clinical education for medical students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eBetween January and June 2024, 241 medical students who received internship training in the emergency department were randomly divided into two groups: a control group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;121) that received bedside teaching and a research group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;120) that received SimMan 3G simulation training. The theoretical performance, practical skills, and satisfaction levels of the two groups of students were compared and analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe enthusiasm for learning in the control group was 86.77% (105/121), significantly lower (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) than that in the research group (96.67%, 116/120). The scores for theoretical knowledge, practical skills, case analysis, and comprehensive quality were all significantly higher in the study group than in the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The satisfaction with teaching was significantly lower (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the control group (85.12%, 103/121) than in the research group (98.33%, 118/120).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe SimMan 3G high-fidelity simulator demonstrates significant potential in optimizing emergency medicine training through structured scenario-based learning (SBL) modules.\u003c/p\u003e","manuscriptTitle":"Enhancing Emergency Clinical Training with SimMan 3G Simulation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 12:45:10","doi":"10.21203/rs.3.rs-6361427/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33b4b0c8-bf3f-4352-a594-49973d92cf65","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-23T10:23:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-13 12:45:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6361427","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6361427","identity":"rs-6361427","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}