Simulation-based learning (SBL) has emerged as a transformative approach in medical education, recreating real-life scenarios to provide a controlled, risk-free environment for developing clinical skills, critical thinking, and decision-making competencies (1). With roots in aviation and military training, SBL has become a cornerstone of modern healthcare education, effectively bridging the gap between theoretical knowledge and clinical practice. This value is further underscored during the COVID-19 pandemic, when traditional clinical training was disrupted (2). Its adoption spans diverse disciplines, from anesthesiology to emergency medicine, driven by evolving clinical practices, time constraints in training, and heightened medicolegal awareness (3, 4). Simulations vary in complexity and fidelity, ranging from low-tech task trainers for intravenous catheterization to high-fidelity manikins capable of mimicking physiological responses, such as breathing, pupillary reflexes, and drug interactions (5). These tools are deployed in simulation centers, in situ settings, or remotely, tailored to meet specific learning objectives (6, 7). Studies consistently highlight SBL’s efficacy in enhancing technical proficiency, reducing medical errors, and improving patient outcomes, while its cost-effectiveness encourages the implementation of structured, phased programs that optimize resource utilization (8).

Postgraduate medical education, particularly in high-stakes fields like emergency medicine, has increasingly integrated SBL to address the limitations of traditional apprenticeship models. For emergency medicine, where rapid decision-making is paramount, trauma-focused simulations have proven effective in closing experience gaps, particularly in resource-limited settings (9). Residency programs demand not only procedural expertise but also competencies in crisis management, interdisciplinary communication, and leadership, skills ideally cultivated through repetitive, feedback-driven simulations (10). Illustrative of this approach, Beirut University’s emergency medicine curriculum implements a structured 12-h simulation program based on Kern’s model, which is tailored to teach foundational skills to junior residents and advanced resuscitation and team management to senior trainees (11). However, challenges persist, including insufficient instructor training, financial constraints, and technological barriers, as evidenced in Canadian programs where these factors hinder broader implementation (12).

Curriculum development for SBL requires systematic frameworks to ensure alignment with educational goals. Kern’s six-step model, encompassing needs assessment, objective setting, content design, stakeholder engagement, implementation, and evaluation, provides a robust structure for creating context-specific, learner-centered programs (13). Its iterative nature allows for continuous refinement based on multimodal feedback, including self-assessment, observational data, and neurophysiological metrics (14). This study aims to design and evaluate a simulation-based curriculum for emergency medicine residents, utilizing Kern’s model to address identified gaps in procedural and non-technical skill training. By synthesizing evidence on SBL’s pedagogical strengths, cost considerations, and adaptability, the program seeks to enhance clinical readiness while navigating implementation challenges. The findings will contribute to the growing body of research on optimized simulation training frameworks, ultimately supporting safer, more competent healthcare delivery.

This study explored the development and initial implementation of a simulation-based curriculum systematically designed using Kern’s model and investigated its perceived utility for addressing both technical and non-technical skills among emergency medicine residents. Our findings suggest that multi-patient simulations were perceived by participants as effective in replicating high-pressure emergency environments, which aligns with prior studies emphasizing their role in practicing task-switching, prioritization, and crisis management skills (22, 23). Participants reported that the structured debriefing sessions were a critical component, facilitating the transformation of experiential shortcomings into learning opportunities, fostering self-awareness, and providing a forum for recalibrating clinical reasoning (24, 25). The qualitative data indicated that the perceived benefits of this simulation exercise extended beyond procedural proficiency to include empathy, leadership, and resilience in high-stakes situations.

Participants reported stress levels akin to real emergencies, with novices citing simulation inexperience as a compounding factor. While stress increased motivation for pharmacological and procedural review (26), it also prompted defensive practices such as unnecessary imaging in pediatric trauma, reflecting broader malpractice-driven overtesting trends (27). Simulation’s capacity to replicate these pressures offers a safe space to address defensive behaviors, as noted by Guraya et al. (28), who advocate for targeted scenarios to recalibrate clinical decision-making. In parallel, the ectopic pregnancy scenario highlighted participant-identified challenges in maintaining empathy and nonjudgmental communication amid cultural stigma, underscoring the value of culturally immersive simulations (29). Similarly, challenges in managing agitated families during pediatric cases highlight the need for advanced communication training, a gap previously identified in Canadian emergency programs (30).

Leadership and team coordination emerged as critical competencies, with senior residents demonstrating superior crisis resource management. This aligns with previous reports that link effective leadership to reduced medical errors in emergencies (31). Post-simulation debriefings were pivotal in reinforcing these skills, as participants reported improved self-awareness and strategies for workload distribution, consistent with previous findings (32). However, the persistence of stress-induced automaticity in some learners suggests the need for repeated simulations to entrench adaptive behaviors (33).

A key strength of this study is its rigorous, multi-phase development process grounded in Kern’s established curricular framework (13). Participants perceived the use of complex, multi-patient scenarios as reflective of the cognitive demands and contextual challenges encountered in real emergency department settings. In addition, the mixed-methods design supported an in-depth exploration of the learning experience by situating qualitative focus group findings within the broader curriculum development process.

This study has several limitations. The implementation phase involved a small sample of residents from a single institution, with no control group or baseline assessments, limiting generalizability and the ability to attribute perceived improvements solely to the simulation. The reliance on self-reported data from focus groups and debriefings introduces potential social desirability bias and reflects short-term perceptions rather than objective or longitudinal outcomes. Consequently, the long-term effects on clinical behavior, patient outcomes, and skill retention remain unknown. Although the scenarios were designed to approximate real clinical environments, inherent differences between simulation and practice may limit direct transferability, and results may vary with alternative simulation modalities or scenario designs. Notably, the exclusion of certain high-risk scenarios, such as environmental injuries, toxic exposures, and psychiatric emergencies, by local experts contrasts with recommendations that advocate for their inclusion due to their alignment with rare but critical events (34). This discrepancy may reflect localized prioritization of clinical needs or gaps in regional expertise, underscoring the need for context-sensitive curriculum design (35).

For clinical educators, this study provides a validated, practical blueprint for implementing a simulation-based curriculum that addresses critical competencies beyond medical knowledge. Emergency medicine training programs can adopt similar multi-patient, scenario-based exercises to safely expose residents to high-stress decision-making, ethical dilemmas, and communication challenges (35). This approach directly prepares trainees for the realities of clinical practice, potentially reducing errors and enhancing patient safety by building confidence and competence in a risk-free environment.

While participants reported improvements in technical and non-technical skills, its impact on long-term behavioral change remains uncertain. As Tremblay (36) cautions, stress exposure alone does not guarantee knowledge retention or real-world application. Furthermore, the mixed attitudes toward simulation efficacy among some participants, particularly those resistant to altering entrenched practices, echo Schepper et al. (37), who identify institutional culture as a barrier to transformative learning. Future studies should explore longitudinal outcomes, including patient care metrics and malpractice rates, to validate the simulation’s translational benefits.

This study explores the potential value of simulation-based learning in postgraduate emergency medicine education, consistent with literature demonstrating its benefits for resuscitation skills, crisis resource management, and patient safety. Using expert consensus and the Delphi method, a context-specific simulation program was developed to address emergency training needs in Türkiye. Participants identified multi-patient simulations as particularly effective for preparing for high-stress, multitasking environments and for strengthening non-technical skills such as leadership, teamwork, and communication. Unstructured debriefings were identified as supporting reflective learning and identification of skill gaps, while the integration of ethical dilemmas enhanced perceived competence in managing complex decisions related to confidentiality and informed consent. These findings suggest that well-structured simulations may help cultivate resilient, patient-centered practitioners by addressing competency gaps, ethical challenges, and systemic stressors. However, success hinges on contextual adaptability, robust debriefing frameworks, and alignment with evolving clinical demands. As healthcare complexity grows, simulation must remain dynamic, bridging the chasm between theoretical rigor and the chaotic reality of emergency care.