The study setting and data sources were developed based on institutional documents of Fujian Medical University maintained through official means for the years 2020–2024. Data sources included institutional teaching and training reports for each academic year, documentation of simulation session reports, faculty development documentation and records, and construction and management documentation of the Medical Simulation Center. Additional supporting documentation was also acquired, which included quality-assurance reports, documentary assessments of student assessments and performance, and assessments of clinical skills. These documents provided a rich source of institutional data for exploring the development, intent, and outcomes of research-based on the Medical Simulation Center in medical education (12–14).

A qualitative narrative synthesis was used for analysis of the institution documents. The narrative synthesis was necessary as it allows for the triangulation of quantitative indicators (e.g., number of simulations or hours of faculty training) with qualitative indicators (e.g., commentaries, policy, reports, or evaluations) into terms. The narrative synthesis intended to elicit significant themes and effective practices relating to infrastructure development, faculty capacity building, curricular alignment, and evaluation systems. The outcomes of thematic analysis of documents are reconstructed in Table 1, with recommendations related to key aspects and educational value of the research Medical Simulation Center that emerged from the study. Using iterative reading techniques and clumping techniques upon themes, effective practices gleaned from the Fujian Medical University model effectively practices, and participating concepts of consensus and widely held international commentary on a framework for medical education, effective practice (15, 16).

The analysis framework provided in the study drew from previous work undertaken as part of the study of Saratila et al. (17) and Romancenco et al. (33); the work found refers to the notion of simulation-based education being an opportunity to enhance the transfer of clinical competencies and to bring together theory-based content and practical applications. These frameworks were claimed and conceptually located in Competency-Based Medical Education (CBME), which outlines measurable outcomes, structured assessment, and the progressive nature of skill acquisition and assessment. The analytical process made sense of institutional reports and commentary into four categories of infrastructure and resources, faculty training and professional development, curricular alignments, and quality assurance networks. The analysis phenomena adhered to the original purpose of current best practices, while ensuring a sound conceptual analysis of the study within CBME (18–22).

No human or animal subjects participate in this study. All data were harvested from research-based documents held at Fujian Medical University, which did not compromise the confidentiality of participating human subjects, nor did the documents constitute any identifiable information about individuals used as data sources. This study did not contrive formal ethics committee recommendations; consequently, all facets of the process of data collection and analysis adhered to policies of the Fujian Medical University and Chinese national guidelines for transparency in educational research and confidentiality of research projects (23, 24).

Between 2020 and 2024, the Medical Simulation Center at Fujian Medical University reached several significant milestones to advance simulation-based education. During this time, the number of simulation-based training labs increased from 8 to 14 in key areas, including emergency medicine, surgical skills, obstetrics and gynecology, and nursing. Regarding utilization, the increase in student participation grew from about 1,200 to more than 2,800 students per year, a growth of 133%. Additionally, the summers of 2023 include a successful institutional accreditation from the Fujian Provincial Department of Education, which recognized it as a program of best practices using competency-based medical education. In the summer of 2024, the center coordinated formal agreements with 2 regional teaching hospitals to begin to standardize simulation curriculum for clinical students to ensure equitable exposure (10–12).

The systematic implementation of simulation training has resulted in measurable increases in student performance and satisfaction. Institutional data indicated that students who participated in at least three modules improved Objective Structured Clinical Examination (OSCE) scores between 15 and 20% above baseline scores (13, 14). Faculty also commented on an observable increase in accuracy when completing procedures, and also noted a reduction in demonstrating common technical errors during clinical placements. In more depth, for example, student satisfaction surveys (n = 650) collected in the summer of 2023–2024 indicated 94.3% of the students agreed that simulation helped students feel more confident in their skills, and 89.6% of students improved in timing and team communication after simulation training. After the internal “Simulation Instructor Development Program” was implemented, faculty involvement increased by 45% demonstrating greater institutional capacity (15, 16, 18).

To increase realism and learner engagement, the Medical Simulation Center has added digital tools that utilize the latest technology. This includes high-fidelity manikins for critical care training, virtual-reality (VR)-assisted surgical modules, and AI-assisted learning performance tracking systems. In addition to the educational residency program, more than one-third of simulation sessions involved the use of VR and AI by 2024, which adhered to worldwide standards for adaptive learning and learners’ personal skills assessment (19, 20). Student comments confirmed that technology was effective in enhancing engagement and scenario recall by over 30 % compared to non-electronic learning experiences.

To ensure consistency in evaluations of students, the institution adopted standardized evaluation tools, including OSCEs, Direct Observation of Procedural Skills (DOPS), and structured debriefing protocols. Accreditation requirements were aligned with standards established by the Society for Simulation in Healthcare (SSH) and the International Nursing Association for Clinical Simulation and Learning (INACSL) to ensure a worldwide perspective and authority of credibility.

Between the years of 2021 through 2024, the institution performed annual internal audits, and over 90% compliance was achieved to establish safety and scenario integrity, as well as learning evaluations (21–23).

Interprofessional education (IPE) was achieved, and all curricular elements embrace collaborative activities where medical students and the school of nursing and pharmacy, and rehabilitation science education programs are represented. From 2022, the institution implemented team-based simulation sessions focused on scenarios of emergency response, perioperative collaboration, and patient communication.

Survey data demonstrated that 92% of respondents reported increased interprofessional understanding, and team performance during simulation multi-role scores increased by, on average, 18%. All evidence suggested that the Model was capable of strengthening teamwork and reducing team variability across professions (24–26).

To better ensure continued sustainability, in 2024, the center established a “shared-resource consortium” with three partnered teaching institutions providing risk-shared access to the simulator and educator resources. This consortium decreased the relative costs of simulator learning by approximately 28% per student while increasing accessibility of simulation learning experiences in rural teaching sites.

The educators also established the “Train-the-Trainer” program with the primary purpose of expanding the number of qualified instructors from 15 to 29 certified simulation educators within 2 years. As a result of the shared-resource consortium and the train-the-train program, the simulation program was established to promote ongoing maintenance and expansion for both education and clinical contexts.

The combination of long-term budget and financial planning and agreements to share resources elevates the Fujian Medical University Medical Simulation Center into a scalable and replicable model for medical education reform.

The center successfully obtained institutional accreditation from the Fujian Provincial Department of Education in 2023, recognizing it as a model for competency-based medical education. In 2024, the center-initiated a collaboration with two regional teaching hospitals to standardize simulation curricula, ensuring consistent exposure for clinical students (10–12). A summary of key institutional outcomes from 2020 to 2024 is presented in Table 2.

This study’s findings correlate well with the current literature available on simulation-based medical education. Saratila et al. (17) discussed that simulation-based learning results in significantly improved skill transfer and decision-making, which absolutely correlates with improvements in performance on the OSCE and with the student satisfaction measured in this study. Romancenco et al. (33) also highlighted faculty training and standardizing training scenarios as key ingredients to the quality of simulation programs, which was observed in this study as the model made incredible approaches through the “Simulation Instructor Development Program.” Furthermore, the reference to sustainability and interprofessional learning expands the work of Romancenco et al. (33), who suggested inter-institutional partnerships and shared resources to promote efficiency and sustainability for longer periods. By introducing a consortium framework, the model demonstrated how Fujian Medical University is utilizing partnerships in the region to maximize resources while taking care to maintain the quality of training (24–26).

On the other hand, the current study distinctly discusses the institutional management aspects, or administration, in utilizing alignment and ongoing quality checks to strengthen the effectiveness of learning.5.2 Implications for Institutions.

The Fujian model offers a replicable approach to Medical Simulation Centers, especially for medical schools in underdeveloped or resource-limited environments. Its integrated framework—across infrastructure, faculty, and curriculum—represents a well-balanced model for the institution that seeks to adopt competency-based medical education (CBME).

The findings demonstrate that ongoing faculty development, structured evaluation, and interprofessional training are all important to creating practice-ready outcomes for graduates. Evaluation systems that integrated accreditation required assessments suggested a shift from simulation being just a form of teaching, but now it has developed into the institution’s strategic asset.

Additionally, achieved 28% cost savings of the consortium model and generated enough certified educators, suggesting that institutional growth is sustainable without sacrificing educational quality, and provides a scale model (18, 27).

There are limitations to this study despite its strengths. It was a single-center descriptive study, rather than multi-center comparative work, reliant on reports at the institution rather than comparative multi-center data. Therefore, while the findings give insight into structural and pedagogical effectiveness, the findings apply to the local context and need to be interpreted with caution.

The study lacked a longitudinal cohort for validating outcome measures for extending outcomes from simulation training into clinical practice.

Finally, the data in this study were primarily descriptive; theoretical performance was limited to fractionating and statistical summarizing, and future research aims should incorporate mixed methods or quasi-experimental designs to clarify or develop stronger causal links (17, 28, 29).

Novel technologies, such as virtual reality (VR) or artificial intelligence (AI), and tele-simulation, are changing medical education in a global context. Implementation of these modalities can support educational experiences by enhancing realism, differentially adapting training levels while maintaining forward progress, and extending access to remotely located learners.

In a Fujian context, implementation of performance analytics could further individualize simulation learning based on overall performance trends, and tele-simulation could create space for inter-campus center training across entities (7, 30–32).

In the future, as education evolves, simulation-based learning will establish a back-and-forth relationship between technological technology and pedagogical integrity. Institutions will still need to be learner-focused, making sure that simulation is a complement—not a substitute for clinical experience.