# Simulation-based education in paramedic training: effects of perceived competence and practice frequency on clinical skills

## TL;DR

This study shows that simulation-based training significantly improves paramedic students' clinical skills and self-confidence through repeated practice.

## Contribution

The study demonstrates the effectiveness of simulation-based education in paramedic training, emphasizing the role of practice frequency and perceived competence.

## Key findings

- Simulation-based education led to significant improvements in all clinical skills with very large effect sizes.
- A strong positive correlation was found between practice frequency and perceived competence.
- High success rates were achieved in critical procedures like intubation and defibrillation after training.

## Abstract

Simulation-based education is increasingly used in health professions training to strengthen clinical competence and self-efficacy. Paramedic students, in particular, need repeated practice opportunities to acquire essential intervention skills. Limited exposure to clinical scenarios may reduce their perceived competence and procedural success. This study aimed to evaluate the effectiveness of simulation-based training in improving paramedic students’ clinical skills and to examine the impact of perceived competence and practice frequency on performance outcomes.

A single-center, one-group pretest–posttest quasi-experimental design was employed with 60 students enrolled in the Paramedic Program of a public university in Türkiye. Data were collected using researcher-developed forms measuring demographics, training-related evaluations, perceived competence, and frequency of practice, with these variables assessed using Likert-type items. Eight procedural skills were assessed through structured observation based on standardized guidelines. Statistical analyses included descriptive statistics, paired samples t-tests, Wilcoxon signed-rank tests, and Spearman correlation analysis.

Before training, most students had limited or no experience with core interventions, and their success rates were low. Following simulation-based education, statistically significant improvements were observed in all skills (p < 0.001), with a very large effect size for the increase in practice frequency (Cohen’s d = 2.94). A 100% success rate was achieved in oxygen administration and fracture stabilization, with notable gains in advanced procedures such as intubation (90%), life support (81.7%), defibrillation (76.7%), and cardiac arrest management (75%). Perceived competence scores increased significantly (p < 0.001). A positive correlation was found between frequency of practice and perceived competence, with a correlation coefficient of Spearman’s r = 0.303 (p = 0.019).

Simulation-based education is effective in enhancing paramedic students’ clinical performance, practice frequency, and self-perceived competence. These findings provide practical guidance for curriculum planners by supporting the structured integration of high-fidelity simulation, repeated practice opportunities, and simulation-based assessment methods into paramedic education programs. However, given the single-group pretest–posttest design, the findings should be interpreted with caution regarding causal inference.

Not applicable.