High-Frequency Simulation-Based Assessment to Improve Clinical Competence in Paramedicine Education

Background: Clinical competence is essential for paramedicine graduates, who must make rapid, high-stakes decisions in unpredictable environments. Ensuring students reach a practice-ready standard requires structured, evidence-informed assessment strategies. Although simulation-based education is widely used, few studies have explored how high-frequency simulation combined with structured performance-based assessment (PBA) tracking supports competence development over time. Aim: The aim was to determine the effect of high-frequency simulation with structured formative assessment on developing simulation-based clinical competence and summative practical exam outcomes in paramedicine education. Methods: This secondary analysis examined 2024 performance data from 2 undergraduate paramedicine courses at Griffith University. High-frequency simulation was combined with graded formative PBAs to support competence development. Weekly simulations were assessed using the Clinical Competence Assessment Tool (CCAT), providing real-time grading and structured feedback. Associations between formative performance and summative practical exam outcomes were analyzed using paired t tests, mixed ANOVA, and hierarchical regression. Ethics approval was granted (GUHREC: 2024/073). Results: Students completed an average of 4.6 simulations (SD=1.4 and 1.7), with 222 simulations recorded in second year (n=48) and 187 in third year (n=41). Both cohorts showed significant improvement in mean practice scores over time, with higher final exam scores observed ( P <0.05). Practice frequency had incremental effects on performance over time ( P <0.05) and was an independent predictor of exam outcome (B=3.46, P <0.05). Conclusions: High-frequency simulation with structured PBA tracking significantly improves competence and exam performance. This scalable formative strategy supports accreditation standards in paramedicine education.