Integrating simulation-based training into a problem-based learning framework to improve knowledge of anaphylactic shock management: a randomized educational intervention study

Training interns to manage acute emergencies effectively remains challenging, particularly in resource-limited primary care settings. Although Problem-Based Learning (PBL) promotes clinical reasoning, it may be insufficient for developing practical emergency management skills. Simulation-based training provides experiential learning opportunities; however, evidence on integrating simulation into PBL for emergency training in primary care contexts remains limited. This study evaluated the effectiveness of integrating simulation-based training into PBL for improving interns’ knowledge and knowledge gains for managing anaphylactic shock. Fifty-four pre-graduation medical and nursing interns undergoing emergency medicine rotations were recruited and organized into interdisciplinary teams consisting of one physician and two nurses. All participants first completed a pre-test and learning needs assessment, followed by a brief One-Minute Preceptor (OMP) session. Participants were then randomly assigned to either a control group or an intervention group. The control group received OMP plus structured PBL instruction, whereas the intervention group received simulation-based training integrated into the PBL framework, followed by Plus–Delta reflective debriefing. Simulation scenarios were designed to reflect resource-limited primary care settings and emphasized teamwork and key treatment procedures. Knowledge acquisition was assessed using structured written examinations before and after training. Both groups demonstrated significant improvement in post-training scores compared with baseline ( p <0.05). However, the intervention group achieved significantly greater score improvements than the control group. Before training, interns reported the greatest uncertainty regarding clinical manifestations (42.6%) and treatment strategies (40.7%) of anaphylactic shock. Baseline scores for treatment implementation and teamwork were relatively low, but improved markedly after training, particularly in the intervention group. Additionally, approximately two-thirds of participants assigned themselves lower scores than instructors during simulation-based formative assessment. Integrating simulation-based training into PBL was associated with improved knowledge of treatment implementation and teamwork principles in anaphylactic shock management. This simplified, resource-adapted educational model provides opportunities for experiential practice and reflective learning and may offer a feasible approach to emergency education in resource-limited primary care settings.