Corresponding author: Anan K Al Badawi, (Itqan, Hamad Medical Corporation, — Aalbadawi1@hamad.qa
Submitted: 10 Sep 2025 · Accepted: 13 Jan 2026
Paramedics face unique challenges when managing paediatric emergencies due to limited clinical exposure, insufficient training, the unpredictable prehospital environment, and scarce resources [1]. These factors increase anxiety and medical error risk, especially during rare, high-stakes events [2]. Simulation-based education (SBE) provides a safe, controlled environment that bridges the gap between knowledge and practice by allowing learners to rehearse decision-making and technical skills.
This review assesses the current state of paediatric simulation literature, evaluates the effectiveness of SBE in paramedic training using the Kirkpatrick evaluation framework, and identifies directions for future research.
A comprehensive search was conducted across PubMed, PsycINFO, CINAHL, ERIC, and Scopus for studies published between 2003 and 2023, using keywords and MeSH terms related to paramedics, prehospital care, paediatrics, and simulation. The review followed PRISMA 2020 guidelines, and methodological quality was appraised using the Joanna Briggs Institute checklists. Studies were categorised according to the four Kirkpatrick levels.
A total of 227 articles were identified, and upon removing duplicates, 184 were screened, and 60 were assessed for eligibility, following which 46 were excluded. In the remaining 14 studies, the use of SBE was generally reported to have had a positive impact on paramedics’ confidence and competence in performing several procedures (Table 1). Several studies reported that paramedics often felt uncomfortable providing care to children, made fewer errors, and wished they had more such training opportunities. No studies reported on how the training interventions contributed to improving actual patient care to fulfil the criteria of Kirkpatrick level 4. The full details of the findings have recently been reported [3].
| Study Focus – Findings Summary | Number of Studies | |
|---|---|---|
| Kirpatrick Level 1 | Participants’ reaction: High rating of simulation-based courses, wish for more regular and improved pediatric training opportunities using highly realistic simulation, appreciation for interprofessional collaboration. Perceived improved comfort in performing specific airway management procedures, such as needle cricothyrotomy. | 3 |
| Kirpatrick Level 2 | Knowledge acquisition: Increased knowledge assessment scores and higher reported level of confidence in treating pediatric patients, and improved triage assessment accuracy skills. | 11 |
| Kirpatrick Level 3 | Behavioural changes: Observed better adherence to specific protocols, enhanced skills in laryngeal mask airway insertion, improved teamwork and management of pediatric emergencies, and a reduction in errors. | 4 |
| Kirpatrick Level 4 | Benefits for patients: No study designed to evidence this level of impact. | 0 |
Simulation shows promise in improving paramedics' readiness for paediatric emergencies, especially knowledge, skills, and confidence. Future studies should use longitudinal designs to determine whether simulation training improves patient safety and clinical outcomes.
1. Itqan Clinical Simulation and Innovation Center, Hamad Medical Corporation, Doha, Qatar
2. Independent Education Consultant, Doha, Qatar
3. Hamad Medical Corporation Ambulance Service, Doha, Qatar
4. Weill Cornell Medicine-Qatar, Doha, Qatar
5. School of Health, Medicine, and Life Sciences, University of Hertfordshire, Hatfield, UK
6. Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
All authors contributed equally and validated the final version of record.
This work was primarily conducted by the first author as part of his Master in Medical Education with Dundee University, Scotland
The Authors declare that there is no conflict of interest.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
No registration applicable.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Ethical approval for this study was not required.