SST in Emergency Education

Clinical clerkship in emergency medicine represents a critical transition period for medical students, bridging the gap from theoretical knowledge to practical application. The traditional "didactic lecture + bedside teaching" model has the investigatorsll-documented limitations, including disconnection betthe investigatorsen theory and practice, passive student engagement, and insufficient training in clinical reasoning.

In recent years, innovative pedagogical models-such as the Flipped Classroom (FC) combined with the SNAPPS structured clinical reasoning framework, and Case-Based Scenario Simulation Teaching (CBSST)-have demonstrated promising outcomes in emergency and critical care medical education. While traditional lecture-based instruction falls short in fostering active learning and critical thinking, case-based scenario simulation immerses learners in highly realistic clinical contexts, enabling interns to experience the urgency of emergency care before actual clinical practice and to master the core elements of team-based resuscitation.

Entrustable Professional Activities, EPAs has gained increasing recognition in healthcare training. Simulation-based collaborative training betthe investigatorsen medical and nursing students improves role clarification, facilitates task coordination, and narrows knowledge-system gaps betthe investigatorsen disciplines. Hothe investigatorsver, existing studies have largely focused on general clinical skills rather than specifically targeting CPR scenarios involving collaborative medical-nursing intern teams. Furthermore, there is a paucity of systematic evaluations regarding the effectiveness of case-based scenario simulation in this specific context.

Previous single-center randomized controlled trials have shown that the FC+SNAPPS model significantly improves interns' theoretical knowledge, Mini-CEX clinical core competencies (history taking, physical examination, clinical assessment, and clinical judgment), and teaching satisfaction. Similarly, CBSST has been shown to simultaneously enhance theoretical scores, procedural skills, clinical judgment, and teamwork among medical and nursing interns during CPR training. Nevertheless, current research remains limited in several aspects:

• Limited evaluation dimensions: Most studies rely on immediate theoretical examinations and Mini-CEX skill scores as primary outcomes, lacking assessment of whether trainees "can be trusted to perform professional activities independently"-a core competency indicator.
• Insufficient model comparison: Existing studies predominantly compare a single innovative model against conventional instruction, with little direct comparison betthe investigatorsen different innovative models or exploration of synergistic effects.
• Limited external validity: Single-center, small-sample designs restrict generalizability.
• Unknown long-term effects: There is a lack of longitudinal follow-up regarding knowledge retention, skill maintenance, and clinical entrustment decision-making capacity.

Entrustable Professional Activities (EPAs) represent a competency-based core assessment framework in medical education, emphasizing supervising physicians' entrustment decisions regarding whether a learner can independently execute a specific clinical activity. EPA evaluation extends beyond "can they do it" (knowledge and skills) to encompass trust and behavioral competence, aligning closely with the high-risk, practice-intensive nature of emergency medicine. Incorporating EPA as a guiding evaluation tool can compensate for the limitations of traditional Mini-CEX in assessing "independent decision-making and responsibility-bearing," thereby providing more clinically practical evidence for teaching model reform.

Inclusion criteria

• First-time clinical internship;
• No prior BLS certification;
• Attendance rate ≥ 90%.

Exclusion criteria

• Leave of absence ≥10% during the training period;
• Withdrawal from the study for other reasons after enrollment.