Structured simulation-based education in emergency medicine residency programs: Pavia’s proposal for competence development and crisis management (Italy)

The growing complexity of Emergency Medicine (EM) - due to overcrowding, boarding, and the expanding social role of emergency departments - requires standardized and structured training models. Simulation in medicine is essential for education, training, and improving patient care. Italian EM residency programs face additional challenges, including variable training quality and limited access to simulation-based education. To address these issues, the University of Pavia has developed a five-year simulation curriculum integrated into its EM residency program. This study presents this model and evaluates its alignment with national and European standards. A descriptive comparative analysis was conducted by aligning the curriculum's learning objectives and simulation activities with the European Society for Emergency Medicine (EUSEM) Core Curriculum and the guidelines set by the Italian Ministry of Education (MIM), incorporating feedback from national associations. Each competency was classified independently as fully, partially, or not covered. The goal of this model is to standardize training quality, increase preparedness for complex emergencies, and promote a reflective professional culture. The curriculum includes more than 25 simulation sessions each year, progressing from foundational procedural and cognitive skills (Years 1–2: ultrasound, ventilation, suturing, ACLS-like scenarios) to complex interdisciplinary simulations (Years 3–4: trauma, pediatrics, resuscitation), culminating in advanced training covering leadership, ethics, medico-legal aspects and maxi-emergencies (Year 5). Training modalities include high- and low-fidelity simulations, peer-to-peer learning, and 3D-printed skill trainers. Feedback is collected after each session and annually. Facilitators are certified through SIMMED, EEDUSIM, and other accredited programs, and they undergo regular retraining. The curriculum has achieved 95% alignment with European standards and 100% alignment with Italian standards. The only gaps identified are in a few procedures, such as Extracorporeal Membrane Oxygenation and Resuscitative Endovascular Balloon Occlusion of the Aorta. Simulation-based education fills critical gaps in EM training, especially in non-technical skills, procedural readiness, and crisis decision-making. The Pavia model, although developed in a single center, aligns with national and international standards. Its innovative features, such as the use of 3D printing, integration within clinical training, and potential collaboration among different EM residency programs, suggest that it is a scalable proposal for national adoption. Broader implementation could support standardization in EM, make the specialty more attractive, and improve workforce preparedness in Italy.