Impact of Hands-on Pediatric Emergency Training: A Prospective pre–post interventional study on Wound Suturing, Airway Management, and Orthopedic Casting Skills. (Preprint)

BACKGROUND Opportunities to practice high-stakes pediatric emergency procedures (airway management, wound suturing, and orthopedic casting) in real settings are limited. A focused, well structured hands on workshop (Basic Emergency skills techniques workshops BEST 3N1) was implemented to improve knowledge and procedural competence among pediatric emergency practitioners in Saudi Arabia. We aimed to evaluate pre–post changes in knowledge, station-based procedural performance, and free-text–scored competence following a three-day hands-on course. OBJECTIVE Our study evaluates the impact of a structured, hands-on training program covering wound suturing, airway management, and orthopedic casting on the knowledge and procedural skills of pediatric emergency practitioners in Saudi Arabia. METHODS Design, Setting, and Participants: Prospective before–after evaluation conducted under the Prince Sultan Military Medical City ( PSMMC ) BEST 3N1 Scientific Committee at the Medical Skills and Simulation Center, Princess Nourah bint Abdulrahman University, Riyadh. Analyses used complete pre–post pairs per assessment: Day 1 suturing skill techniques (n=88), Day 2 Airway management skills (n=77), Day 3 Emergency Orthopedic casting skills (n=77), and 30-item knowledge test (n=94). Intervention: Standardized hands-on curriculum in three domains, wound suturing and care, airway management, and orthopedic casting, delivered by a multidisciplinary faculty. Outcomes and Analysis: (Day1) Suture skills Station-based 4-item procedural checklists (0–8 totals). (Day2) airway management skills used an analogous 4-item checklist in a second domain, summarized on the same 0–8 total scale. (Day 3) orthopedic casting skills keyword-rubric scores for equipment, steps, and post-care (0–10 each; total 0–30). 30-item multiple-choice test (total score). Primary analyses used Wilcoxon signed-rank for non-normal differences; paired t-tests with Cohen’s dz were sensitivity analyses. Item-level binary changes used McNemar tests; multiple testing on knowledge items used Benjamini–Hochberg FDR 5%. α=0.05 (two-sided). RESULTS Results: Day 1 totals increased from 4.14 ± 1.72 to 7.72 ± 0.68; mean gain 3.58 (Wilcoxon p=0.001; paired t(87)=19.67; p < 0.001, 95% CI 3.22–3.94; dz=2.10). “Done well” proportions rose markedly in micro-skills (instrument holding 25.3%→95.6%). Day 2 totals rose from 5.47 ± 1.88 to 7.81 ± 0.56; mean gain 2.34 (Wilcoxon p≤0.05; paired t(76)=10.48; p < 0.001, 95% CI 1.89–2.78; dz=1.19). Day 3 total competence improved from 4.20 to 6.39; mean gain 2.19 (paired t(76)=11.16; p < 0.001, dz=1.27), with component increases in equipment (+0.74), steps (+0.94), and post-care (+0.51) (all p<0.001). Knowledge scores improved from 19.04/30 (63.5%) to 22.32/30 (74.4%); mean gain 3.28 (95% CI 2.16–4.39; t(93)=5.82; p=0.001); 7/30 items remained significant after FDR correction. CONCLUSIONS A short, practical pediatric emergency workshop significantly improved participants’ knowledge, skills, and performance, especially in areas where their initial ability was weakest. Findings support blended, simulation-based curricula for high-acuity, low-frequency pediatric procedures. CLINICALTRIAL Ethical Approval This study was reviewed and approved by the Institutional Review Board (IRB) of Prince Sultan Military Medical City, Riyadh, Saudi Arabia. The research protocol was granted ethical approval under IRB Approval No: E-2598, dated 24 June 2025. The approval is valid for one year from the date of issue .