Building Trauma Care Capacity through multidisciplinary Simulation in Nepal: descriptive mixed- methods educational research

In many parts of the world, a serious injury is a race against time where the difference between life and death often depends on how quickly and correctly a medical team responds. Trauma, caused by falls, vehicle crashes, and other accidents, remains a leading cause of death and disability, particularly in nations where medical resources are stretched thin. For decades, global health experts have developed structured ways to teach doctors and nurses how to handle these emergencies, but bringing these methods to places with limited equipment and funding has been a persistent challenge. One powerful approach involves simulation-based education, a training method where healthcare workers practice on realistic models and in controlled scenarios rather than on actual patients. This allows teams to make mistakes, learn from them, and refine their communication without risking anyone's safety. Another key concept is the idea of multidisciplinary training, where doctors, nurses, and other staff learn to work together as a single unit, understanding each other's roles before a crisis ever strikes. When these two ideas combine, they offer a way to build a stronger, more coordinated response to injury, even in settings where high-tech tools are scarce.

In April 2025, a team of researchers in Nepal put this combination to the test for the first time in their country. They organized a hybrid training program that brought together physicians, nurses, and paramedics to learn two of the world's most respected trauma courses: one for doctors and one for nurses. The goal was not just to teach the steps of treating an injured person, but to see if this specific style of learning—mixing online lessons with hands-on practice in a simulated emergency room—could actually change how confident these professionals felt about their abilities. The study took place at a large teaching hospital east of Kathmandu, a facility that serves as a major referral center for trauma cases. The researchers wanted to know if the participants liked the training, if they felt more capable afterward, and what specific parts of the experience worked best or needed improvement.

The training itself was designed to mirror the chaos and pressure of a real emergency. Participants first studied the core principles online, covering the basics of trauma care. Then, they gathered in person for intensive sessions where they worked in mixed teams to manage simulated patients. These scenarios involved manikins representing people with various injuries, from broken bones to severe bleeding. The teams had to perform critical tasks like securing an airway, stopping blood loss, and stabilizing the spine, all while communicating clearly under time pressure. After each simulation, the group sat down for a debriefing, a structured conversation where they reflected on what went well and what could be better. This feedback loop is considered the engine of learning in simulation, turning a practice run into a deep educational experience. The researchers surveyed the participants immediately after the course to measure their satisfaction and their self-reported confidence in eight specific skills, ranging from the initial assessment of a patient to the complex task of inserting a needle into the chest to relieve pressure.

The results showed that the approach worked remarkably well. Out of the forty-three people who attended the training, thirty-seven completed the survey, representing a high response rate. Nearly all of them, ninety-two percent, rated the course as very good or excellent. They felt the learning objectives were clear and that the content met their needs. More importantly, their confidence levels jumped significantly across every single skill area they were tested on. Before the training, participants rated their ability to manage trauma on a scale of one to five, with one being not confident and five being very confident. After the course, their average scores rose noticeably in every category. The biggest improvements were seen in technical procedures like inserting a needle or tube into the chest and managing the airway, but even the softer skills, such as teamwork and communication, saw a strong increase. The participants felt they were better prepared to lead a team and make decisions during a real emergency.

Beyond the numbers, the stories the participants shared revealed why the training felt so effective. They described the hands-on practice as the most valuable part, noting that it bridged the gap between reading about a procedure and actually doing it. The realistic nature of the simulations, where they had to work together under pressure, helped them understand how their roles fit into the larger picture of patient care. Many mentioned that the debriefing sessions were crucial, providing a safe space to reflect on their performance and clarify their thinking. However, the feedback was not without its critiques. Participants pointed out that the course felt too short, leaving them wanting more time to practice complex procedures. They also noted that the equipment, while helpful, was not always as advanced as they would have liked, which sometimes limited the realism of the scenarios. Despite these hurdles, the overall sentiment was one of deep gratitude and motivation. Many expressed a strong desire for more frequent training opportunities in Nepal, recognizing that this kind of preparation could save lives.

The study concluded that simulation-based training is not only possible in a low-resource setting like Nepal but is also highly effective at building confidence and teamwork. The researchers found that the mix of online learning and in-person simulation allowed them to maximize the time spent on practical skills while keeping logistical demands manageable. The success of bringing doctors, nurses, and paramedics together to learn as a team highlighted the importance of breaking down professional silos, a critical factor in emergency care where split-second coordination is essential. While challenges remain, such as the need for more time, better equipment, and a sustainable way to fund future courses, the path forward is clear. By adapting these training models to local needs and continuing to invest in faculty development, Nepal can strengthen its trauma care system. The findings suggest that with the right approach, even resource-limited environments can cultivate a highly skilled, coordinated workforce ready to handle the most critical injuries.