Abstract:

Background:
Leadership is a fundamental competency in modern healthcare, yet its development is often underrepresented in undergraduate medical education. Simulation-Based Medical Education (SBME) offers a dynamic and safe environment for students to engage in realistic clinical situations that foster decision-making, teamwork, and self-reflection. Despite growing evidence of its benefits, few studies have evaluated the impact of simulation combined with structured debriefing on leadership development among medical students. This study aimed to assess the effect of a brief simulation-based intervention, followed by structured debriefing using the PEARLS framework, on students’ self-perceived leadership competencies.

Methods:
A quasi-experimental, mixed-methods study was conducted with twenty-five fourth-year medical students from a private university in northeastern Mexico. Participants engaged in a ten-minute high-fidelity clinical simulation involving a standardized patient and nurse, followed by a twenty-minute structured debriefing session guided by trained facilitators using the PEARLS framework. The Foundational Healthcare Leadership Self-Assessment (FHLSA), a validated 21-item instrument measuring five leadership domains—communication, collaboration, accountability, team management, and self-management—was administered at three time points: pre-simulation, post-simulation, and post-debriefing. Data were analyzed using the Friedman test and post hoc Wilcoxon signed-rank tests with Bonferroni correction (α = .017). Effect sizes were calculated to determine the magnitude of change.

Results:
All students completed the three assessments. Mean total leadership scores increased from 4.46 (SD 0.52) pre-simulation to 4.68 (SD 0.56) post-debriefing. The Friedman test revealed significant differences across time for total leadership (p = .0024) and self-management (p = .012). Post hoc analyses showed significant improvements between pre- and post-simulation (p = .008, r = 0.48) and between pre- and post-debriefing (p = .004, r = 0.52), with moderate to large effect sizes. Other domains showed upward but non-significant trends, possibly due to ceiling effects from high baseline scores.

Conclusions:
This pilot study suggests that even brief simulation experiences, when integrated with structured debriefing, can enhance leadership development among undergraduate medical students, particularly in self-management. Improvements in self-awareness and emotional regulation highlight the value of experiential learning in fostering the behavioral and reflective dimensions of leadership. Although further research with larger samples and objective measures is needed, these findings support the integration of simulation and structured debriefing as deliberate strategies within medical curricula to promote leadership, communication, and professional growth from early stages of training.

Keywords:

Simulation-based medical education, Leadership, Debriefing, Undergraduate medical training, Experiential learning, Educational innovation.