We conducted a prospective pre-post interventional study during the 8th BEST 3N1 workshop. The workshop was conducted from February 11 to February 13, 2025, at the Simulation and Skills Development Centre, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. The course was organized under the oversight of the Prince Sultan Military Medical City (PSMMC) BEST 3N1 Scientific Committee.

The available course registration dataset contained 99 candidate records. All eligible participants attending the workshop and working in pediatric emergency care settings were invited to participate in the study. The registration dataset contained a variable labeled “gender,” with “male” and “female” as the available recorded categories, in addition to nationality, physician specialty, physician level, and training center. Sex assigned at birth and additional gender identities were not collected separately. Age and years of clinical experience were not collected. Personal identifiers, including names, mobile numbers, email addresses, and Saudi Commission for Health Specialties registration details, were used only for administrative registration or data matching and are not reported in the manuscript.

Analysis was conducted using complete matched preworkshop and postworkshop data for each assessment. The number of paired observations differed in outcomes because some participants withdrew and did not complete all workshop assessment components. Participants with incomplete or unmatched preworkshop and postworkshop data for a specific assessment were excluded from the specific analysis. The final paired analytic samples were 88 participants (88.9%) for the day 1 wound suturing checklist, 77 participants (77.8%) for the day 2 airway management checklist, 77 participants (77.8%) for the day 3 orthopedic casting competence assessment, and 94 participants (94.9%) for the written knowledge test. All 99 eligible candidates initially agreed to participate, and none declined participation at recruitment.

BEST 3N1 is a standardized hands-on educational program introduced by PSMMC in 2017. The workshop evaluated in this study included 3 procedural domains: basic emergency suture techniques, pediatric airway management, and pediatric orthopedic emergencies and casting. The course program listed 24 continuing medical education hours, corresponding to 8 hours of scheduled educational activities per day during 3 consecutive days.

Day 1 focused on basic emergency suture techniques and included registration, welcoming activities, a pretraining competency assessment, introduction to instruments and sutures, supervised hands-on practice, candidate self-training with close feedback, a posttraining competency assessment, and a closing discussion. The structured suturing content included simple interrupted sutures, horizontal and vertical mattress sutures, buried and subcuticular sutures, hand injuries, facial injuries, and use of surgical glue and staplers.

Day 2 focused on pediatric airway management and included registration, a pretraining competency assessment, group rotation through airway workshop stations, candidate self-training with close feedback, a posttraining competency assessment, a multiple-choice knowledge examination, and a closing discussion. The airway stations included surgical cricothyrotomy; needle cricothyrotomy; pediatric ear, nose, and throat emergencies; simulation; direct laryngoscopy and supraglottic airways; and video laryngoscopy.

Day 3 focused on pediatric orthopedic emergencies and casting and included registration, a pretraining competency assessment, principles of orthopedic casting, group rotation through orthopedic workshop stations, candidate self-training with close feedback, a posttraining competency assessment, and a closing discussion. The orthopedic stations included hand and wrist casting; humerus, elbow, and clavicle casting; and foot, ankle, and knee casting.

Teaching was delivered by a multidisciplinary faculty. Faculty specialties represented in the course materials included pediatric emergency medicine; anesthesiology; pediatric surgery; plastic and maxillofacial surgery; ear, nose, and throat surgery; and orthopedic surgery, with technical support for relevant procedural stations.

Participants completed preworkshop and postworkshop assessments of procedural performance and knowledge. The primary outcomes were changes in checklist-based procedural performance, orthopedic casting competence assessed using a keyword-based rubric, and written knowledge test scores.

Continuous paired outcomes were summarized using means and SDs, and medians and IQRs were reported where appropriate. Normality of the paired difference scores (postworkshop minus preworkshop) was assessed using the Shapiro-Wilk test and visual inspection of Q-Q plots. Day 1 wound suturing and day 2 airway management difference scores showed significant departures from normality (Shapiro-Wilk P=.01 and P=.02, respectively); these outcomes were analyzed using the Wilcoxon signed-rank test. P values were reported as the primary inferential result. Day 3 orthopedic casting competence scores and total written knowledge scores were analyzed using 2-tailed paired t tests. Within-participant effect sizes were reported using Cohen d_z where applicable.

This study was reviewed and approved by the Institutional Review Board of PSMMC, Riyadh, Saudi Arabia (approval E-2598). Written informed consent was obtained from all participants for the use of their workshop assessment data. Participants were informed that study participation was voluntary, their data would be kept confidential, and they could withdraw at any time without consequences. Participants received no financial or nonfinancial compensation for their participation in the study.

The BEST 3N1 workshop was associated with immediate improvement in wound suturing, pediatric airway management, orthopedic casting competence, and written knowledge. Improvements across all domains indicate that a concentrated course combining demonstration, supervised practice, feedback, and reassessment strengthens performance in low-frequency pediatric emergency procedures. Differences between domains should not be interpreted as evidence that one component was superior because the assessments used different scales, methods, and baseline levels. Waters et al [12] reported that multidisciplinary in situ simulation improved team performance and use of a rapid sequence intubation checklist in a pediatric emergency department. Mustafa et al [13] also found that a collaborative simulation-based intervention improved pediatric advanced airway management processes in general emergency departments, and their findings support structured airway practice.

The suturing findings are consistent with research emphasizing active practice and feedback. Tejos et al [14] found that video-guided practice without peer or expert feedback was insufficient compared with feedback-supported approaches. Tieken et al [15] showed that feedback-containing instruction improved suturing and knot-tying performance, while Hanada et al [16] found improvement in objectively measured suturing quality after extended simulation practice. The supervised BEST 3N1 stations have supported learning by enabling correction of instrument handling, needle positioning, tissue entry, and knot-tying techniques.

The casting results are supported by orthopedic simulation research. Moktar et al [17] developed a cast-application simulator and objective checklist that produced scores reflecting training level and showed high rater reliability. Seeley et al [18] also validated a pediatric distal-radius reduction and casting model using objective procedural and radiographic outcomes. These studies support structured casting assessment and highlight the need to establish the reliability and validity of the program.

The improvement in written knowledge complements the procedural findings and indicates that hands-on instruction reinforces cognitive and psychomotor learning simultaneously. Lammers et al [19] found that simulation and procedural laboratory approaches improved selected pediatric emergency skills, although limited exposure did not consistently improve overall performance. Thim et al [20] concluded that pediatric emergency simulation improves time-critical performance and adherence to expected tasks, while noting variation in interventions and outcomes. A distinctive contribution is the integration of wound suturing, pediatric airway management, and orthopedic casting within one 3-day multidisciplinary program. This approach provides an efficient model for maintaining readiness in several procedural domains rather than organizing separate single-skill courses. Refresher sessions and standardized assessments could improve durability and reproducibility.

This study had several limitations, and the findings should be interpreted in the context of its single-center, uncontrolled pre-post design; variable paired sample sizes; unblinded assessments; and program-specific assessment instruments. The day 3 free-text responses were not scored by multiple raters, and interrater reliability was not assessed. The orthopedic casting scores have been affected by subjective interpretation and rater-related measurement error. Long-term retention of procedural skills and transfer of workshop performance to clinical practice or patient outcomes were not assessed. Future evaluations should use independent raters, validated tools, retention testing, and clinical performance indicators.

The 3-day BEST 3N1 workshop was associated with immediate improvements in wound suturing, pediatric airway management, orthopedic casting competence, and written knowledge among pediatric emergency care practitioners. By integrating 3 low-frequency procedural domains within 1 multidisciplinary, hands-on program, the course offers a practical model for structured skills training in pediatric emergency medicine. Long-term retention, transfer of skills to clinical practice, and patient outcomes were not evaluated. Future studies should use validated assessment instruments, independent raters, longer follow-up, and multicenter controlled designs.