Perceptions of Emergency Medical Care students on high-fidelity manikins versus standardised patients: Insights from a pilot mixed-methods study.

Background: Simulation-based education is central to Emergency Medical Care (EMC) training, particularly in preparing students for high-pressure, pre-hospital environments. High-fidelity manikins (HFMs) and standardised patients (SPs) are widely used simulation modalities; however, comparative evidence from low- to middle-income countries remains limited. Understanding student satisfaction with these modalities is important for ensuring educational quality and making informed resource allocation. Aim: This study explored EMC students' satisfaction with HFMs and SPs to inform pedagogical and resource-related decisions. Setting: The study was conducted in a university-based simulation laboratory at a South African higher education institution. Methods: A pilot mixed-methods design was employed. Fifteen first-year EMC students completed the same clinical simulation scenario using both a SP and a HFM. Satisfaction was measured using a revised Satisfaction Scale for High-Fidelity Clinical Simulation and two open-ended questions. Quantitative data were analysed descriptively, and qualitative responses were analysed thematically. Results: High levels of satisfaction were reported for both simulation modalities. Standardised patients received higher satisfaction scores for realism, theory-practice integration and self-confidence, while HFMs were rated more favourably for practising technical skills and learning from mistakes. Qualitative findings indicated that SPs enhanced realism and engagement but were associated with increased stress. Conclusion: Despite the small cohort, clear preferences and educational implications emerged. The findings support the use of blended simulation approaches and highlight the need for further, larger-scale research. Contribution: This study provides preliminary evidence to inform simulation-based curriculum design and resource allocation in EMC education within resource-constrained contexts.