{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:08:36Z","timestamp":1790258916794,"version":"4.1.0"},"reference-count":27,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,2]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Introduction<\/jats:title>\n Up to 40% of major complications during airway management result from human factors. Through human factors such as planning, effective communication, strong leadership and clear role allocation within the team, smooth airway securement can be facilitated and the risk of complications reduced. Simulation-based teaching provides real-time situations and allows healthcare workers and learners to identify, refine and improve their technical and non-technical skills. This study aims to evaluate the effect of simulation-based human factors training on airway management among healthcare providers working in the emergency department of a tertiary healthcare setting in a low- and middle-income country.<\/jats:p>\n <\/jats:sec>\n \n Methods and analysis<\/jats:title>\n This will be a quasi-experimental study with a pre-post design to infer the impact of simulation-based human factors training among emergency medicine healthcare providers on paediatric airway management. The study will be conducted at the Centre of Innovation in Medical Education, Aga Khan University Hospital, Karachi. Participants will include emergency department healthcare providers who meet the inclusion criteria and are selected through purposive non-probability sampling. A total of 74 participants will be enrolled. Data will be analysed using Stata. Descriptive statistics will be presented as frequencies and percentages for categorical variables and as means with SD or medians with IQRs for continuous variables as appropriate. Changes in first-pass intubation success and time to secure the airway (\u226430\u2009vs >30\u2009s) following the intervention will be assessed using McNemar\u2019s test. Changes in TEAM, CTS and NASA-TLX scores will be evaluated using a paired t-test. Generalised Estimating Equations will be used to identify factors associated with airway management outcomes, with results reported as adjusted ORs and 95% CIs. A p-value <0.05\u2009will be considered statistically significant.<\/jats:p>\n <\/jats:sec>\n \n Ethics and dissemination<\/jats:title>\n Ethical approval has been obtained from the Aga Khan University Ethical Review Committee (ERC: 2026\u201312851-41186). Written informed consent will be obtained from all participants, and participation will be voluntary. Findings will be disseminated through thesis submission, conference presentations and peer-reviewed publications.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-124203","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:50:26Z","timestamp":1790257826000},"page":"e124203","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of simulation-based human factors training among emergency medicine healthcare providers on paediatric airway management: a study protocol for a quasi-experimental pre-post study at a tertiary healthcare centre in Karachi, Pakistan"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7284-8073","authenticated-orcid":false,"given":"Abid Ali","family":"Jamali","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1562-2094","authenticated-orcid":false,"given":"Shahan","family":"Waheed","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0983-0644","authenticated-orcid":false,"given":"Faisal W","family":"Ismail","sequence":"additional","affiliation":[{"name":"The Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyam S","family":"Tikmani","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4367-1042","authenticated-orcid":false,"given":"Ahmed","family":"Raheem","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"2026092406500948000_16.9.e124203.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-025-03458-1"},{"key":"2026092406500948000_16.9.e124203.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/arwy.arwy_13_24","article-title":"Recent advances in paediatric airway management","volume":"7","author":"Doctor","year":"2024","journal-title":"Airway"},{"key":"2026092406500948000_16.9.e124203.3","article-title":"Airway management in pediatric patients: an update","volume":"22","author":"Malhotra","year":"2018","journal-title":"Anaesth Pain Intensive Care"},{"key":"2026092406500948000_16.9.e124203.4","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1038\/s41390-025-04142-6","article-title":"Adverse events in pediatric orotracheal intubation in the pediatric emergency department: systematic review and meta-analysis","volume":"99","author":"Alsabri","year":"2026","journal-title":"Pediatr Res"},{"key":"2026092406500948000_16.9.e124203.5","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1097\/PEC.0b013e3182713316","article-title":"Pediatric endotracheal intubations for airway management in the emergency department","volume":"28","author":"Bano","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"2026092406500948000_16.9.e124203.6","doi-asserted-by":"crossref","first-page":"563","DOI":"10.29309\/TPMJ\/2024.31.04.7968","article-title":"Frequency of tracheal intubation associated adverse events and contributing factors in the Pediatric Intensive Care Unit (PICU)","volume":"31","author":"Shaikh","year":"2024","journal-title":"TPMJ"},{"key":"2026092406500948000_16.9.e124203.7","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S2213-2600(15)00508-1","article-title":"Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis","volume":"4","author":"Fiadjoe","year":"2016","journal-title":"Lancet Respir Med"},{"key":"2026092406500948000_16.9.e124203.8","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4103\/arwy.arwy_6_21","article-title":"Paediatric airway: challenges for the anaesthesiologist","volume":"4","author":"Shetty","year":"2021","journal-title":"Airway"},{"key":"2026092406500948000_16.9.e124203.9","unstructured":"International Ergonomics and Human Factors Association . 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