The study, conducted in May 2025, recruited resident physicians from nine tertiary Grade III, Class A general hospitals spread across eight provinces spanning the southern, eastern, northern, western, and central regions of China. Participants were drawn through a combination of convenience and stratified sampling, a design intended to capture the diversity of China’s hospital landscape rather than a single institution’s experience. Of the 151 physicians enrolled, 133, or 88.1 percent, completed assessments both one week before and immediately after the exercise, giving the researchers a substantial paired dataset for analysis.

Perhaps the most striking finding in the baseline data is how unprepared this cohort was on paper before the training began. Only 7.52 percent of participants reported having received any previous disaster training, and a mere 0.75 percent, effectively one or two individuals in the entire sample, had actual disaster response experience. For a country that faces earthquakes, floods, industrial accidents, and mass-casualty events, the near-total absence of hands-on disaster preparation among frontline trainee physicians underscores a systemic vulnerability that the authors argue deserves urgent attention from medical educators and hospital administrators alike.

The intervention itself was a disaster-management-focused tabletop exercise, or TTX, a format long used in military planning, public health preparedness, and corporate crisis management. In a tabletop exercise, participants gather around a table and work through a scripted but realistic disaster scenario, discussing and deciding how they would triage patients, allocate scarce resources, communicate with command structures, and coordinate with prehospital services. Unlike full-scale simulation drills, tabletop exercises require no physical equipment, no simulated casualties, and no disruption to hospital operations, which makes them inexpensive, scalable, and easy to embed into existing residency curricula. The trade-off is that they test decision-making and communication rather than physical procedural skills, which is why the researchers paired the exercise with independent instructor observation rather than relying solely on self-report.

The statistical results were consistent across every psychological outcome the team measured. Perceived disaster management capability, self-confidence, satisfaction with learning, and critical thinking all improved significantly after the exercise, with all comparisons reaching P < 0.001. Because the data were not normally distributed, the researchers used non-parametric Wilcoxon signed-rank tests, reporting a Z statistic of −9.945 for the change in perceived capability. The effect size of r = 0.86 is unusually large for an educational intervention, suggesting that the exercise did not merely nudge perceptions but fundamentally restructured how these physicians understood their own readiness for disaster work.

Regression analysis added an important layer of nuance to the findings. When the researchers modeled which factors independently predicted higher post-exercise perceived capability, two variables emerged: self-confidence in learning (B = 9.385, β = 0.315, P = 0.003) and critical thinking (B = 4.142, β = 0.303, P = 0.001). In practical terms, residents who came away from the exercise feeling more confident and thinking more critically about disaster scenarios also rated their overall disaster management capability higher. This pattern supports a theoretical model in which scenario-based learning works not by transmitting facts but by activating metacognitive processes, forcing learners to reason through uncertainty, defend decisions to peers, and confront the limits of their own knowledge in a psychologically safe setting.

The study did not rely exclusively on subjective self-assessment, and this is where its design becomes particularly instructive. During the training, instructors independently completed a surge-capacity assessment checklist, evaluating how well participants executed specific disaster-response tasks. The instructors rated a significantly higher proportion of fully implemented items during the in-hospital phase of the exercise than during the prehospital phase, 57.9 percent versus 36.7 percent, a difference that reached statistical significance at P = 0.031. When the researchers drilled down into the first-level dimensions of the checklist and applied a Holm correction for multiple comparisons, only resource requirements remained significantly different between phases (adjusted P = 0.047), while no second-level dimension survived the correction. The pattern, however, was clear enough to carry a practical message: these young physicians were notably weaker at the prehospital interface, the chaotic zone between the disaster scene and the hospital doors.

That weakness matters because prehospital emergency response is where disaster medicine most often fails in real events. Decisions about field triage, casualty collection points, ambulance distribution, and communication with incident command happen before a patient ever reaches the emergency department, and a hospital physician who has never rehearsed that interface may struggle to integrate incoming information with in-hospital surge capacity. The authors explicitly highlight the need for greater emphasis on prehospital emergency response in future disaster preparedness training, suggesting that tabletop scenarios should deliberately extend their narratives beyond the hospital walls to include the full chain of evacuation, transport, and handover.

The study’s methodology reflects careful attention to research ethics and validity. The protocol was approved by the Ethics Committee of Naval Military Medical University prior to data collection, and the study was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent after being fully informed of the study’s background, procedures, and objectives, and questionnaires deliberately excluded names and personal identifiers to protect confidentiality. The research team, led by first authors Dan Han, Chen Qiu, and Mengxing Qian, with corresponding author Jingjing Liu of the First Affiliated Hospital of Naval Medical University, also acknowledged eleven experts who helped develop the surge-capacity assessment indicator system, lending the observational component a structured, consensus-based foundation rather than an ad hoc checklist.

For the international medical education community, the implications extend well beyond China. Resident physicians worldwide receive notoriously little formal disaster training, and full-scale simulation drills are expensive, logistically complex, and difficult to repeat frequently enough to build durable competence. The Chinese results, showing very large gains in perceived capability, confidence, satisfaction, and critical thinking from a single scenario-based tabletop session, make a compelling economic and pedagogical case for embedding TTX into standard residency curricula. The authors are careful to frame their findings as associations rather than proof of causation, and the single-group pre-post design without a control arm means some improvement could reflect test-retest effects or enthusiasm. Still, the magnitude of the changes, the multi-province sampling, and the independent instructor observations together make a strong argument that when it comes to disaster preparedness, a table, a scenario, and a room full of trainee physicians thinking aloud may be one of the most cost-effective educational interventions available to hospitals today.

Subject of Research: Scenario-based tabletop exercise training for disaster preparedness among resident physicians in China

Article Title: Educational effectiveness of scenario-based tabletop exercises for disaster preparedness among resident physicians in China

Article References: Han, D., Qiu, C., Qian, M., Hu, X., Gao, J., & Liu, J. (2026). Educational effectiveness of scenario-based tabletop exercises for disaster preparedness among resident physicians in China. BMC Medical Education. https://doi.org/10.1186/s12909-026-10527-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10527-w

Keywords: tabletop exercises, disaster preparedness, resident physicians, medical education, emergency response, surge capacity, critical thinking, self-confidence, prehospital care, China, simulation training, BMC Medical Education