en آموزش پزشکی Medical Education پژوهشي اصیل Orginal Research <span style="line-height:2;"><span style="font-family:Times New Roman;"><span style="font-size:16px;">simulation-only and participation-based clinical training for nurses remains limited. This study compared simulation-based and participation-based clinical training for improving endotracheal intubation competency among acute care nurses.<br> <b>Materials & Methods: </b>A convergent mixed-methods, quasi-experimental pre-test/post-test study was conducted across the Emergency Department (ED), Intensive Care Unit (ICU), Coronary Care Unit (CCU), and Neonatal Intensive Care Unit (NICU) over six months. Eighty nurses were randomly assigned to simulation-based or participation-based training. Outcomes included knowledge (0&ndash;40), attitude (10&ndash;40), and Direct Observation of Procedural Skills (DOPS) scores.<br> <b>Results:</b> The two groups were comparable at baseline (knowledge: 26.68 &plusmn; 5.91vs 26.20 &plusmn; 7.61, p = 0.756; attitude: 26.78 &plusmn; 7.11vs 26.90 &plusmn; 6.79, p = 0.936; DOPS: 11.55 &plusmn; 2.31vs 11.98 &plusmn; 2.64, p = 0.445). After adjustment, post-test scores favored participation-based training: knowledge mean difference = 2.47, Cohen&rsquo;s d = 0.51(p = 0.025); attitude mean difference = 2.81, Cohen&rsquo;s d = 0.61(p = 0.008); DOPS mean difference = 1.48, Cohen&rsquo;s d = 0.78(p < 0.001); and satisfaction mean difference = 0.77, Cohen&rsquo;s d = 0.51(p = 0.025). Qualitative themes highlighted realism, safety, feedback, and transfer to practice.<br> <b>Conclusions:</b> Participation-based training produced greater gains in knowledge, attitudes, and performance than simulation. Future research should examine whether hybrid models combining simulation and real-patient training can balance safety with realism.&nbsp; </span></span></span><br> &nbsp; intubation, intratracheal, simulation training, clinical competence, education, nursing, critical care nursing, inservice training 0 0 http://edujournal.zums.ac.ir/browse.php?a_code=A-12-3519-1&slc_lang=en&sid=1 Esmaiel Maghsoodi smko.umsu@yahoo.com 5300319475328460037712 5300319475328460037712 No Department of Nursing, Maragheh University of Medical Sciences, Maragheh, Iran Hossein Alikhah Alikhah78@gmail.com 5300319475328460037713 5300319475328460037713 No Clinical department, medical school, Maragheh university of medical sciences, Maragheh, Iran Somayeh Ghavipanjeh Rezaiy ghavipanjehrezaiy@yahoo.com 5300319475328460037714 5300319475328460037714 No Department of Nursing, Maragheh University of Medical Sciences, Maragheh, Iran Allahverdi Arjmand drarjmand1281@gmail.com 5300319475328460037715 0009-0006-6843-0658 No Department of General & Vascular Surgery, Maragheh University of Medical Sciences, Maragheh, Iran Erfan Hosseinian nikejordan863@gmail.com 5300319475328460037716 0009-0006-6843-0658 Yes Maragheh University of Medical Sciences, Maragheh, Iran