Background Emergency manuals (EMs) are guides that provide a sequence of procedures and are used in response to critical events in the operating room. Literature has described the clinical advantage of such cognitive aids but implementation remains a problem because habits can be difficult to change. Studies have shown that successful use of EMs can be achieved by simulation training. This form of active learning engages the participants and provides the advantage of hands-on experience. Therefore, a simulation competition, namely Simulation Wars, was established in China to promote simulation training and increase training participation. This study aims to assess whether participation in such a simulation competition increases the participants' implementation of EMs in the operating room in real situations of crisis. Methods Anesthesia providers who participated in the 2017 Zhongshan Emergency Manuals simulation training competition and multi-institutional survey studies were eligible to participate in this study. A year after the inaugural competition, surveys were distributed to the participating providers to assess their use of EMs in the operating room post competition. Results One hundred six anesthesia providers across two different hospitals qualified for the study. The response rates among anesthesia providers were similar for both surveys, with 45/51 (88.2%) pre-competition and 48/55 (87.2%) post-competition. Analysis shows that EM usage during critical events increased significantly following a simulation training competition (p<0.05). Conclusion The study indicates that EM use in the operating room significantly increased after participating in the simulation training competition.
