Abstract
BACKGROUND: Early clinical training in undergraduate medical education often occurs in unstructured environments, limiting student participation and competency development. The SimZones framework offers a progressive approach to simulation-based education, yet evidence for its implementation in first-year medical students remains limited. OBJECTIVE: To describe the design, implementation, and outcomes of a structured clinical simulation program for first-year medical students using the SimZones framework. METHODS: A descriptive study with mixed-methods analysis was conducted in 2024 with 116 first-year medical students at a Chilean medical school. Students participated in structured Zone 1 simulation activities throughout the academic year in small groups (5-6 students), using 12 validated assessment instruments developed and validated by a multidisciplinary expert panel comprising 202 specific procedural steps including 30 critical safety steps. Activities focused on technical, communication, and attitudinal skills with study guides, pre-tests, and formative rubrics. The program culminated with a Zone 2 integrative activity simulating primary care consultations using standardized patients, clinical documentation, and faculty debriefing using the Plus/Delta model. Performance was assessed using standardized rubrics, and qualitative observations were analyzed thematically. RESULTS: All 116 students completed the program. High performance was observed in attitudinal competencies (≥97%) and communication domains (≥89%), while technical skills showed variable achievement rates (range 63%-78%). Qualitative analysis identified strengths in empathy, professionalism, and teamwork, with areas for improvement in procedural technique, interview sequencing, and time management. CONCLUSIONS: Early progressive simulation using the SimZones framework effectively develops foundational competencies in first-year medical students. The structured approach, combining deliberate practice with formative assessment and guided debriefing, supports competency-based medical education objectives while identifying specific areas requiring additional reinforcement in technical skill training.