Objective To investigate the effectiveness of high-fidelity simulation-based scenario teaching in developing core competencies of anesthesiology trainees, and to provide empirical evidence for innovative standardized training models in anesthesiology. Methods 100 anesthesiology residents and rotating surgical physicians in the Department of Anesthesiology of Longyan First Hospital, Fujian Province, were divided into a traditional teaching group (n=50) and a simulation teaching group (n=50) based on different teaching approaches. Both groups received a 2 months standardized training course with identical total credit hours, with the simulation teaching group using high-fidelity simulation-based scenario teaching to replace traditional special case studies and emergency condition teaching. The effectiveness of the two teaching methods was evaluated through multiple dimensions including clinical thinking ability assessment, emergency condition attitude assessment, performance evaluation, and teaching satisfaction survey. Results The simulation teaching group significantly outperformed the traditional teaching group in total scores of clinical thinking scale, overall scores of emergency condition attitude, and comprehensive performance. The simulation teaching group demonstrated particularly outstanding performance in emergency condition operation assessment and clinical pre-operative visit and post-operative follow-up capability assessment. Additionally, the simulation teaching group received higher recognition in terms of overall evaluation and teaching methodology in the satisfaction survey. Conclusion High-fidelity simulation-based scenario teaching can significantly enhance the clinical thinking ability, emergency condition management capability, and comprehensive clinical skills of anesthesiology trainees, while reducing their psychological pressure in face of critical situations and improving their learning satisfaction. This teaching model demonstrates clear advantages in developing core competencies of anesthesiology trainees.