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Abstract Background Simulation training is widely used in medical education as students rarely perform clinical procedures, and confidence can influence practitioners’ ability to perform procedures. Thus, this study assessed students’ perceptions and experiences of a pediatric skills program and compared their informed self-assessment with their preceptor-evaluated performance competency for several pediatric clinical procedures. Methods A total of 65 final-year medical students attended a weeklong pediatric skills training course by the University of Tripoli that used a manikin and various clinical scenarios to simulate real-life cases. Participants completed questionnaires self-assessing their performance skills, while examiners evaluated each students’ competency on five procedural skills (lumbar puncture, nasogastric tube insertion, umbilical vein catheterization, intraosseous access, and suprapubic aspiration) using an objective structured clinical examination (OSCE) model. Differences between agreement levels in question responses were evaluated through a nonparametric chi-square test for a goodness of test fit, and the relationship between confidence levels and the OSCE scores for each procedure was assessed using Spearman’s rank-order correlation. Results All participants completed the informed self-assessment questionnaire and OSCE stations. The frequency differences in agreement levels in students’ questionnaire responses were statistically significant. No significant differences were found between students’ self-assessment and preceptors’ evaluation scores. For each procedure’s passing score rate, umbilical vein catheterization had the highest passing rate (78.5%) and nasogastric tube placement the lowest (56.9%). The mean performance scores were above passing for all procedures. The Wilcoxon signed-rank test revealed no significant differences between participants’ self-assessment and their preceptor-evaluated competency; students correctly perceived and assessed their ability to perform each procedure. Conclusions High competence in several life-saving procedures was demonstrated among final-year medical students. The need for consistent and timely feedback, methods to increase medical students’ confidence, and further development and improvement of competency-based assessments are also highlighted.