The DOI matches its Crossref record; 202 of the 203 references it cites were found in a registry or an index.
Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review
Abstract
REVIEW DATE: 1969 to 2003, 34 years. BACKGROUND AND CONTEXT: Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. OBJECTIVES: Review and synthesize existing evidence in educational science that addresses the question, 'What are the features and uses of high-fidelity medical simulations that lead to most effective learning?'. SEARCH STRATEGY: The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the 'grey literature' were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. INCLUSION AND EXCLUSION CRITERIA: Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. DATA EXTRACTION: Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. DATA SYNTHESIS: Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. HEADLINE RESULTS: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following: providing feedback--51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice--43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration--27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level--15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies--11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation--11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment--10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning--10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes--seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity--four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. CONCLUSIONS: While research in this field needs improvement in terms of rigor and quality, high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care settings.
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“While technological advancements offer promising solutions through digital platforms, high-fidelity simulations, and streamlined feedback mechanisms, significant challenges remain in ensuring alignment with varying curricula, gathering longitudinal evidence of student growth, and developing flexible implementation models that can accommodate diverse learning objectives and timelines [12,13].”
From Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189 (2026) · cites this paper as [13]
In the citing paper
“However, it has been accepted that simulation facilitates learning when it is used in the appropriate conditions that include providing feedback, repetition, curriculum integration, individualized learning and controlled environment [28].”
From The virtual patient as a learning tool: a mixed quantitative qualitative study (2018) · cites this paper as [28]
In the citing paper
“This suggests that instructional strategies, whether technology-based or not, must include some solid principles from pedagogical theory that were incorporated to the VP course and some of what Issenberg et al. described as key for simulation-based learning [28].”
From The virtual patient as a learning tool: a mixed quantitative qualitative study (2018) · cites this paper as [28]
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“In the 2005 BEME review Issenberg and colleagues have found a correlation between the use of simulation and effective learning (Issenberg et al. 2005).”
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“Focused more specifically on SBME, our results provide quantitative evidence in support of previous qualitative reviews that have identified feedback as an important instructional design feature (Issenberg et al. 2005; McGaghie et al. 2010).”
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Debriefing Using a Structured and Supported Approach
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“experiences); clear outcomes definition; and realistic, relevant practice (Issenberg et al., 2005).”
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“reviewed 109 articles for conditions of highfidelity simulations that lead to effective learning.(19) The authors reported that the 3 conditions that lead to effective learning most cited in 25%e47% of the articles are provision of feedback, repetitive practice, and curriculum integration.”
BackgroundComplexity, risk and simulation in learning procedural skills
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“Simulation without debriefing has been shown to be ineffective, because errors can be repeated if team members have not been informed that they were making mistakes [8].”
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“Learning through simulation also provides immediate feedback, facilitates repeated experiences activated on various levels of difficulty, activates different varied learning strategies, enables drills and individual learning, defines clear and achievable goals, and imitates real life to a certain extent (Issenberg et…”
Medical Education Research As Translational Science
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“Students who have learned as much as possible through simulated experiences should enter the clinical area better prepared to provide safe patient care (Issenberg et al., 2005).”
BackgroundStructured Debriefing and Students' Clinical Judgment Abilities in Simulation
Mariani, B. A., Cantrell, M. A., Meakim, C. H., Prieto, P., & Dreifuerst, K. T. (2012) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2011.11.009 · Cited by 159
“…practice nursing students has been supported by the National League for Nursing, 2003, National League for Nursing, 2005, the National Council of State Boards of Nursing (2010), and leaders in nursing education (Dreifuerst, 2009, Dreifuerst, 2010, Jeffries, 2005, Stanley and Dougherty, 2010).”
BackgroundMethodIntegration of e-learning technologies in an interprofessional health science course
Carbonaro, M., King, S., Taylor, E., Satzinger, F., Snart, F., & Drummond, J. E. (2008) · Medical Teacher · doi:10.1080/01421590701753450 · Cited by 158
“For these reasons health science educators, both pre-licensure and postgraduate, have been called to accelerate the integration of information technologies in their curricula (McLoughlin & Luca 2002; Vroman & Kovacich 2002; Issenberg et al. 2005).”
BackgroundDebriefing in Simulated-Based Learning: Facilitating a Reflective Discussion
Arafeh, J. M. R., Hansen, S. S., & Nichols, A. (2010) · Journal of Perinatal & Neonatal Nursing · doi:10.1097/jpn.0b013e3181f6b5ec · Cited by 195
Trends and the future of postgraduate medical education
Harden, R. M. (2006) · Emergency Medicine Journal · doi:10.1136/emj.2005.033738 · Cited by 157
“A recent best evidence medical education (BEME) systematic review on the features and uses of hi-fidelity medical education simulations that lead to effective learning was completed by Issenberg and co-workers.”
BackgroundRealistic health care simulation scenario: what is relevant for its design?
Kaneko, R., & Lopes, M. H. B. D. M. (2019) · Revista da Escola de Enfermagem da USP · doi:10.1590/s1980-220x2018015703453 · Cited by 162
Diesen, D. L., Erhunmwunsee, L., Bennett, K. M., Ben‐David, K., Yurcisin, B. M., Ceppa, E. P., Omotosho, P. A., Perez, A., & Pryor, A. D. (2011) · Journal of surgical education · doi:10.1016/j.jsurg.2011.02.007 · Cited by 155
“Our results confirm earlier reports that medical simulators enhance learning in trainees especially when trainees practice with progressively more difficult simulations.(26-29) Since the institution of simulation, there has been the question of which modality most efficiently and effectively leads to skills acquisitio…”
ResultScalese, R. J., & Issenberg, S. B. (2005) · Journal of Veterinary Medical Education · doi:10.3138/jvme.32.4.461 · Cited by 155
Self-citationDankbaar, M. E. W., Alsma, J., Jansen, E. E. H., van Merrienboer, J. J. G., van Saase, J. L. C. M., & Schuit, S. C. E. (2016) · Advances in Health Sciences Education · doi:10.1007/s10459-015-9641-x · Cited by 147
“In contrast, the effectiveness of technology-enhanced simulation training, in comparison with no intervention, has been well established for knowledge and skills (Cook et al. 2011; Issenberg et al. 2005).”
BackgroundMethods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery
García, I. O., González, P. S., Lamata, P., Chmarra, M. K., Pagador, J. B., Sánchez‐Margallo, J. A., Sanchez-Margallo, F. M., & Aguilera, E. J. G. (2011) · Journal of Surgical Research · doi:10.1016/j.jss.2011.06.034 · Cited by 154
“• They provide immediate feedback to the trainee based on these metrics, as well as keeping an updated versión of his/her learning curve, which enhances the learning process [81].”
BackgroundCheng, A., Lockey, A. S., Bhanji, F., Lin, Y., Hunt, E. A., & Lang, E. (2015) · Resuscitation · doi:10.1016/j.resuscitation.2015.04.004 · Cited by 165
Enhancing Patient Safety in Nursing Education Through Patient Simulation
Durham, C. F., & Alden, K. R. (2008) · Europe PMC (PubMed Central) · Cited by 153
Using Cognitive Load Theory to Inform Simulation Design and Practice
Reedy, G. B. (2015) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2015.05.004 · Cited by 177
Human Patient Simulation in a Pharmacotherapy Course
Seybert, A. L., Kobulinsky, L. R., & McKaveney, T. P. (2008) · American Journal of Pharmaceutical Education · doi:10.5688/aj720237 · Cited by 151
Garden, A. L., Fevre, D. M. L., Waddington, H. L., & Weller, J. M. (2015) · Anaesthesia and Intensive Care · doi:10.1177/0310057x1504300303 · Cited by 151
The Use of Simulation in Emergency Medicine: A Research Agenda
Bond, W. F., Lammers, R. L., Spillane, L. L., Smith‐Coggins, R., Fernandez, R., Reznek, M. A., Vozenilek, J. A., & Gordon, J. A. (2007) · Academic Emergency Medicine · doi:10.1197/j.aem.2006.11.021 · Cited by 159
“Whether the simulation is devoted to routine or rare clinical events, comprehensive selfreflection during a ‘‘debriefing’’ session is essential.(16,20,21) Debriefing gives learners the opportunity to think critically about their performance, deconstruct events and errors that unfold during the scenario, and acquire ne…”
BackgroundMethodWang, E. E., Quinones, J., Fitch, M. T., Dooley‐Hash, S., Griswold‐Theodorson, S., Medzon, R., Korley, F. K., Laack, T. A., Robinett, A., & Clay, L. (2008) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2008.00218.x · Cited by 151
Co-debriefing for Simulation-based Education
Cheng, A., Palaganas, J. C., Eppich, W., Rudolph, J. W., Robinson, T., & Grant, V. J. (2015) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000077 · Cited by 150
“Proactive strategies optimize the chances of creating a positive cofacilitator dynamic and foster effective collaboration between co-facilitators by (1) encouraging facilitators to build rapport by getting to know each other; (2) sharing philosophies, teaching skills, and perspectives; and (3) planning joint instructi…”
BackgroundInfluentialThe Emotional and Cognitive Impact of Unexpected Simulated Patient Death
Fraser, K. L., Huffman, J., Ma, I. W. Y., Sobczak, M., McIlwrick, J., Wright, B. J., & McLaughlin, K. (2013) · CHEST Journal · doi:10.1378/chest.13-0987 · Cited by 153
Kron, F. W., Fetters, M. D., Scerbo, M. W., White, C. B., Lypson, M. L., Padilla, M. A., Gliva‐McConvey, G. A., Belfore, L. A., West, T. D., Wallace, A. M., et al. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.10.024 · Cited by 163
Piromchai, P., Avery, A., Laopaiboon, M., Kennedy, G. E., & O’Leary, S. J. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010198.pub2 · Cited by 157
A Randomized Trial of Simulation-Based Deliberate Practice for Infant Lumbar Puncture Skills
Kessler, D. O., Auerbach, M. A., Pusic, M. V., Tunik, M. G., & Foltin, J. C. (2011) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e318216bfc1 · Cited by 147
“Baseline Assessment At the start of the study, questionnaires were completed to assess (1) prior training in and (2) experience with the infant LP procedure, (3) knowledge (using a 6-item quiz), and (4) confidence with the procedure (using a 4-point Likert scale).”
MethodLiaw, S. Y., Chan, S. W., Chen, F.-G., Hooi, S. C., & Siau, C. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3322 · Cited by 147
“We incorporated the features for effective learning identified by a systematic review into our simulation design [19].”
Stocker, M., Burmester, M., & Allen, M. L. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-69 · Cited by 146
“sity of feedback and guided reflection after the simulated experience [13,16,19,26,27,29,30].”
BackgroundInfluentialPlackett, R., Kassianos, A. P., Mylan, S., Kambouri, M. A., Raine, R., & Sheringham, J. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03410-x · Cited by 157
Eyck, R. P. T., Tews, M. C., & Ballester, J. M. (2009) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2009.03.025 · Cited by 146
Krautter, M., Weyrich, P., Schultz, J., Buss, S. J., Maatouk, I., Jünger, J., & Nikendei, C. (2011) · Teaching and Learning in Medicine · doi:10.1080/10401334.2011.586917 · Cited by 149
“24 , 25 Instruction time was not limited for either of the instructional approaches.”
BackgroundKhamis, N., Satava, R. M., Alnassar, S. A., & Kern, D. E. (2015) · Surgical Endoscopy · doi:10.1007/s00464-015-4206-x · Cited by 144
“[18] was cited 1520 times, evidence-based and highly relevant.”
BackgroundVirtual reality simulation training for health professions trainees in gastrointestinal endoscopy
Khan, R., Plahouras, J., Johnston, B. C., Scaffidi, M. A., Grover, S. C., & Walsh, C. M. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008237.pub3 · Cited by 144
Third-Year Undergraduate Nursing Students’ Perceptions of High-Fidelity Simulation
Wotton, K., Davis, J., Button, D., & Kelton, M. (2010) · Journal of Nursing Education · doi:10.3928/01484834-20100831-01 · Cited by 142
Ohtake, P. J., Lazarus, M., Schillo, R., & Rosen, M. A. (2013) · Physical Therapy · doi:10.2522/ptj.20110463 · Cited by 142
Gruppen, L. D., Irby, D. M., Durning, S. J., & Maggio, L. A. (2018) · MedEdPublish · doi:10.15694/mep.2018.0000211.1 · Cited by 142
Simulation Methodology in Nursing Education and Adult Learning Theory
Rutherford-Hemming, T. (2012) · Adult Learning · doi:10.1177/1045159512452848 · Cited by 169
“Changing clinical experiences, shorter times in training, and working time restrictions created skill deficiencies in medical students (Bradley, 2006; Issenberg et al., 2005).”
BackgroundComparison of Postsimulation Debriefing Versus In-Simulation Debriefing in Medical Simulation
Heukelom, J. N. V., Begaz, T., & Treat, R. W. (2010) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e3181be0d17 · Cited by 141
Steinberg, A. D., Bashook, P. G., Drummond, J. L., Ashrafi, S. S., & Žefran, M. (2007) · Journal of Dental Education · doi:10.1002/j.0022-0337.2007.71.12.tb04434.x · Cited by 141
“Additionally, in a recent best evidence in medical education (BEME) systematic review on the effectiveness of learning by using medical simulators, it was noted that simulators facilitate trainee learning and complement clinical medical education.(8) The majority of current dental simulators used in dental schools use…”
BackgroundNishisaki, A., Hales, R. L., BIAGAS, K. V., Cheifetz, I. M., Corriveau, C., Garber, N. A., Hunt, E. A., Jarrah, R., McCloskey, J., Morrison, W. E., et al. (2009) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0b013e3181956d29 · Cited by 140
“Issenberg et al (15) performed a systematic review to identify which features of high-fidelity simulation are considered efFigure 2.”
BackgroundThe use of simulation for pediatric training and assessment
Weinberg, E. R., Auerbach, M. A., & Shah, N. B. (2009) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e32832b32dc · Cited by 140
A review of the uses of virtual reality in engineering education
di Lanzo, J. A., Valentine, A., Sohel, F. A., Yapp, A. Y. T., Muparadzi, K. C., & Abdelmalek, M. (2020) · Computer Applications in Engineering Education · doi:10.1002/cae.22243 · Cited by 158
“In addition, a 2005 BEME systematic review (which spanned 34 years, from 1969 to 2003) focusing on the uses of high‐fidelity simulation‐based medical education concluded that such uses are educationally effective and complement traditional medical education, though conceded that improvement of the rigour and quality o…”
Background
Metadata
- Authors
- Barry Issenberg, S., Mcgaghie, W. C., Petrusa, E. R., Lee Gordon, D., & Scalese, R. J.
- Affiliations
- Northwestern University (US)
- Duke Medical Center (US)
- University of Miami (US)
- Venue
- Medical Teacher
- Publisher
- Informa UK Limited
- Published
- 2005-01
- Volume
- 27
- Issue
- 1
- Pages
- 10-28
- ISSN
- 0142-159X (ISSN-L)
- 1466-187X
- OpenAlex
- W2162661914
- Cited by
- 3,966
- References
- 203
- Citations by year
- 2026: 311 · 2025: 239 · 2024: 194 · 2023: 177 · 2022: 198 · 2021: 245 · 2020: 224 · 2019: 233 · 2018: 191 · 2017: 178 · 2016: 227 · 2015: 252 · 2014: 199 · 2013: 233 · 2012: 190
- FWCI
- 9.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Teacher (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Education › Simulation-Based Education in Healthcare
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Social Sciences › Education › Innovations in Medical Education
- Keywords
- high-fidelity simulation, simulation-based medical education, medical education, instructional feedback, repeated practice, curriculum integration, task difficulty, student outcomes, research quality, graduate medical education, student motivation, learner confidence, student self-efficacy, student self-assessment, student self-regulation, learner autonomy
- MeSH terms
- Clinical Competence, Education, Medical, Humans, Research Design, Software, Patient Simulation, Total Quality Management, Medical Errors
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