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 The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality.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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Review article: Medical education research: an overview of methods
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“Consequently, there has been a continued increase in medical educational research publications.(3) In the meantime, the profile of researchers has evolved.”
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“Debriefing has been identified as a critical component and best practice within health care-based simulation educational approaches (22, 37, 38).”
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“The strong face validity of high-fidelity simulation may explain the increasing use of simulators for training, despite the lack of clear evidence.(6) Our study confirms that anesthesia nontechnical skills are not only learned by practicing crisis resource management scenarios during high-fidelity simulation but are a…”
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“Several studies have shown improved performance in simulated crises after simulation training.(1) However, evidence documenting the transfer of skills rehearsed during simulated emergencies into actual clinical decision-making is limited.”
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“come evaluation of such interventions [6–8].”
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“Analysis of coding sheets utilized in existing and similar BEME reviews (Issenberg et al. 2005; Hean et al. 2012) were also used as a benchmark, as was the Cochrane Collaboration’s Data collection form for intervention reviews (Higgins 2011).”
MethodYudkowsky, R., Luciano, C., Banerjee, P. P., Schwartz, A., Alaraj, A. M., Lemole, G. M., Charbel, F. T., Smith, K. M., Rizzi, S., Byrne, R. W., et al. (2013) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e3182662c69 · Cited by 115
“9 Both simulation-based and live procedure outcome measures showed significant improvement after practice, demonstrating that skills obtained on the simulator could be transferred to the surgical setting.”
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Sustained effect of simulation‐based ultrasound training on clinical performance: a randomized trial
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de Giovanni, D., Roberts, T. E., & Norman, G. R. (2009) · Medical Education · doi:10.1111/j.1365-2923.2009.03398.x · Cited by 113
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Peer-assisted learning (PAL): skills lab tutors’ experiences and motivation
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Marken, P. A., Zimmerman, C. M., Kennedy, C. S., Schremmer, R. D., & Smith, K. V. (2010) · American Journal of Pharmaceutical Education · doi:10.5688/aj7407120 · Cited by 113
Outcome-based education – the ostrich, the peacock and the beaver
Harden, R. M. (2007) · Medical Teacher · doi:10.1080/01421590701729948 · Cited by 113
Larsen, D. P., Butler, A. C., Lawson, A. L., & Roediger, H. L., III (2012) · Advances in Health Sciences Education · doi:10.1007/s10459-012-9379-7 · Cited by 120
Ericsson, K. A. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511609817.022 · Cited by 116
Cherry, M. G., Fletcher, I. J., O’Sullivan, H., & Shaw, N. B. (2012) · Medical Teacher · doi:10.3109/0142159x.2011.614293 · Cited by 111
Hallinger, P., & Wang, R. (2019) · Simulation & Gaming · doi:10.1177/1046878119888246 · Cited by 124
“Documents from medical education (e.g., Gaba, 2004; Issenberg et al., 1999, 2005; McGaghie et al., 2010) again accumulated the most Scopus citations.”
BackgroundResultInfluentialThe effects of simulation-based resuscitation training on nurses' self-efficacy and satisfaction
Roh, Y. S., Lee, W. S., Chung, H. S., & Park, Y. M. (2011) · Nurse Education Today · doi:10.1016/j.nedt.2011.11.008 · Cited by 110
“Simulator validity is one of the features of high-fidelity simulations that can lead to effective learning, and clinical learners prefer realism with opportunities for hands-on experience (Issenberg et al., 2005).”
BackgroundThe use of virtual patients in medical school curricula
Cendan, J., & Lok, B. (2012) · Advances in Physiology Education · doi:10.1152/advan.00054.2011 · Cited by 109
Capturing differences in dental training using a virtual reality simulator
Mirghani, I., Mushtaq, F., Allsop, M. J., Al‐Saud, L. M., Tickhill, N., Potter, C., Keeling, A. J., Mon-Williams, M. A., & Manogue, M. R. (2016) · European Journal Of Dental Education · doi:10.1111/eje.12245 · Cited by 109
“Central to these issues is whether the systems relate to real world dentistry as training on these systems needs to ultimately translate to the clinic (9,10).”
BackgroundReview of mannequin‐based high‐fidelity simulation in emergency medicine
Fritz, P. Z., Gray, T., & Flanagan, B. T. (2007) · Emergency Medicine Australasia · doi:10.1111/j.1742-6723.2007.01022.x · Cited by 107
“Issenberg et al.(50) undertook a systematic review of the literature on the features of HFS that facilitate effective PZ Fritz et al.”
BackgroundRystedt, H., & Sjöblom, B. (2012) · Instructional Science · doi:10.1007/s11251-012-9213-x · Cited by 107
Singh, S. S., Sedlack, R. E., & Cook, D. A. (2014) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2014.01.037 · Cited by 107
Morgan, P. J., Tarshis, J., LeBlanc, V. R., Cleave‐Hogg, D. M., DeSousa, S., Haley, M., Herold, J., & Law, J. A. (2009) · British Journal of Anaesthesia · doi:10.1093/bja/aep222 · Cited by 106
Experience Curves as an Organizing Framework for Deliberate Practice in Emergency Medicine Learning
Pusic, M. V., Kessler, D. O., Szyld, D., Kalet, A. L., Pecaric, M. R., & Boutis, K. (2012) · Academic Emergency Medicine · doi:10.1111/acem.12043 · Cited by 106
Goals, Success Factors, and Barriers for Simulation-Based Learning
Dieckmann, P., Friis, S. M., Lippert, A. M., & Østergaard, D. (2012) · Simulation & Gaming · doi:10.1177/1046878112439649 · Cited by 116
“This idea is in line with our own previous work (Dieckmann, 2009; Dieckmann et al., 2007) as well as that of others (Curran, 2008; Issenberg et al., 2005; Johnson, 2004; Rystedt & Lindwall, 2004).”
BackgroundResultSimulation training improves ability to manage medical emergencies
Ruesseler, M., Weinlich, M., Muller, M. P., Byhahn, C., Marzi, I., & Walcher, F. (2010) · Emergency Medicine Journal · doi:10.1136/emj.2009.074518 · Cited by 103
Hubert, V., Duwat, A., Deransy, R., Mahjoub, Y., & Dupont, H. (2014) · Anesthesiology · doi:10.1097/aln.0000000000000138 · Cited by 102
Design principles for virtual patients: a focus group study among students
Huwendiek, S., Reichert, F., Bosse, H. M., de Leng, B. A., van der Vleuten, C. P. M., Haag, M., Hoffmann, G. F., & Tönshoff, B. (2009) · Medical Education · doi:10.1111/j.1365-2923.2009.03369.x · Cited by 115
Simulation in Healthcare and Nursing
Cannon-Diehl, M. R. (2009) · Critical Care Nursing Quarterly · doi:10.1097/cnq.0b013e3181a27e0f · Cited by 104
Progress in virtual reality simulators for surgical training and certification
de Visser, H., Watson, M. J. O., Salvado, O., & Passenger, J. D. (2011) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2011.tb02942.x · Cited by 103
“However, it must also be able to repeat a scenario exactly, as it is crucial for trainees, and trainers, to analyse mistakes and learn from them, as shown by Issenberg et al 9 in their analysis of the features of high-fidelity simulations that lead to effective learning.”
BackgroundMethodEducation of student nurses – A systematic literature review
Jeppesen, K. H., Christiansen, S., & Frederiksen, K. (2017) · Nurse Education Today · doi:10.1016/j.nedt.2017.05.005 · Cited by 103
Davoudi, M., Osann, K., & Colt, H. G. (2008) · Respiration · doi:10.1159/000126493 · Cited by 103
Sim One, Do One, Teach One: Considerations in Designing Training Curricula for Surgical Simulation
Kolozsvari, N. O., Feldman, L. S., Vassiliou, M. C., Demyttenaere, S. V., & Hoover, M. L. (2011) · Journal of surgical education · doi:10.1016/j.jsurg.2011.03.010 · Cited by 103
Patel, V. L., Yoskowitz, N. A., & Arocha, J. F. (2008) · Advances in Health Sciences Education · doi:10.1007/s10459-007-9091-1 · Cited by 111
“In a recent review of medical simulations ( Issenberg et al. 2005 ), it was found that under certain conditions, high-fidelity medical simulations facilitate learning.”
BackgroundThe Future of e-Learning in Medical Education: Current Trend and Future Opportunity
Kim, S. S. (2006) · Journal of Educational Evaluation for Health Professions · doi:10.3352/jeehp.2006.3.3 · Cited by 102
“Appendix 1 summarizes results from the recently published studies [7, 9, 13-16].”
ResultVirtual and augmented reality in dental education: The good, the bad and the better
Dzyuba, N., Jandu, J., Yates, J. M., & Kushnerev, E. (2022) · European Journal Of Dental Education · doi:10.1111/eje.12871 · Cited by 102
Schwartz, L. R., Fernandez, R., Kouyoumjian, S., Jones, K. A., & Compton, S. A. (2007) · Academic Emergency Medicine · doi:10.1197/j.aem.2006.09.052 · Cited by 102
“published a systematic literature review defining several uses of HPS that lead to effective learning.(7) While such support for this technology is impressive, the overall characteristics of available research were not.”
Background(2013) · Task-based language teaching · doi:10.1075/tblt · Cited by 102
Simulation and Introductory Pharmacy Practice Experiences
Lin, K. A., Travlos, D. V., Wadelin, J. W., & Vlasses, P. H. (2011) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe7510209 · Cited by 103
“With simulation, students are provided immediate feedback on their performance, and if the simulation is recorded, have the opportunity to self-reflect and assess their performance.(2,17) Students in medical, nursing, and pharmacy schools tout the safe learning environment as one of best features of simulation.”
BackgroundChallenges for educationalists
Schuwirth, L., & van der Vleuten, C. P. M. (2006) · BMJ · doi:10.1136/bmj.38952.701875.94 · Cited by 102
Subramanian, A., Timberlake, M. D., Mittakanti, H. R., Lara, M., & Brandt, M. L. (2012) · Journal of surgical education · doi:10.1016/j.jsurg.2012.05.013 · Cited by 101
“The lack of consistency between the endpoints of various studies prohibits the determination of their efficacy compared to standard teaching methods.(6) StepStone Interactive Medical Software is a web-based medical teaching tool that provides the user with a highly focused set of evaluative and interventional tasks.”
BackgroundNicksa, G. A., Anderson, C. E., Fidler, R., & Stewart, L. (2015) · JAMA Surgery · doi:10.1001/jamasurg.2014.2235 · Cited by 100
Debriefing 101: training faculty to promote learning in simulation-based training
Paige, J. T., Arora, S., Fernandez, G. L., & Seymour, N. E. (2014) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2014.05.034 · Cited by 100
Simulation in medical education
Ker, J., & Bradley, P. (2013) · Wiley eBooks · doi:10.1002/9781118472361.ch13 · Cited by 103
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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