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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 The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality.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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Piquette, D., Reeves, S., & LeBlanc, V. R. (2009) · Journal of Interprofessional Care · doi:10.1080/13561820802697818 · Cited by 76
Competency assessment in simulation-based procedural education
Michelson, J. D., & Manning, L. A. (2008) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2007.09.050 · Cited by 65
Simulation-Based Assessment and the Regulation of Healthcare Professionals
Holmboe, E. S., Rizzolo, M. A., Sachdeva, A. K., ROSENBERG, M. B., & Ziv, A. (2011) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e3182283bd7 · Cited by 69
Enhancing the Effectiveness of Team Debriefings in Medical Simulation: More Best Practices
Lyons, R., Lazzara, E. H., Benishek, L. E., Zajac, S. A., Gregory, M. E., Sonesh, S. C., & Salas, E. (2015) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(15)41016-5 · Cited by 66
Downar, J., McNaughton, N., Abdelhalim, T., Wong, N. S. M., Lapointe‐Shaw, L., Seccareccia, D., Miller, K., Dev, S. P., Ridley, J., Lee, C., et al. (2016) · Palliative Medicine · doi:10.1177/0269216316652278 · Cited by 65
Viljoen, C. A., Millar, R. S., Manning, K., & Burch, V. C. (2020) · BMC Medical Education · doi:10.1186/s12909-020-02403-y · Cited by 72
Teaching Technical Skills to Surgical Residents
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Weile, J. B., Nebsbjerg, M. A., Ovesen, S. H., Paltved, C., & Ingeman, M. L. (2021) · Advances in Simulation · doi:10.1186/s41077-021-00154-4 · Cited by 64
“Background The use of simulation-based team training as an educational tool has increased over the past decades [1, 2].”
BackgroundPliego, J. F., Wehbe–Janek, H., Rajab, M. H., Browning, J. L., & Fothergill, R. E. (2008) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e3181658188 · Cited by 64
Volk, M. S., Ward, J. A., Irias, N., Navedo, A. T., Pollart, J., & Weinstock, P. H. (2011) · Otolaryngology · doi:10.1177/0194599811400833 · Cited by 64
“HFS has been shown to be a robust teaching tool uniquely suited to provide realistic encounters without risk of patient harm.(6) In this context, the emphasis is shifted.”
BackgroundSilberman, N. J., Litwin, B. A., Panzarella, K. J., & Fernandez-Fernandez, A. (2016) · Journal of Physical Therapy Education · doi:10.1097/00001416-201630010-00003 · Cited by 63
A fresh cadaver laboratory to conceptualize troublesome anatomic relationships in vascular surgery
Mitchell, E. L., Sevdalis, N., Arora, S., Azarbal, A. F., Liem, T. K., Landry, G. J., & Moneta, G. L. (2011) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2011.09.098 · Cited by 63
The effect of simulator training on clinical skills acquisition, retention and transfer
Fraser, K. L., Peets, A. D., Walker, I. O., Tworek, J., Paget, M., Wright, B. J., & McLaughlin, K. (2009) · Medical Education · doi:10.1111/j.1365-2923.2009.03412.x · Cited by 63
Virtual reality job interview training for veterans with posttraumatic stress disorder
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“…trainees to practice new skills, 3) , 4) consistent feedback in-the-moment, 5) interpersonally safe environment, 6) accurate representation skills and strategies as the level of difficulty (e.g., hierarchical learning), and 8) access web-based didactic material to enhance learning et al., 2005).”
Preparing Residents Effectively in Emergency Skills Training With a Serious Game
Dankbaar, M. E. W., Roozeboom, M. B., Oprins, E. A. P. B., Rutten, F., van Merriënboer, J. J. G., van Saase, J. L. C. M., & Schuit, S. C. E. (2016) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000194 · Cited by 62
“Technology-enhanced simulation programs provide learning opportunities for controlled skills practice, without risk to the patient.(3) The effectiveness of simulation programs is well established.”
BackgroundSimulation in Occupational Therapy Curricula: A literature review
Bennett, S. H., Rodger, S., Fitzgerald, C., & Gibson, E. M. (2017) · Australian Occupational Therapy Journal · doi:10.1111/1440-1630.12372 · Cited by 63
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Papanikolaou, I. G., Haidopoulos, D., Paschopoulos, M. E., Chatzipapas, I., Loutradis, D., & Vlahos, N. (2019) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2019.01.016 · Cited by 63
Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments
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Physiotherapy as a clinical service in emergency departments: a narrative review
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Simulación en Educación Médica
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Technology-Enhanced Simulation for Health Professions Education
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Technology in postgraduate medical education: a dynamic influence on learning?
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Hendricson, W. D. (2012) · Journal of Dental Education · doi:10.1002/j.0022-0337.2012.76.1.tb05240.x · Cited by 61
Korndorffer, J. R., Bellows, C. F., Tekian, A. S., Harris, I. B., & Downing, S. M. (2011) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2011.07.001 · Cited by 61
Calvert, K. L., McGurgan, P., Debenham, E. M., Gratwick, F. J., & Maouris, P. (2013) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/ajo.12120 · Cited by 61
High-Fidelity Patient Simulation Series to Supplement Introductory Pharmacy Practice Experiences
Vyas, D., Wombwell, E., Russell, E., & Caligiuri, F. J. (2010) · American Journal of Pharmaceutical Education · doi:10.5688/aj7409169 · Cited by 61
“High-fidelity simulation has been widely studied in the medical and nursing literature as a means to teach technical, clinical, and teamwork skills.(17-27) The inclusion of simulation in IPPEs has gained acceptance and is encouraged by ACPE as described in the Policies and Procedures for ACPE Accreditation of Professi…”
MethodMixed-Reality Simulation for Neurosurgical Procedures
Bova, F. J., Rajon, D. A., Friedman, W. A., Murad, G. J. A., Hoh, D. J., Jacob, R., Lampotang, S., Lizdas, D. E., Lombard, G. J., & Lister, J. R. (2013) · Neurosurgery · doi:10.1227/neu.0000000000000113 · Cited by 61
Mosley, C., Dewhurst, C., Molloy, S., & Shaw, B. N. J. (2012) · Medical Teacher · doi:10.3109/0142159x.2012.681222 · Cited by 61
“1999) and incorporates many facets within the simulation scenarios, which facilitate learning (Issenberg et al. 2005) although learning was not sustained.”
BackgroundInfluential
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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