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Evaluating Clinical Simulations for Learning Procedural Skills: A Theory-Based Approach
Abstract
Simulation-based learning is becoming widely established within medical education. It offers obvious benefits to novices learning invasive procedural skills, especially in a climate of decreasing clinical exposure. However, simulations are often accepted uncritically, with undue emphasis being placed on technological sophistication at the expense of theory-based design. The author proposes four key areas that underpin simulation-based learning, and summarizes the theoretical grounding for each. These are (1) gaining technical proficiency (psychomotor skills and learning theory, the importance of repeated practice and regular reinforcement), (2) the place of expert assistance (a Vygotskian interpretation of tutor support, where assistance is tailored to each learner's needs), (3) learning within a professional context (situated learning and contemporary apprenticeship theory), and (4) the affective component of learning (the effect of emotion on learning). The author then offers four criteria for critically evaluating new or existing simulations, based on the theoretical framework outlined above. These are: (1) Simulations should allow for sustained, deliberate practice within a safe environment, ensuring that recently-acquired skills are consolidated within a defined curriculum which assures regular reinforcement; (2) simulations should provide access to expert tutors when appropriate, ensuring that such support fades when no longer needed; (3) simulations should map onto real-life clinical experience, ensuring that learning supports the experience gained within communities of actual practice; and (4) simulation-based learning environments should provide a supportive, motivational, and learner-centered milieu which is conducive to learning.
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“Classroom role-play helps, but lacks the distinctiveness of real conversations (5).”
From Using generative AI for interview simulations to enhance student research skills in biology education (2025) · cites this paper as [5]
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“According to Kolb’s experiential learning and Kneebone theory-based approach, structured role-play enables learners to engage in focused practice in safe, controlled, learner-centered environments [19,20].”
Høyer, C. B. (2009) · Dansk Universitetspædagogisk Tidsskrift · doi:10.7146/dut.v3i6.5602 · Cited by 2
“For at opnå dette er det vigtigt, at der skabes et trygt miljø, hvor deltagerne tør begå fejl uden frygt for udstillelse af inkompetence over for andre, hårdhændet negativ feedback eller hån (Murray, 2004; Kneebone, 2005; Fanning & Gaba, 2007).”
BackgroundKlemm, K., Schmidli, J., Assadian, A., Widmer, M. K., Meile, T., Kiser, H., & Eckstein, H. (2014) · Gefässchirurgie · doi:10.1007/s00772-013-1291-9 · Cited by 2
“Kneebone R (2005) Evaluating clinical simulations for learning procedural skills: a theory-based approach.”
BackgroundInfluentialSimulation in pediatric nursing education: Are there enough evidence for future practice?
John, B., & Marath, U. (2022) · IP Journal of Paediatrics and Nursing Science · doi:10.18231/j.ijpns.2021.026 · Cited by 2
Tay, Y. X., Ng, G. Y. H., Xue, M., Lim, C. X. Y., Hsiao, C.-W., Wei, Y.-M., & Ong, C. C. P. (2023) · Radiography · doi:10.1016/j.radi.2023.11.001 · Cited by 2
Schulz, F., Hultin, M., & Gyllencreutz, L. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-098284 · Cited by 2
“10 This narrow focus limits the ability to assess the comprehensive range of skills required for effective MCI response.”
Optimising the educational utility of live tissue training in trauma surgery
Swain, C. S., Cohen, H. M. L., Routh, J., Helgesson, G., Rickard, R. F., & Karlgren, K. (2025) · BMC Medical Education · doi:10.1186/s12909-025-07846-9 · Cited by 2
“These were summarised as: sustained deliberate practice in a safe environment consolidated as part of a defined curriculum; accessibility of expert tutors; learning that maps onto real-life experience; and a supportive, motivational, and ‘learner-centred milieu’ [27].”
Blended Simulation Based Medical Education: A Complex Learning/Training Opportunity
Shahoumian, A., Saunders, M., Zenios, M., Parchoma, G., & Hanson, J. (2014) · Lecture notes in computer science · doi:10.1007/978-3-319-07485-6_47 · Cited by 2
““[S]imulations are often accepted uncritically, with undue emphasis being placed on technological sophistication at the expense of theory-based design” [16] [page.”
BackgroundFresh simulation options in critical care nursing education
Archer, E. (2010) · SUNScholar (Stellenbosch University) · doi:10.7196/ajhpe.63 · Cited by 2
Complementing theory with practice to enhance Students' learning.
Suliman, M. I., Imran, F., Ahmed, S. A., Rahim, I. U., Shafiq, A., & Qayum, I. (2016) · PubMed · Cited by 2
Shultz, C. G., Cooke, J., Denay, K. L., Llanes, M., Zazove, P., & Kelley, S. A. (2016) · International Journal for Innovation Education and Research · doi:10.31686/ijier.vol4.iss5.547 · Cited by 2
Collaborative health and social care, and the role of interprofessional education
Chambers, A., Clouder, L., Jones, M., & Wickham, J. (2013) · Elsevier eBooks · doi:10.1016/b978-0-7020-4344-4.00002-x · Cited by 2
Metadata
- Authors
- Kneebone, R.
- Affiliations
- St Mary's Hospital (GB)
- Corresponding author
- Kneebone, Roger
- ORCID
- Kneebone, Roger
- Venue
- Academic Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-06
- Volume
- 80
- Issue
- 6
- Pages
- 549-553
- ISSN
- 1040-2446 (ISSN-L)
- OpenAlex
- W2054537285
- Cited by
- 423
- References
- 18
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 17 · 2023: 14 · 2022: 14 · 2021: 19 · 2020: 19 · 2019: 26 · 2018: 25 · 2017: 21 · 2016: 26 · 2015: 31 · 2014: 31 · 2013: 23 · 2012: 26
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Medicine (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
- simulation-based training, procedural training, medical education, psychomotor skill acquisition, deliberate practice, situated learning, affective learning, student-centered learning environment, skill consolidation
- MeSH terms
- Computer-Assisted Instruction, Computer Simulation, Education, Medical, Evaluation Studies as Topic, Humans
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