The DOI matches its Crossref record; 18 of the 18 references it cites were found in a registry or an index.
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]
Citations
Cites
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Simulation in surgical training: educational issues and practical implications
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Self-citationA Comprehensive Anesthesia Simulation Environment
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The Educational Impact of Bench Model Fidelity on the Acquisition of Technical Skill
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Anesthesia crisis resource management: Real-life simulation training in operating room crises
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An innovative model for teaching and learning clinical procedures
Kneebone, R. L., Kidd, J. M., Nestel, D., Asvall, S., Paraskeva, P. A., & Darzi, A. W. (2002) · Medical Education · doi:10.1046/j.1365-2923.2002.01261.x · Cited by 289
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Additional file 1 of Unravelling the skillset of point-of-care ultrasound: a systematic review
Mulder, T. A., van de Velde, T., Dokter, E., Boekestijn, B., Olgers, T. J., Bauer, M. P., & Hierck, B. P. (2024) · Figshare · doi:10.6084/m9.figshare.26583570
Day, K., & Singer, C. M. (2026) · International Journal of Speech-Language Pathology · doi:10.1080/17549507.2025.2608349
“The finding also parallels earlier work that emphasises the importance of developing realistic simulations for students (e.g. Kneebone, 2005; MacLean et al., 2019).”
Imediegwu, K., Odo, C. C., Onyebuchukwu, C., Okeke, K. C., Agulanna, S. T., Eleweke, I. G., Asuquo, B., Uku, T. U., & Onwuasoigwe, C. A. (2026) · Journal of the West African College of Surgeons · doi:10.4103/jwas.jwas_103_23
“[6,7] ” [8-11] A cross-sectional study on general surgery residents (postgraduate years 1–5) at Yale University School of Medicine and the University of Toronto revealed that 95.5% of the participants believed that simulation training improved their laparoscopic skills.”
InfluentialTransforming pharmacy education and practice in Nigeria: a call for reform
Ikhile, I., Mosanya, A. U., & Ukoha-Kalu, B. O. (2026) · International Journal of Pharmacy Practice · doi:10.1093/ijpp/riag011
Sebastian, D., Vora, S., Dell, M. L., & Griffith, J. (2026) · Academic Psychiatry · doi:10.1007/s40596-026-02303-1
“The standardized and reflective structure of simulation allows learners to observe communication models, process personal reactions, and articulate uncertainty in a psychologically safe environment [5].”
Izart, M., Sarı, A., Caussin, É., Smail, Y., Berès, F., Goff, S. O. L., Abdel-Gawad, S., Lemarteleur, V., Jordan, L., Attal, J., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-8661165/v1
Reminiac-Houssais, M.-S. (2020) · theses.fr (ABES) · doi:10.70675/8467861cz8829z4e45zae3az4cc36eeb8755
Huang, Y., Liu, C., Cai, Y., Xu, L., Hou, Y., & Fan, M. (2026) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3772318.3790322
“As Kneebone [42] documented, clinical competence requires recognizing non-verbal cues and cultivating procedural fluency—dimensions unattainable through text alone.”
The Structured Clerkship: A Competency-Based Model for Undergraduate Anesthesiology Training
Habibi, A., Karimian, M., & Alshohadaei, S. M. S. (2026) · Journal of Medical Education · doi:10.5812/jme-169434
Kwon, Y. G., Choi, S. Y., Park, H. Y., Shin, Y. S., & Kim, C. W. (2026) · Journal of Robotic Surgery · doi:10.1007/s11701-026-03484-5
“Robotic surgery education aligns with this framework by integrating simulation-based practice, structured feedback, conceptual learning, and supervised clinical application [21].”
Pritchard, R., Keskin, E., Shahid, M., Willers, J. W., Chu, J., & Hall, A. (2026) · Cureus · doi:10.7759/cureus.109657
“While models like SONIC are valuable training tools, trainees should not rely on task-trainers alone to increase competency [23].”
Yavner, J., Ferguson, C., Sharath, S., Glaser, K. K. J., Medvedovsky, S., Eisner, S., Kirwin, J. D., & Kougias, P. (2026) · Global Surgical Education - Journal of the Association for Surgical Education · doi:10.1007/s44186-026-00539-x
Chen, Y., Li, Y., & Wu, J. G. (2026) · International Conference on Distance Education and Learning (ICDEL) · doi:10.1109/icdel70250.2026.11663919
“First, theoretical knowledge is often quickly forgotten, primarily evidenced by difficulties in retaining key content such as indications, contraindications, procedural steps, and safety precautions over the long term [4].”
First Experience With Using a Simulator in Teaching Physiology of the Cardiovascular System
Mazgutova, N., Mokrá, D., Andrea, Plevková, J., Biringerová, Z., & Mokrý, J. (2026) · Physiological Research · doi:10.33549/physiolres.935831
“In recent years, simulations have become widely used in medical education to advance the acquisition of clinical skills, improve team working, and encourage deliberate practice in the clinical environment [1-3].”
Implementing a Portable, Simulation-Based Trauma Curriculum for Rural Hospitals: Planning Pilot Year
Moore, G., Aldaher, Z., Harp, C., Wilcox, J., Dunn, K., Via, K., Gunji, S., Skadan, S., Jones, C., Zevallos, E., et al. (2026) · Journal of Surgical Research · doi:10.1016/j.jss.2026.09.016
Artificial intelligence: Reshaping medical education and the healthcare system
Meo, S. A. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-45973-3.00003-8
Forest machine operator students’ experiences of simulation-based learning
Manu, M., Silvennoinen, M., Näykki, P., & Vesisenaho, M. (2026) · Nordic Journal of Vocational Education and Training · doi:10.3384/njvet.2242-458x.261636
“This finding is in accordance with previous studies highlighting the importance of the teacher’s presence, feedback, and guidance in simulations especially with young students, or novice learners (Jossberger et al., 2018; Kneebone, 2005; Rudolph et al., 2013).”
DiCostanzo, F. (2015) · Rowan Digitals Works (Rowan University) · Cited by 1
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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