Clinical Simulation in Nursing (2012) 8, e429-e435

www.elsevier.com/locate/ecsn

Featured Article

Simulation and Psychomotor Skill Acquisition:

A Review of the Literature
Jennifer Gunberg Ross, PhD, RN, CNE*
College of Nursing, Villanova University, Villanova, PA 19085, USA

KEYWORDS Abstract: Decreased opportunities for skill practice and mounting concerns that graduate nurses are
literature review; not competent in basic psychomotor skills requires nurse educators to reevaluate methods to teach
nursing; these skills. Simulation offers a fresh approach to psychomotor skills education allowing the student
psychomotor skills; to integrate knowledge from all three learning domains while practicing the skill. This article discusses
simulation; the current state of the science on the use of simulation for psychomotor skill acquisition. This liter-
skill ature review identifies that limited empirical evidence exists to support the efficacy of simulation to
teach psychomotor skills, most notably within the discipline of nursing. The existing data stem from
studies with limitations that affect the interpretation and generalizability of the results. These findings
suggest the need for further research in the area of simulation and psychomotor skill acquisition within
nursing education.
Cite this article:
Ross, J. G. (2012, November). Simulation and psychomotor skill acquisition: A review of the literature.
Clinical Simulation in Nursing, 8(9), e429-e435. doi:10.1016/j.ecns.2011.04.004.
2012 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier
Inc. All rights reserved.

Background
Nursing shortages, busy clinical environments, increased
demand for student clinical placements, and a shift away
from acute care continue to decrease the opportunities for
nursing students to learn psychomotor skills within patient
care settings (Castanelli, 2009; Sears, Goldsworthy, &
Goodman, 2010). Not only have these factors decreased
learning opportunities for students, they have also created
inconsistencies among the clinical practicum experiences
of student nurses. Because of the limited opportunities for
psychomotor skill development, concerns are mounting
among nurses and nurse educators that newly graduated
nurses are not proficient in many of the basic psychomotor
* Corresponding author: Jennifer.Ross@villanova.edu (J. G. Ross).
skills needed for competent nursing care (Farley & Hendry,
1997; Gerrish, 2000; Hilton, 1996; Hilton & Pollard, 2004;
Knight, 1998; Knight & Mowforth, 1998; Salyers, 2007).
Furthermore, inexperienced students increase risk of patient
harm when learning and practicing basic skills on patients
(Castanelli, 2009). Such concerns necessitate consideration
of the efficacy of teaching strategies for psychomotor skills
in nursing education.
Traditionally, psychomotor skill education in health care
has been fragmented. Skills are divided into components
including the psychomotor skill, cognitive knowledge, and
affective considerations, and each is taught separately. This
technique allows the student to progress from simple to
complex, but it fails to fully incorporate the many
complexities involved in performing psychomotor skills
on actual patients (Nestel, Kneebone, & Kidd, 2003).

1876-1399/$ - see front matter 2012 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.ecns.2011.04.004
Simulation and Psychomotor Skill Acquisition e430

Usually, psychomotor skills are taught on static manikins in quantitative studies related to the use of simulation in the
a college-based laboratory environment allowing for a safe, acquisition of psychomotor skills. For the purposes of this
controlled setting where students can learn skills at their own review, simulation encompassed the use of task-trainers,
pace without fear of patient harm. However, such education in static manikins, role playing, and patient care scenarios
the collegiate setting is completely separate and unique from only; computer-based simulation and virtual reality simu-
the clinical environment lation studies were excluded. Furthermore, this review
where the skill will focuses only on the acquisition of psychomotor skills;
Key Points eventually be performed studies exploring the transfer of skills learned in simulation

There is limited em- (Kneebone et al., 2004). Stu- to actual patient care are outside the scope of this literature
pirical evidence in dents often cite difficulty review. Databases included in the literature search were the
the nursing literature transitioning from the college Cumulative Index of Nursing and Allied Health Literature
supporting the effi- learning laboratory setting to (CINAHL), PubMed, and Educational Resources Informa-
cacy of simulation to actual clinical environments tion Center (ERIC). Key terms used for the search included
teach psychomotor (Medley & Horne, 2005); the following: simulation, clinical competence, clinical
skills. however, all health care prac- performance, skill, nursing skills, and psychomotor skills.

The existing data titioners must eventually care Various combinations of the above terms were created
stem from studies for patients in actual clinical using the Boolean search terms AND, OR, and NOT to
with limitations that environments independently. generate the most comprehensive list of empirical articles
affect the interpreta- Given the concerns about available. Additional limits of humans and English
tion and generaliz- students ability to transfer were placed on database searches. Database searching
ability of the findings. knowledge and skills from identified a total of 530 articles for initial review. However,

More research is the learning laboratory in it is important to note that this total article number may
needed to support the the collegiate setting to actual include some articles that were listed in more than one
use of simulation to patient care areas, it is imper- search or in more than one database.
teach psychomotor ative that nurse educators In addition to thorough searches of the relevant literature
skills. consider innovative methods databases, an ancestral search of reference lists of all
to teach these skills and ease relevant articles was also performed. Reference lists were
the transition to clinical practice. screened for titles, which included the key terms of
Simulation offers many advantages to students learning simulation, simulator, skills, psychomotor, performance,
psychomotor skills. As mentioned previously, psychomotor acquisition, competency, training, learning, or teaching.
skills do not exist independently, but rather contain compo- Fifty-one articles were identified through this process.
nents from all three learning domains: psychomotor, cogni- However, as with the database searches, some articles
tive, and affective. Traditionally, each domain of learning has may have been referenced more than once.
been taught individually, but all are necessary when interact- The searches described above yielded a total of 581
ing with patients in the clinical environment (Kneebone et al., articles for initial review. Each articles abstract was first
2002). Kolbs (1984) experiential learning theory suggests that reviewed for relevance, and then the full article was
students learn most effectively when the learning environment obtained and screened for appropriateness. This compre-
combines relevant components of psychomotor, cognitive, hensive screening process yielded a total of four research
and affective knowledge because learning is a continuous pro- studies related specifically to psychomotor skill acquisition
cess based on experience. Patient care simulations, by nature, and simulation in nursing education. Because of the dearth
integrate all domains of learning (Goldenberg et al., 2005; of quantitative studies evaluating simulation training on
Nehring et al., 2001) allowing students to completely synthe- psychomotor skill competency in nursing, multiple health
size the related components of knowledge before working in care disciplines were included in this review, including
an actual clinical environment. Transfer of knowledge is eased various subspecialties of medicine and allied health,
by decreased anxiety and increased self-confidence, qualities leading to a total of 19 articles for inclusion.
that are evident in simulated learning experiences such as sim-
ulation (Goldenberg et al., 2005; Wilford & Doyle, 2006). Be-
cause simulation mimics real clinical environments, the goal is Results
for students to more easily apply what they learn in simulation
to actual patient care settings (Wilford & Doyle, 2006). Nursing

Alinier, Hunt, Gordon, and Harwood (2006) conducted

Methods a preeposttest study to determine the effectiveness of
scenario-based, intermediate fidelity, full-scale simulation
A comprehensive search of the literature was conducted training on the clinical skills and competence of second-
between January 2008 and January 2011 to obtain relevant year diploma nursing students. Alinier, Hunt, and Gordon

pp e429-e435
Clinical Simulation in Nursing
Volume 8
Issue 9

Simulation and Psychomotor Skill Acquisition
provided preliminary results on the same study in 2004.
The clinical skills evaluated in this study included psycho-
motor skills such as electrocardiogram electrode place-
ment, airway management, pulse oximetry measurement,
ventilator tubing installation, and blood pressure measure-
ment. In addition, several cognitive and other practical
skills were assessed. Furthermore, each participant was
given a questionnaire before the posttest that asked about
their confidence, previous experience in health care, and
stress related to technology. Based on power analysis,
a sample size of 125 (d 0.5, a 0.05, power 0.8)
was required; however, after accounting for dropouts, a con-
venience sample of 99 was used in the study. The authors
acknowledge that the sample used was sufficient to detect
the effect size in the sample. All subjects were given a pre-
test in the form of an Objective Structured Clinical Exam-
ination (OSCE). Subjects were randomly assigned to
control (n 50) and experimental (n 49) groups after
the pretest. The experimental group received simulation
training after the pretest, and the control group received
no additional training. Six months after the pretest, all sub-
jects took part in a posttest OSCE. Task-specific checklists
were used for each skill tested. Data were analyzed using
t tests. The experimental group improved their performance
on the OSCE between the pre- and posttests 7% more than
the control group; this difference is statistically significant
(p < 0.001). The authors concluded that simulation training
has a positive impact on student performance.
Radhakrishnan, Roche, and Cunningham (2007) con-
ducted a quasi-experimental pilot study to evaluate the use
of a high-fidelity simulator (Laerdal SimMan) on
second-degree baccalaureate nursing students performance
of several patient care skills, including basic assessment
skills, safety, and communication. A convenience sample
of 12 second-degree BSN nursing students were randomly
assigned to either the control group or the experimental
group. The experimental group received simulation practice
in managing a two-patient assignment, while the control
group did not receive any additional practice outside of clin-
ical. At the end of the semester, all subjects were evaluated
in a simulated patient care scenario. Data were analyzed
with the chi-square test. The experimental group scored sig-
nificantly higher than the control group in safety (p 0.001)
and basic assessment skills (p 0.009). More specifically,
the experimental group assessed vital signs significantly bet-
ter than the control group (p 0.009). The small sample
size markedly limits the power and generalizability of find-
ings. There was no pretest to compare posttest results, mak-
ing it difficult to analyze the results. In addition, the control
group did not have an alternative activity during the exper-
imental groups simulation training, indicating that the sig-
nificant results could be related to a factor other than
simulation training, such as increased time of practice.
In 2008, Moule, Wilford, Sales, and Lockyer published
a single group mixed methods study exploring nursing stu-
dents knowledge and skill performance of manual handling
pp e429-e435
Clinical Simulation in Nursing
Volume 8
Issue 9
e431
and basic life support (BLS) after simulation training.
Power analysis revealed a necessary sample size of 62;
however, only 50 first- and third-year nursing students com-
pleted the study. Pre- and posttest multiple choice tests were
administered to assess cognitive knowledge while posttest-
only vignettes and OSCEs were used to assess skill perfor-
mance. All students received simulation training that
included scenarios and debriefing. Mean scores on the
BLS multiple choice test increased significantly
(p < 0.01) while mean scores on the manual handling mul-
tiple choice test increased, but not significantly (p 0.07).
Mean scores for the posttest vignette and OSCE were
68.5% and 77.8%, respectively, with no pretest for compar-
ison. Students responded positively to the benefits of simu-
lation for skill acquisition. The authors suggested that the
results show simulation helps students gain knowledge
and skills; however, without pretest vignettes and OSCE
or a control group, it is hard to interpret these data because
there are no data for comparison of results.
Ackermann (2009) conducted a two-group quasi-exper-
imental study exploring the effect of a high-fidelity simula-
tion intervention on baccalaureate nursing students
acquisition and retention of cardiopulmonary resuscitation
(CPR) knowledge and skills. Power analysis indicated
a necessary sample size of 68 subjects; 65 junior baccalau-
reate nursing students completed the pretest and first post-
test (acquisition), while only 49 subjects completed the
second posttest (retention). Subjects were randomly as-
signed to either a control or experimental group. After stan-
dard training, all subjects were evaluated at pretest using
multiple choice tests to assess knowledge. The experimen-
tal group participated in a mock code simulation using
Laerdals SimMan, and the control group received no ad-
ditional intervention. All subjects were then posttested for
knowledge and skill performance. Multiple choice tests
were used to assess knowledge, while simulated mock co-
des, using Laerdals Resusci-Anne manikin, were used
to assess skill performance. All subjects were subsequently
posttested a second time 3 months later using the same
evaluation strategies. At the first posttesting, the experi-
mental group had significantly higher knowledge scores
(p 0.015) and skill performance (p < 0.001) than the con-
trol group. The author concluded that high-fidelity simula-
tion had a positive effect on CPR knowledge and skill
acquisition and retention. Because the control group did
not have an alternative activity during the experimental
groups simulation training, it is hard to determine whether
the significant results were actually related to the simula-
tion training or simply a result of the extra practice time ex-
perienced by the experimental group.
The dearth of reports of nursing research studying
psychomotor skill acquisition and simulation clearly dem-
onstrates the need for further research in this area. The
available nursing literature suggests that simulation is
effective at increasing knowledge and skill performance
in nursing students; however, these results must be
Simulation and Psychomotor Skill Acquisition
reviewed critically, because most studies had small or
underpowered samples, or less rigorous empirical designs,
such as a lack of pretest for comparison, lack of control
group for comparison, or unequal practice times for the
experimental and control groups, which makes it difficult to
assess practical significance. Poorly designed studies do not
allow for causal interpretation of the results because the
study findings could result from factors other than the
intervention.
Medicine
In 2004, Curran, Aziz, OYoung, and Bessell conducted
a preeposttest study to determine the effectiveness of
a high-fidelity computerized simulation (ANAKIN neonatal
simulator) on knowledge and skill retention of neonatal
resuscitation. A convenience sample of 60 third-year med-
ical students was randomly assigned to either the control
group or experimental group. All subjects received a stan-
dard neonatal resuscitation program (NRP) and were given
both knowledge and skills tests immediately after standard
training. These served as pretests for the study. The control
group then watched a video, while the experimental group
worked with the simulator 4 months after the initial NRP
training. At this point, all subjects were evaluated in knowl-
edge and confidence. Finally, 8 months after initial NRP
training, all subjects were posttested for skill ability using
the high-fidelity simulator. Skill performance was evaluated
using the NRP task-specific checklist. Within-group com-
parisons of skill performance were evaluated using t tests.
Both the experimental group (p 0.007) and control group
(p < 0.001) showed a statistically significant decline in
skills performance from NRP training to 8 months post-
training. While the experimental group received higher
scores than the control group on the knowledge
(p 0.927) and skill performance (p 0.841) posttests,
these results were not statistically significant. Calculated
power level was not reported; therefore it is unclear
whether there was enough power to detect a difference. A
satisfaction survey administered to all subjects revealed
that students felt positive about the simulation identifying
that simulation improved their understanding. On the other
hand, students felt anxious because they were being ob-
served. The authors concluded that skill performance dete-
riorates over time and simulation is not an effective method
to assist with skill retention. No recommendations were
made, although the authors acknowledged the inability to
generalize findings as a limitation of the study.
Deering, Poggi, Macedonia, Gherman, and Satin (2004)
conducted a posttest-only study to determine if simulator
training improves obstetric residents performance in a sim-
ulated shoulder dystocia vaginal delivery. A convenience
sample of 33 obstetric residents were randomly assigned
to a control group (n 17) and an experimental group
(n 16). The experimental group received simulation
training using patient care scenarios with a high-fidelity
pp e429-e435
Clinical Simulation in Nursing
Volume 8
Issue 9
e432
birthing simulator (Noelle) on proper techniques for a vagi-
nal delivery with shoulder dystocia. Within 2 weeks of
training, all subjects performed a simulated shoulder dysto-
cia delivery using the same birthing simulator. Residents
were evaluated using a task-specific checklist for skill
performance and a Likert scale for preparation and
performance. Data were statistically analyzed using the
ManneWhitney U test. The experimental group achieved
a significantly higher overall score (p 0.012) than the
control group on the posttest-simulated delivery. The au-
thors concluded that training with a birthing simulator im-
proves resident performance of a shoulder dystocia
delivery. Because no pretest was administered, there is no
way to determine that the control and experimental groups
were comparable at the start of the study, and there is no
point of comparison for the posttest results.
A study by Wayne et al. (2005) explored the effect of
high-fidelity simulation training on medical residents Ad-
vanced Cardiac Life Support (ACLS) skill performance.
Thirty-eight second-year medical residents were randomly
assigned to a control group or experimental group. All sub-
jects were pretested for baseline ACLS skill performance.
After pretest, the experimental group engaged in
scenario-based simulation training using a high-fidelity pa-
tient manikin while the control group received no addi-
tional training. After subsequent testing, the experimental
group and control group crossed over so all subjects ulti-
mately received the simulation training. Resident perfor-
mance of ACLS skills was measured using a task-specific
checklist. The experimental group scored 38% higher
than the control group (p < 0.0001) on ACLS skill perfor-
mance after simulation training. Consequently, the authors
determined that repetitive practice with a high-fidelity sim-
ulator significantly improved medical residents perfor-
mance of ACLS skills. A limitation of this study is the
lack of a comparable experience for the control group dur-
ing the experimental groups simulation training. It is pos-
sible the significant results represent simply the extra time
spent by the experimental group practicing rather than a re-
flection of simulation training.
Deering, Brown, Hodor, and Satin (2006) performed
a one-group, preeposttest study to determine if simulation
training improves obstetric residents performance in
breech delivery. Twenty obstetric residents were pretested
on simulated vaginal breech delivery performance to assess
initial knowledge base. No differences were found among
the subjects before the intervention. All subjects then par-
ticipated in scenario-based simulation training with
a high-fidelity birthing simulator (Noelle). Within 2 weeks
of the simulation training, all residents were posttested on
a simulated vaginal breech delivery using the same simula-
tion system. Pre- and posttests were scored using a task-
specific checklist for skill performance and a Likert scale
for safety performance. Data were analyzed using Wil-
coxon signed rank test, McNemar chi-square, regression
analysis, and paired t tests as appropriate. Statistical
Simulation and Psychomotor Skill Acquisition
findings revealed that both overall median performance
scores (p 0.001) and safety performance (p 0.001)
were significantly higher after simulation training. The re-
searchers concluded that resident performance of a simu-
lated vaginal breech birth improves with simulation
training. Because there was no control group for compari-
son, it is difficult to determine if these results were actually
related to the simulation intervention.
Hutton, Kenealy, and Wong (2008) conducted a one-
group preeposttest study to assess the effectiveness of
a simulation model (SuperAnnie) to teach chest tube inser-
tion to junior physicians. Forty-nine physicians completed
all requirements of the study. All subjects were pretested
on chest tube insertion on the simulation model. After pre-
testing, all subjects underwent chest tube insertion training
that involved observing and practicing chest tube insertion
on the simulation model for 2 hours in small groups. One
month after the training, all subjects were posttested on
chest tube insertion using the same simulation model. Chest
tube insertion skill was measured using a task-specific
checklist. Chest tube insertion scores significantly im-
proved from pretest to posttest (p < 0.001). The authors
concluded that the simulation model training program ef-
fectively improved chest tube insertion skill. One limitation
of this study was the lack of control group, which makes it
difficult to determine if the significant results were actually
related to the simulation training.
In 2009, Barsuk, Ahya, Cohen, McGaghie, and Wayne
published an article describing a preeposttest study explor-
ing the effect of simulation training on temporary hemodi-
alysis catheter insertion skills. Eighteen nephrology fellows
participated in the study; 12 participated in simulator train-
ing while six did not. All subjects were posttested on tem-
porary hemodialysis catheter insertion using a task-specific
checklist on the simulator CentralLineMan. Data were an-
alyzed using the ManneWhitney U test. The simulator-
trained group had significantly higher posttest scores than
the control group (p 0.001). The authors acknowledged
the small sample size as a limitation of this study. In addi-
tion, the control group was not pretested to ensure homoge-
neity of the sample before the intervention.
Lee et al. (2009) conducted a preeposttest study to deter-
mine the effect of simulation training on medical students
technical skill in vascular surgery. Forty-one medical stu-
dents were pretested on a renal stent insertion on an endo-
vascular simulator (The Simbionix Angiomentor) after
receiving traditional education. Then, over the next 8 weeks,
students received weekly simulation practice on various vas-
cular procedures on the same endovascular simulator. At the
end of the course, students completed a second renal stent
insertion as a posttest. Renal stent insertion competency
was measured using a global rating scale. Students showed
significant technical skill improvement from pre- to posttest
(p < 0.01). The lack of a control group for comparison
makes it difficult to ascertain whether the significant results
were actually related to the simulation training.
pp e429-e435
Clinical Simulation in Nursing
Volume 8
Issue 9
e433
Other studies have been conducted on high-fidelity
cardiac patient simulators (Harvey and HeartSim II)
among medical residents, critical care nurses, and graduate
nursing students. These findings consistently demonstrate
improved cardiology skills (Issenberg et al., 2002;
Woolliscroft, Calhoun, Tenhaken, & Judge, 1987), and im-
proved ability to recognize heart sounds after simulator
training (Butter et al., 2010; Champagne, Harrell, &
Friedman, 1989; Harrell, Champagne, Jarr, & Miyaya,
1990a; Harrell, Champagne, Jarr, & Miyaya, 1990b).
The medical literature demonstrates that simulation is an
effective method to enhance skill knowledge and perfor-
mance. In addition to the above findings, a systematic
review of high-fidelity simulation in medical education
showed that simulation can improve learning in clinical and
procedural skills and patient management, although in this
review simulation was not compared with other educational
modalities (Issenberg et al., 2005). Skill retention after sim-
ulation training shows mixed results. However, these results
must be interpreted with caution because many of the study
designs could have been more rigorous. Omission of either
a pretest or a control group makes it difficult to determine if
positive results were actually related to the intervention or
to extraneous variables.
Allied Health
Seybert & Barton (2007) conducted a one-group prospec-
tive study to assess the use of simulation-based learning
on doctor of pharmacy students accurate performance of
blood pressure (BP) measurement. A convenience sample
of 102 students was enrolled in this study. All subjects re-
ceived didactic classroom content on BP measurement im-
mediately followed by simulation training on BP
measurement with a high-fidelity simulator (Laerdal Sim-
Man). A second simulation training on BP was provided
2 weeks later. A task-specific checklist was used to
measure BP assessment performance on the same high-
fidelity simulator for all subjects after each simulation
session. Subjects completed a Likert-style survey instru-
ment before and after simulation to assess their attitudes
towards simulation. Analysis of variance (ANOVA) was
used to statistically analyze performance of BP assessment.
Student performance of BP assessment showed significant
improvement after each simulation training session
(p 0.029). Survey results indicated that students felt
that simulation would improve their ability to measure
BP. Based on these results, the authors concluded that
pharmacy students showed a significant improvement in
the performance of BP measurement after simulation train-
ing. Because of the prospective design of this study, no as-
sumption of cause and effect was made, but there were
significant differences.
Tuttle et al. (2007) conducted a quasi-experimental,
repeated measures study to determine the effect of simulation
training on mini bronchoalveolar lavage (BAL) performance
Simulation and Psychomotor Skill Acquisition
among respiratory therapists. A convenience sample of 107
respiratory therapists was studied. Twenty-four respiratory
therapists had their current performance of mini BAL as-
sessed with a scenario-based, high-fidelity simulation assess-
ment. These therapists had been trained with standard
training at some point before the evaluation. Subsequently,
83 respiratory therapists received Web-based instruction on
mini BAL followed by simulation training with a high-
fidelity mannequin (Laerdal SimMan). Performance was
evaluated at three points in time: after Web-based training,
after simulation training, and 90 days after simulation train-
ing. Performance was assessed using a task-specific checklist
during a scenario-based simulation using the same simula-
tion manikin. Respiratory therapists performed better after
simulation training than after either standard training or
Web-based training (p < 0.01). In addition, 90-day skill re-
tention after simulation training was better than immediate
assessment after initial training or Web-based training
(p value not reported). Based on these results, the authors
concluded that mini BAL training can be enhanced with sim-
ulation. In addition, the researchers determined that simula-
tion training helps with skill retention.
Rigorous empirical data exploring the use of simulation
for psychomotor education in allied health fields is very
limited. The studies that are available further support the
use of simulation for psychomotor skill education. Use of
more rigorous research designs using two groups with
a pretest for comparison and power analysis would
strengthen these findings.
Discussion
With the upsurge of simulation use, the literature related to
simulation in health care education is rapidly expanding.
Much of the available simulation literature is descriptive in
nature, with a surprisingly limited numbers of empirical
studies. The majority of empirical literature on simulation
is found within the medical profession; however, there is
a growing body of evidence available on the use of
simulation in nursing and allied health care. Despite the
widespread adoption of simulation in nursing education,
there is a dearth of research available exploring the efficacy
of simulation on competency development (Harlow &
Sportsman, 2007). Much of the empirical data that is avail-
able is of questionable rigor. Furthermore, there is a general
lack of quantitative studies exploring the effectiveness of
simulation in cognitive and psychomotor skill attainment.
Although the health care literature exploring simulation
is vast, the available literature related to simulation and
psychomotor skills has a limited focus on specific psycho-
motor skills (most notably cardiac assessment). Most
available studies explore various uses for high-fidelity
simulation, while low-fidelity simulation, though the more
common method to teach psychomotor skills, is less
commonly studied. In addition, there is a lack of rigorous,
pp e429-e435
Clinical Simulation in Nursing
Volume 8
Issue 9
e434
high-quality studies on the use of simulation and psycho-
motor skill acquisition.
This literature review focused on health care education
literature related to simulation training in the acquisition of
psychomotor skills. Overall, this literature review reveals
the following:

Most of the available literature is found in the medical
profession; there are limited empirical studies available
exploring the use of simulation for psychomotor skills
training in nursing education.

Most of the available empirical evidence demonstrating
the efficacy of simulation for psychomotor skill acqui-
sition focuses on high-fidelity simulation.

Simulation appears to enhance psychomotor skill per-
formance; however, much of the evidence supporting
the use of simulation in psychomotor skills acquisition
stems from studies with limitations, such as small sam-
ple sizes and lack of control group for comparison;
therefore the results must be interpreted with caution.

Simulation is well received by students.
This literature review demonstrates the need for further
research regarding the use of simulation in the education of
psychomotor skills in nursing education, specifically:

Quantitative evaluation of the efficacy of simulation to
teach psychomotor skills within the nursing discipline.

Quantitative evaluation of low-fidelity simulation to
teach psychomotor skills.

Inclusion of more varied psychomotor skills.

Use of rigorous, true experimental designs with power-
driven sample sizes and control groups to test psycho-
motor skill performance after simulation training.
Conclusion
Psychomotor skills are a necessary component for all health
care practice. Simulation offers a novel method for teaching
psychomotor skills. However, robust quantitative research
about the efficacy of this teaching strategy is sorely lacking,
especially in the nursing literature. Given the importance of
competent psychomotor skill performance, it is essential
that teaching strategies are explored for their efficacy.
Simulation is rapidly gaining popularity as a gold-standard
teaching technique for psychomotor skills. However, the
current nursing literature is devoid of adequate empirical
evidence to support the use of this strategy in such a context.
Continued research efforts are needed to empirically
support this current education trend.
References
Ackermann, A. D. (2009). Investigation of learning outcomes for the ac-
quisition and retention of CPR knowledge and skills learned with the
 Simulation and Psychomotor Skill Acquisition
use of high-fidelity simulation. Clinical Simulation in Nursing, 5(6),
e213-e222.
Alinier, G., Hunt, B., & Gordon, R. (2004). Determining the value of sim-
ulation in nurse education: Study design and initial results. Nurse Edu-
cation in Practice, 4(3), 200-207.
Alinier, G., Hunt, B., Gordon, R., & Harwood, C. (2006). Effectiveness of
intermediate-fidelity simulation training technology in undergraduate
nursing education. Journal of Advanced Nursing, 54(3), 359-369.
Barsuk, J. H., Ahya, S. N., Cohen, E. R., McGaghie, W. C., &
Wayne, D. B. (2009). Mastery learning of temporary hemodialysis cath-
eter insertion by nephrology fellows using simulation technology and
deliberate practice. American Journal of Kidney Diseases, 54(1), 70-76.
Butter, J., McGaghie, W. C., Cohen, E. R., Kaye, M. E., & Wayne, D. B.
(2010). Simulation-based mastery learning improves cardiac ausculta-
tion skills in medical students. Journal of General Internal Medicine,
25(8), 780-785.
Castanelli, D. J. (2009). The rise of simulation in technical skills teaching
and the implications for training novices in anaesthesia. Anaesthesia In-
tensive Care, 37(6), 903-910.
Champagne, M. T., Harrell, J. S., & Friedman, B. J. (1989). Use of a heart
sound simulator in teaching cardiac auscultation. Focus on Critical
Care, 16(6), 448-456.
Curran, V. R., Aziz, K., OYoung, S., & Bessell, C. (2004). Evaluation of
the effect of a computerized training simulator (ANAKIN) on the reten-
tion of neonatal resuscitation skills. Teaching and Learning in Medicine,
16(2), 157-164.
Deering, S., Brown, J., Hodor, J., & Satin, A. J. (2006). Simulation training
and resident performance of singleton vaginal breech delivery. Obstet-
rics & Gynecology, 107(1), 86-89.
Deering, S., Poggi, S., Macedonia, C., Gherman, R., & Satin, A. J. (2004).
Improving resident competency in the management of shoulder dystocia
with simulation training. Obstetrics & Gynecology, 103(6), 1224-1228.
Farley, A., & Hendry, C. (1997). Teaching practical skills: A guide for pre-
ceptors. Nursing Standard, 11(29), 46-48.
Gerrish, K. (2000). Still fumbling along? A comparative study of the newly
qualified nurses perception of the transition from student to qualified
nurse. Journal of Advanced Nursing, 32(2), 473-480.
Goldenberg, D., Andrusyszyn, M. A., & Iwasiw, C. (2005). The effect of
classroom simulation on nursing students self-efficacy related to health
teaching. Journal of Nursing Education, 44(7), 310-314.
Harlow, K. C., & Sportsman, S. (2007). An economic analysis of patient
simulators for clinical training in nursing education. Nursing Econom-
ics, 25(1), 24-29.
Harrell, J. S., Champagne, M. T., Jarr, S., & Miyaya, M. (1990a). Heart
sound simulation: How useful for critical care nurses? Heart & Lung,
19, 197-202.
Harrell, J. S., Champagne, M. T., Jarr, S., & Miyaya, M. (1990b). Teaching
cardiovascular assessment. The Journal of Continuing Education in
Nursing, 21(6), 241-244.
Hilton, P. (1996). Clinical skills laboratories: Teaching practical nursing.
Nursing Standard, 10(37), 44-47.
Hilton, P., & Pollard, C. (2004). Supporting clinical skills developments.
Nursing Standard, 18(35), 31-36.
Hutton, I. A., Kenealy, H., & Wong, C. (2008). Using simulation models to
teach junior doctors how to insert chest tubes: A brief and effective
teaching module. Internal Medicine Journal, 38(12), 887-891.
Issenberg, S. B., McGaghie, W. C., Gordon, D. L., Symes, S., Petrusa, E. R.,
Hart, I. R., et al. (2002). Effectiveness of a cardiology review course for
internal medicine residents using simulation technology and deliberate
practice. Teaching & Learning in Medicine, 14(4), 223-228.
pp e429-e435
Clinical Simulation in Nursing
Volume 8
Issue 9
e435
Issenberg, S. B., McGaghie, W. C., Petrusa, E. R., Gordon, D. L., &
Scalese, R. J. (2005). Features and uses of high-fidelity medical simula-
tions that lead to effective learning: A BEME systematic review. Medi-
cal Teacher, 27(1), 10-28.
Kneebone, R., Kidd, J., Nestel, D., Asvall, S., Paraskevas, P., & Darzi, A.
(2002). An innovative model for teaching and learning clinical proce-
dures. Medical Education, 36(7), 628-634.
Kneebone, R. L., Scott, W., Darzi, A., & Horrocks, M. (2004). Simulation
and clinical practice: Strengthening the relationship. Medical Education,
38(10), 1095-1102.
Knight, C. M. (1998). Evaluating a skills centre: Learning psychomotor
skillsdA review of theory. Nurse Education Today, 18(6), 448-454.
Knight, C. M., & Mowforth, G. M. (1998). Skills centre: Why we did it,
how we did it. Nurse Education Today, 18(5), 389-393.
Kolb, D. A. (1984). Experiential learning: Experience as the source of
learning and development. Englewood Cliffs: Prentice Hall.
Lee, J. T., Qiu, M., Teshome, M., Raghavan, S. S., Tedesco, M. M., &
Dalman, R. L. (2009). The utility of endovascular simulation to improve
technical performance and stimulate continued interest of preclinical
medical students in vascular surgery. Journal of Surgical Education,
66(6), 367-373.
Medley, C. F., & Horne, C. (2005). Using simulation technology for un-
dergraduate nursing education. Journal of Nursing Education, 44(1),
31-34.
Moule, P., Wilford, A., Sales, R., & Lockyer, L. (2008). Student experi-
ences and mentor views of the use of simulation for learning. Nurse Ed-
ucation Today, 28, 790-797.
Nehring, W. M., Ellis, W. E., & Lashley, F. R. (2001). Human patient sim-
ulators in nursing education: An overview. Simulation and Gaming,
32(2), 194-204.
Nestel, D., Kneebone, R., & Kidd, J. (2003). Teaching and learning
about skills in minor surgery. Journal of Clinical Nursing, 12(2),
291-296.
Radhakrishnan, K., Roche, J. P., & Cunningham, H. (2007). Measuring
clinical practice parameters with human patient simulation: A pilot
study. International Journal of Nursing Scholarship, 4(1), 1-11.
Salyers, V. L. (2007). Teaching psychomotor skills to beginning nursing
students using a web-enhanced approach: A quasi-experimental study.
International Journal of Nursing Education Scholarship, 4(1).
article 11.
Sears, K., Goldsworthy, S., & Goodman, W. M. (2010). The relationship
between simulation in nursing education and medication safety. Journal
of Nursing Education, 49(1), 52-55.
Seybert, A. L., & Barton, C. M. (2007). Simulation-based learning to teach
blood pressure assessment to doctor of pharmacy students. American
Journal of Pharmaceutical Education, 71(3), 1-6.
Tuttle, R. P., Cohen, M. H., Augustine, A. J., Novotny, D. F., Delgado, E.,
Dongilli, T. A., et al. (2007). Utilizing simulation technology for com-
petency skills assessment and a comparison of traditional teaching
methods of training to simulation-based training. Respiratory Care,
52(3), 263-270.
Wayne, D. B., Butter, J., Siddall, V. J., Fudala, M. J., Lindquist, L. A.,
Feinglass, J., et al. (2005). Simulation-based training of internal medi-
cine residents in advanced cardiac life support protocols: A randomized
trial. Teaching and Learning in Medicine, 17(3), 210-216.
Wilford, A., & Doyle, T. J. (2006). Integrating simulation training into the
nursing curriculum. British Journal of Nursing, 15(17), 926-930.
Woolliscroft, J. O., Calhoun, J. G., Tenhaken, J. D., & Judge, R. D. (1987).
Harvey: The impact of a cardiovascular teaching simulator on student
skill acquisition. Medical Teacher, 9(1), 53-57.