Advances in Health Sciences Education

, Volume 19, Issue 2, pp 251–272 | Cite as

Feedback for simulation-based procedural skills training: a meta-analysis and critical narrative synthesis

  • Rose HatalaEmail author
  • David A. Cook
  • Benjamin Zendejas
  • Stanley J. Hamstra
  • Ryan Brydges


Although feedback has been identified as a key instructional feature in simulation based medical education (SBME), we remain uncertain as to the magnitude of its effectiveness and the mechanisms by which it may be effective. We employed a meta-analysis and critical narrative synthesis to examine the effectiveness of feedback for SBME procedural skills training and to examine how it works in this context. Our results demonstrate that feedback is moderately effective during procedural skills training in SBME, with a pooled effect size favoring feedback for skill outcomes of 0.74 (95 % CI 0.38–1.09; p < .001). Terminal feedback appears more effective than concurrent feedback for novice learners’ skill retention. Multiple sources of feedback, including instructor feedback, lead to short-term performance gains although data on long-term effects is lacking. The mechanism by which feedback may be operating is consistent with the guidance hypothesis, with more research needed to examine other mechanisms such as cognitive load theory and social development theory.


Simulation-based medical education Procedural skills training Feedback Motor learning Technical skills 



The authors thank Patricia Erwin, Jason Szostek, and Amy Wang for their assistance with literature searching, abstract reviewing and data extraction. This work was supported by intramural funds, including an award from the Division of General Internal Medicine, Mayo Clinic.

Conflicts of interest

No relevant conflicts of interest for any of the authors. There was no industry relationship with this work.


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Rose Hatala
    • 1
    • 7
    Email author
  • David A. Cook
    • 2
    • 3
  • Benjamin Zendejas
    • 4
  • Stanley J. Hamstra
    • 5
  • Ryan Brydges
    • 6
  1. 1.Department of MedicineUniversity of British ColumbiaVancouverCanada
  2. 2.Office of Education ResearchMayo Medical SchoolRochesterUSA
  3. 3.Division of General Internal MedicineMayo Clinic College of MedicineRochesterUSA
  4. 4.Department of SurgeryMayo Clinic College of MedicineRochesterUSA
  5. 5.University of Ottawa Skills and Simulation Centre, Academy for Innovation in Medical Education, Faculty of MedicineUniversity of OttawaOttawaCanada
  6. 6.Department of Medicine and The Wilson CentreUniversity of TorontoTorontoCanada
  7. 7.St. Paul’s HospitalVancouverCanada

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