Advances in Health Sciences Education

, Volume 18, Issue 1, pp 99–114 | Cite as

Students’ experiences of learning manual clinical skills through simulation

  • Eva JohannessonEmail author
  • Charlotte Silén
  • Joanna Kvist
  • Håkan Hult


Learning manual skills is a fundamental part of health care education, and motor, sensory and cognitive learning processes are essential aspects of professional development. Simulator training has been shown to enhance factors that facilitate motor and cognitive learning. The present study aimed to investigate the students’ experiences and thoughts about their learning through simulation skills training. The study was designed for an educational setting at a clinical skills centre. Ten third-year undergraduate nursing students performed urethral catheterisation, using the virtual reality simulator UrecathVision, which has haptic properties. The students practised in pairs. Each session was videotaped and the video was used to stimulate recall in subsequent interviews. The interviews were analysed using qualitative content analysis. The analysis from interviews resulted in three themes: what the students learn, how the students learn, and the simulator’s contribution to the students’ learning. Students learned manual skills, how to perform the procedure, and professional behaviour. They learned by preparing, watching, practising and reflecting. The simulator contributed by providing opportunities for students to prepare for the skills training, to see anatomical structures, to feel resistance, and to become aware of their own performance ability. The findings show that the students related the task to previous experiences, used sensory information, tested themselves and practised techniques in a hands-on fashion, and reflected in and on action. The simulator was seen as a facilitator to learning the manual skills. The study design, with students working in pairs combined with video recording, was found to enhance opportunities for reflection.


Learning theory Professional development Qualitative content analysis Simulation Skills training Undergraduate nursing education 



We thank the students who participated in this study and Sofia McGarvey for revising the English language in the quotes. This study was supported by the Centre for Educational Development and Research, Faculty of Health Sciences, and the Division of Community Medicine, Medical Education and the Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Sweden.


  1. Bergmann Tiest, W. M. (2010). Tactial perception of material properties. Vision Research, 50, 2775–2782.CrossRefGoogle Scholar
  2. Bradley, P. (2006). The history of simulation in medical education and possible future directions. Medical Education, 40, 254–262.CrossRefGoogle Scholar
  3. Bray, L., Flynn, A., & Sanders, C. (2011). The experiences of children’s nursing students: Learning urethral catheterisation. Nurse Education in Practice, 11(3), 168–172.CrossRefGoogle Scholar
  4. Cioffi, J., Purcal, N., & Arundell, F. (2005). A pilot study to investigate the effect of a simulation strategy on the clinical decision making of midwifery students. Journal of Nursing Education, 44(3), 185–191.Google Scholar
  5. Côté, L., & Turgeon, J. (2005). Appraising qualitative research articles in medicine and medical education. Medical Teacher, 27(1), 71–75.CrossRefGoogle Scholar
  6. Denzin, N. K., & Lincoln, Y. S. (2000). Handbook of qualitative research (2nd ed.). Thousand Oaks: Sage Publications.Google Scholar
  7. Elliott, D., Grierson, L. E. M., Hayes, S. J., & Lyons, J. (2011). Action representations in perception, motor control and learning: Implications for medical education. Medical Education, 45, 119–131.CrossRefGoogle Scholar
  8. Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105–112.CrossRefGoogle Scholar
  9. Hatala, R. (2011). Practice makes perfect… sometimes. Medical Education, 45, 114–116.CrossRefGoogle Scholar
  10. Issenberg, S. B., McGaghie, W. C., Petrisa, E. R., Gordon, D. L., & Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27, 10–28.CrossRefGoogle Scholar
  11. Issenberg, S. B., & Scalese, R. J. (2008). Simulation in health care education. Perspectives in Biology and Medicine, 51(1), 31–46.CrossRefGoogle Scholar
  12. Jeffries, P. R. (2005). Guest Editorial. Technology trends in nursing education: Next steps. Journal of Nursing Education, 44(1), 1–4.Google Scholar
  13. Johannesson, E., Olsson, M., Petersson, G., & Silén, C. (2010). Learning features in computer simulation skills training. Nurse Education in Practice, 10, 268–273.CrossRefGoogle Scholar
  14. Jöud, A., Sandholm, A., Alseby, L., Petersson, G., & Nilsson, G. (2010). Feasibility of a computerized male urethral catheterization simulator. Nurse Education in Practice, 10(2), 70–75.CrossRefGoogle Scholar
  15. Khan, K., Pattison, T., & Sherwood, M. (2011). Simulation in medical education. Medical Teatcher, 33, 1–3.CrossRefGoogle Scholar
  16. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  17. Kvale, S. (2007). Doing interviews. California: Sage Publications.Google Scholar
  18. Lincoln, Y. S., & Guba, E. G. (1986). But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. In D. D. Williams (Ed.), Naturalistic evaluation (pp. 73–84). New Directions for Program Evaluation, 30. San Francisco, CA: Jossey-Bass.Google Scholar
  19. Lyle, J. (2003). Stimulated recall: A report on its use in naturalistic research. British Educational Research Journal, 29(6), 861–878.CrossRefGoogle Scholar
  20. Marton, F., & Booth, S. (1997). Learning and awareness. Mahwah, New Jersey: Lawrence Erlbaum Associates, Inc.Google Scholar
  21. McGaghie, W. C., & Issenberg, S. B. (2010). A critical review of simulation-based research: 2003–2009. Medical Education, 44, 50–63.CrossRefGoogle Scholar
  22. Melerit UrecathVision. Product information of the computer simulator UrecathVision. Retrieved May 10, 2011, from
  23. Meyrick, J. (2006). What is good qualitative research? A first step towards a comprehensive approach to judging rigour/quality. Journal of Health Psychology, 11(5), 799–808.CrossRefGoogle Scholar
  24. Murray, C., Grant, M. J., Howarth, M. L., & Leigh, J. (2008). The use of simulation as a teaching and learning approach to support practice learning. Nurse Education in Practice, 8, 5–8.CrossRefGoogle Scholar
  25. Polanyi, M. (1966). The tacit dimension. Gloucester, Mass: Doubleday & Company, Inc.Google Scholar
  26. Polit, D. E., & Beck, C. T. (2008). Nursing research. Generating and assessing evidence for nursing practice (8th ed.). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  27. Scalese, R. J., Obesco, V. T., & Issenberg, S. B. (2008). Simulation technology for skills training and competency assessment in medical education. Journal of General Internal Medicine, 23(Suppl 1), 46–49.CrossRefGoogle Scholar
  28. Schön, D. (1987). Educating the reflective practitioner. San Francisco: Jossey Bass.Google Scholar
  29. Shumway-Cook, A., & Woollacott, M. J. (2007). Motor control. Translating research into clinical practice (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  30. Silén, C. (2003). Responsibility and independence in learning: What is the role of the educators and the framework of the educational programme? In C. Rust (Ed.), Improving student learning: Improving student learning—theory, research and practice (pp. 249–262). Oxford: The Oxford Centre for Staff and Learning Development.Google Scholar
  31. Silén, C. (2006). The tutor’s approach in base groups (PBL). Higher Education, 51, 373–385.CrossRefGoogle Scholar
  32. Stefanidis, D., Scerbo, M. W., Korndorffer, J. R., & Scott, D. J. (2007). Redefining simulator proficiency using automaticity theory. The American Journal of Surgery, 193, 502–506.CrossRefGoogle Scholar
  33. Tun, J. K., & Kneebone, R. (2011). Bridging worlds: Applying the science of motor learning to clinical education. Medical Education, 45, 111–114.CrossRefGoogle Scholar
  34. Weidner, T. G., & Popp, J. K. (2007). Peer-assisted learning and orthopaedic evaluation psychomotor skills. Journal of Athletic Training, 42(1), 113–119.Google Scholar
  35. Wulf, G., Shea, C., & Lewthwaite, R. (2010). Motor skill learning and performance: A review of influential factors. Medical Education, 44, 75–84.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Eva Johannesson
    • 1
    • 3
    Email author
  • Charlotte Silén
    • 2
  • Joanna Kvist
    • 1
  • Håkan Hult
    • 3
  1. 1.Division of Physiotherapy, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
  2. 2.Centre for Medical Education, Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
  3. 3.Centre for Educational Development and Research, Faculty of Health SciencesLinköping UniversityLinköpingSweden

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