Simulation-Based Deliberate practice – not ‘one size fits all’?

By: Victoria Brazil (@SocraticEM)


Simulation educators have been quick to adopt deliberate practice and mastery learning approaches, impressed by evidence suggesting effectiveness of these techniques. Deliberate practice focuses on honing specific skills through repetitive, targeted practice. It involves setting clear (mastery) goals, and engaging in intense practice sessions, with specific, carefully structured feedback. The literature on simulation-based deliberate practice (SBDP) and mastery learning is widely cited by simulation program leaders seeking support and resources for simulation based education and includes impressive examples of return on investment.

But the findings of educational effectiveness from SBDP are not universal. ‘Deliberate practice’ is simply a broad descriptor of an instructional design approach and is used to describe a wide variety of educational interventions . Its no surprise that the educational effectiveness of SBDP is context dependent, including factors like the specific skill being taught, the baseline learner expertise level, and the educational alternatives.

The question of whether SBDP is better than ‘self guided’ practice has been recently examined by Petrosoniak et al. in their article – Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice. CJEM. 2023 Jun 161. The study compared emergency medicine residents across multiple institutions who were learning how to perform a bougie assisted cricothyrotomy, a life saving surgical airway technique.  One group used a simulation based deliberate practice approach and one used ‘self guided’ practice. There was no measurable difference in skill level between the 2 groups immediately after or at 6 months post training.

In reflecting on this article and in discussion with the lead author, there are some important messages for those of us weighing options in our educational design for skills training.

  1. Simulation based deliberate practice is time and resource intensive to do well. We simply can’t focus on every required skill to this level of intensity. The return on investment is an important lens to bring to our educational resource allocation choices.
  2. But maybe our inability to train every skill using SBDP matters less than we think, because the good habits and learning skills of the learners might be more transferable than we think. E.g., the residents in this study had probably been exposed to SBDP in other skills training and hence the ‘self guided’ group were likely to be advanced learners who may have naturally adopted an approach that was fairly ‘deliberate’.
  3. Higher levels of skill complexity might be required for the superiority of a SBDP approach to emerge. Its no surprise that medium-high level complexity skills like lumbar puncture and central line insertion have led the success stories.
  4. Some of the benefit of SBDP might simply be in engagement. Other work has shown that mastery learning approaches lead to trainees spending longer and attending more sessions than with self-guided training.

So, I suggest we embrace Simulation-Based Deliberate Practice as a fundamental conceptual principle for practical and procedural skills training. But also, that we are prepared to be sophisticated in our application of that principle – allocating resources to the right skills, the right learners and in a selective way that means our educational programs are feasible and sustainable.

Thanks to the author team for this rigorous work, and the encouragement it offers to undertake more empiric work in this area. Thanks also to my colleague Ben Symon for his lovely discussion of the paper in our recent Simulcast episode.


Petrosoniak A, Sherbino J, Beardsley T, Bonz J, Gray S, Hall AK, Hicks C, Kim J, Mastoras G, McGowan M, Owen J, Wong AH, Monteiro S. Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice. CJEM. 2023 Jun 16.

Image courtesy of Mentone Educational

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