Simulation-Enhanced Blended Learning Versus Traditional See One, Do One Approach for Training Clinical Procedural Skills: A Randomized Non-Inferiority Trial

Mastery of clinical procedural skills is essential in medical practice, especially at various stages of training, and their acquisition is the core objectives. Conventional training methods, particularly the ’see one, do one’ (SODO) approach, remain widely used. In this model, learners first observe a procedure performed by an experienced clinician and then perform it themselves under supervision. Although effective, this approach has notable limitations, including restricted opportunities for repeated practice, variability in patient presentations, and inherent risks of patient harm when procedures are performed by novices (Facilitating flexible learning by replacing classroom time with an online learning environment: a systematic review of blended learning in higher education) (Mccutcheon et al., 2015) These concerns are underscored by ethical guidelines such as the Declaration of Helsinki, which emphasizes the necessity of informed consent and the minimization of risk in medical training involving human subjects. In conventional offline lectures, the predominant model of unidirectional knowledge delivery by instructors often limits the capacity to address students’ holistic learning needs. Conversely, entirely online teaching, even with advanced information technology integration, can leave learners with excessive autonomy and may compromise the consistency and quality of educational outcomes (Müller & Mildenberger, 2021). Blended learning along with simulation, combines cognitive domain with psychomotor domain of medical education, facilitating a more dynamic and interactive educational experience, (Li et al., 2025; Mccutcheon et al., 2015).

Although blended learning has advanced rapidly, its optimal implementation strategies and measurable effectiveness remain subjects of debate. Evidence suggests that blended learning may enhance medical education (Rowe et al., 2012) and undergraduate procedural training programs by integrating cognitive outcomes, supporting individualized learning trajectories, and fostering greater learner confidence and self-efficacy compared with conventional teaching method (Lee et al., 2023). This approach aims to provide a comprehensive learning experience that caters to diverse learning styles and enhances the acquisition of essential clinical skills. In the realm of procedural training, particularly for complex tasks such as intravenous (IV) cannulation, arterial puncture for blood gas analysis, endotracheal tube (ETT) intubation, and supraglottic airway devices insertion, traditional methods such as SODO technique often used but recently come to scrutiny due to associated patient harm. Blended Learning with simulation offers a potential solution by providing a flexible and scalable model that incorporates digital learning and simulation to replace traditional training.

Simulation-based education (SBE) is widely acknowledged for its effectiveness in enhancing procedural competencies, offering learners a risk-free environment to practice clinical skills. Evidence indicates that SBE not only improves technical proficiency but also increases learner confidence and facilitates repeated practice, which is often constrained in real-world clinical settings (Elendu et al., 2024)The incorporation of digital e-learning modules further supports self-directed learning, allowing learners to engage with content at their own pace and consolidate theoretical knowledge. Blended learning (BL) approaches have been shown in some studies to yield comparable or even superior outcomes in skill acquisition and learner satisfaction (Govindan et al., 2023)Conversely, other findings suggest that without adequate integration and institutional support, BL may fall short of its potential. Consequently, rigorous evaluation of BL against traditional educational methods is essential to establish its effectiveness and suitability as a standard approach in medical training.

To address this gap in the literature, we plan to evaluate whether Blended Learning, encompassing digital e-learning modules and simulation-based training, is non-inferior to traditional SODO technique for essential skills among medical interns and anaesthesia trainees.  This study will provide evidence that supports the integration of Blended Learning into medical training curricula, potentially enhancing the efficiency and accessibility of procedural education.