Clinical Skills Practice: What Clinical Skills Are and How to Train Them Between Clinicals

Published · By VMS, Alehundred Studios

Clinical skills practice works best when you rehearse one skill at a time against a clear checklist, get feedback on every attempt, repeat it until you meet a set standard, and spread those sessions over several days instead of cramming them into one. That applies whether the skill is taking a history, examining a patient, explaining a procedure or getting through a CNA skills test. Clinicals give you real patients, but they rarely give you the repetitions. This guide covers what clinical skills are, what the research on deliberate practice, mastery learning and spaced practice says, and a practical plan for training in the skills lab, with peers and at home.

What are clinical skills?

Clinical skills are the things you do with and for a patient: gathering a history, performing a physical exam, communicating, carrying out procedures and making decisions about care. The Society for Simulation in Healthcare sums up the range when it explains that in simulation "Learners address hands-on and thinking skills, including knowledge-in-action, procedures, decision-making, and effective communication."

For medical students, the clearest list comes from the AAMC's 13 Core Entrustable Professional Activities (EPAs), the activities residents are expected to perform on day one of residency. Examples of clinical skills from that list include:

The AAMC's Core EPA toolkits also describe what a skilled performance looks like. For EPA 1, an entrustable learner "Obtains a complete and accurate history in an organized fashion" and "Performs an accurate exam in a logical and fluid sequence." On the way there, students learn to explain exam maneuvers to the patient and to use open-ended questions, silence, body language and listening while avoiding jargon. Those are concrete, observable behaviors, which is exactly what makes them practicable.

Nursing, PA and EMS programs use their own frameworks, but the core is the same: assessment, communication, safe procedures and sound judgment.

Why isn't time in clinicals enough?

Because clinical rotations give you exposure, and skill comes from structured repetition with feedback. On a busy unit you might see one patient with a given problem, perform an exam once, and move on without anyone scoring each step.

The SSH points out that learning in healthcare "is too frequently in an apprenticeship model" and calls that "a haphazard way to learn." Simulation fills the gap: "Because any clinical situation can be portrayed at will, these learning opportunities can be scheduled at convenient times and locations and repeated as often as necessary." It also gives you room to get things wrong safely, since "Working in a simulated environment allows learners to make mistakes without the need for intervention by experts to stop patient harm."

The AAMC frames the goal the same way. Ideally, students "perform the Core EPAs consistently in situations of varying complexity as they practice and receive actionable feedback, formulating learning goals for future demonstrations of competence." The toolkits add that "simulation, reflection, and standardized and structured experiences will all provide data about student competence."

What is deliberate practice?

Deliberate practice is focused training on a specific part of a skill, with immediate feedback and repeated attempts until you reach a defined goal. The concept comes from K. Anders Ericsson's research on expert performance. A scoping review in Medical Science Educator describes it as an approach that "allows for repeated opportunities to practice a skill with directed feedback until learning objectives are met."

That review looked at rapid cycle deliberate practice, a simulation format in which learners stop, get coached and immediately try again. Of 1,224 articles identified, 23 studies met the inclusion criteria, and the authors found that "RCDP is associated with positive outcomes in immediate learner performance."

In practice, deliberate practice means you do not run a full head-to-toe exam ten times and hope it improves. You find the part you keep missing, such as the order of your cardiac exam or how you introduce a sensitive question, and you drill that part with someone telling you right away whether you got it.

What is mastery learning?

Mastery learning sets a fixed standard and lets time vary: you keep practicing until you reach the standard, rather than practicing for a fixed time and accepting whatever score you get. A review in the American Journal of Pharmaceutical Education explains that "Mastery learning, introduced in the 1960s, was developed to ensure all students reach a desired level of mastery or competency."

The evidence is solid. The same review reports that "A meta-analysis of 36 mastery learning studies demonstrated an average effect size of 0.59, a medium to large effect."

How high should your bar be? The authors note that "The literature recommends this standard be no lower than what may constitute a B, or 80%, or no higher than 90%," unless the task is so critical that it must be shown at a higher level, as with patient safety. For your own clinical skills practice, that translates into a simple rule: pick a checklist, set your passing score, and keep going until you hit it more than once.

How often should you do clinical skills practice?

Short sessions spread across several days beat one long session. A systematic review in BMC Medical Education on psychomotor training for surgical novices on VR simulators included 7 studies and found that "Spaced training resulted in better performance scores and faster skill acquisition" than massed training in a single day. It also found that "Spacing across consecutive days seemed more effective than shorter or longer spacing intervals," and concluded that "spacing is superior to massed training."

The mastery learning review points the same way for successive relearning, where students reach the mastery level "in each of multiple practice sessions (ideally three to four different study sessions)."

A realistic schedule: three or four short practice blocks on consecutive days for each skill you are building, then a quick review before an exam or a new rotation.

How can you practice clinical skills between clinicals and at home?

Combine four settings: the skills lab, peers, standardized patients and screen-based virtual patients. Each covers something the others cannot.

  1. Get the checklist first. Use your school's OSCE checklist, the skill sheet for your exam or the AAMC EPA behaviors. A checklist turns practice the abdominal exam into specific steps you can score.
  2. Use open skills lab hours for anything that needs equipment or a manikin: IV insertion, wound care, BVM ventilation, catheter placement.
  3. Practice with peers. Work in threes: one clinician, one patient, one observer reading the checklist aloud and timing. Rotate every round, and have the observer give feedback right away.
  4. Book standardized patient sessions when your school offers them. They are ideal for rehearsing communication, history taking and difficult conversations.
  5. Add virtual patients for repetitions at home. A systematic review and meta-analysis in the Journal of Medical Internet Research defines virtual patients as "interactive computer simulations of real-life clinical scenarios for the purpose of health professions training, education, or assessment." Across 51 trials with 4,696 participants, the pooled analysis favored virtual patients over traditional education for skills (SMD 0.90), and the authors concluded that "virtual patients can more effectively improve skills, and at least as effectively improve knowledge."
  6. Talk out loud. Narrate what you are checking and why. It builds the habit examiners score, and it exposes the steps you skip.
  7. Track your scores. Write down each attempt's checklist score so you can see when you reach your mastery standard and which steps keep costing you points.

Can simulation replace clinical hours?

In nursing, a large national study says a substantial share of clinical time can be simulation without hurting outcomes. The NCSBN National Simulation Study randomized nursing students in ten programs across the US to traditional clinicals, 25% simulation or 50% simulation. Among the 666 students who completed the study, there were no statistically significant differences in clinical competency, nursing knowledge or NCLEX pass rates (p = 0.737), and managers rated the graduates the same at 6 weeks, 3 months and 6 months of practice.

NCSBN concluded that "The study provides substantial evidence that up to 50% simulation can be effectively substituted for traditional clinical experience in all prelicensure core nursing courses under conditions comparable to those described in the study." How many hours your program may substitute is set by your program and your board of nursing, but the message for your own study time is clear: well-designed simulation is real clinical learning.

How do you practice for a CNA clinical skills test?

Treat it like any other checklist exam: learn the official skill list, break each skill into its steps, and rehearse each one out loud until it is automatic. The National Nurse Aide Assessment Program (NNAAP) is a CNA exam that NCSBN describes as "used to determine nurse aide competency." Candidates who pass are added to their state's nurse aide registry.

The content has moved: NCSBN notes that it "no longer develops and owns the content for the NNAAP and the MACE" and directs questions on content and scheduling to Credentia. Ask Credentia or your state for the current skill list, use its steps as your checklist and apply the same method: peers as patients, an observer scoring each step, and short sessions on consecutive days.

How does VMS fit into clinical skills practice?

VMS -- Virtual Medical Simulator, by Alehundred Studios, is built for the at-home part of this plan: it gives you scored repetitions on patient encounters between clinicals, on a PC with mouse and keyboard or in VR with a laser pointer. You choose your program, Medicine (MD, DO), Physician Assistant, Nursing (RN, PN, NP) or EMS (EMT, Paramedic), and every case runs as an OSCE station with one virtual patient, a step-by-step checklist and a score from 0 to 100%.

The encounter follows the habits clinical skills practice is meant to build. You introduce yourself, gain consent, put on gloves or wash your hands, examine the patient with your hands (palpate, auscultate, take a pulse) and with tools such as a stethoscope and reflex hammer, and close the encounter. Cases are built around the exams and standards students prepare for, including the AAMC Core EPAs, the 2026 NCLEX-RN and PN Test Plans, the NCCPA PANCE Blueprint, the National EMS Education Standards and the INACSL Standards of Best Practice, and each case shows which content areas it trains.

The three modes map onto the methods above. Teach mode walks you through a case, Train mode is for deliberate practice, and Test mode removes hints and adds a time limit. The "OSCE exam" button picks a random patient from your program and starts it in Test mode. Every attempt is saved to your account, so you can see your scores rise toward your mastery standard, and educators can see results per student and build cases in the web case editor.

FAQ

What are examples of clinical skills?

Taking a patient history, performing a physical exam, measuring vital signs, communicating with patients and families, obtaining informed consent, presenting a case, and performing procedures such as IV insertion or wound care. The AAMC's 13 Core EPAs are a good reference list for medical students.

How can nursing students practice clinical skills at home?

Use the checklist for each skill, rehearse the steps out loud, practice with a classmate as the patient and another as observer, and add screen-based virtual patients for assessment and communication. Save equipment-heavy skills like IV starts and catheter insertion for open lab hours.

How do I practice for the CNA clinical skills test?

Get your state's current NNAAP skill list from Credentia or your state, use its steps as a checklist, and rehearse each skill with someone scoring you step by step. Spread practice over several days rather than one long session.

How long should you practice a clinical skill?

Until you meet a set standard, not for a set number of hours. Mastery learning research suggests a standard of about 80% to 90% on your checklist, higher for safety-critical steps, reached across three or four sessions on separate days.

Do virtual patients really improve clinical skills?

Yes. A meta-analysis of 51 trials with 4,696 participants found that virtual patients improved skills more effectively than traditional education and improved knowledge at least as well.

Can simulation count toward clinical hours?

In nursing, NCSBN's National Simulation Study found that up to 50% simulation can replace traditional clinical experience in prelicensure core courses with no difference in competency, knowledge or NCLEX pass rates. Your program and board of nursing decide how much applies to you.

Sources

  1. Association of American Medical Colleges. Core Entrustable Professional Activities for Entering Residency: Toolkits for the 13 Core EPAs. AAMC, 2017.
  2. National Council of State Boards of Nursing. NCSBN National Simulation Study. NCSBN, 2026.
  3. National Council of State Boards of Nursing. NNAAP & MACE. NCSBN, 2026.
  4. Society for Simulation in Healthcare. About Simulation. SSH, 2026.
  5. Kononowicz AA, Woodham LA, Edelbring S, et al. Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Journal of Medical Internet Research, 2019.
  6. Fahl JT, Duvivier R, Reinke L, Pierie JPEN, Schönrock-Adema J. Towards best practice in developing motor skills: a systematic review on spacing in VR simulator-based psychomotor training for surgical novices. BMC Medical Education, 2023.
  7. Ng C, Primiani N, Orchanian-Cheff A. Rapid Cycle Deliberate Practice in Healthcare Simulation: a Scoping Review. Medical Science Educator, 2021.
  8. Winget M, Persky AM. A Practical Review of Mastery Learning. American Journal of Pharmaceutical Education, 2022.