Beyond See One, Do One, Teach One: Clinical Skills Training

Beyond "See One, Do One, Teach One": What Has Changed in Clinical Skills Training?

By Lucas Tomczak
Published June 2026
8 min read

Clinical skills training has evolved significantly over the last two decades, but one principle remains unchanged: competence is built through repetition. This article explores what has changed, what hasn’t, and the challenges educators face today.

When I started training as an Anaesthetic Technician in the late 1990s, the way clinical skills were passed on felt almost tribal. You watched someone do something (insert an IV cannula, set up a breathing circuit, assist with an intubation) and then, often sooner than felt comfortable, you were expected to do it yourself. The supervision varied. The feedback varied more. What stayed consistent was the underlying assumption: exposure would eventually become competence, and competence would eventually become confidence.

Nobody called it a philosophy. It was just how things worked.

“See One, Do One, Teach One” wasn’t unique to anaesthetics or to any particular country or institution. It was, for much of the twentieth century, the de facto model for clinical skills training across healthcare. It had a certain logic to it. Learning by doing has always been at the core of practical skill development, and there’s nothing wrong with that part of the equation. The problem was everything around it: the inconsistency, the variable supervision, the assumption that watching once was sufficient preparation for doing, and the reality that not everyone got the same quality of exposure or the same number of attempts before being considered ready.

For the most part, it worked well enough. But “well enough” was measured against a different set of expectations than we hold today.

What has actually changed

It would be easy to frame the last twenty to thirty years of healthcare education as a simple story of progress, with old methods replaced by better ones and technology arriving to solve problems that practice alone couldn’t. The reality is more complicated and, I think, more interesting.

The single most significant shift has been in how healthcare systems think about patient safety. This isn’t a minor adjustment in emphasis. It represents a fundamental change in what we consider acceptable when training clinicians. The publication of To Err is Human in 1999 put hard numbers around what many clinicians already knew quietly: preventable harm was happening at scale, and training culture was part of the problem. That report, and the research and policy responses it triggered, changed the conversation permanently.

Once patient safety became an explicit institutional and regulatory concern, the old model of learning on patients (practicing skills on real people with variable supervision until competency was assumed rather than demonstrated) came under appropriate scrutiny. Simulation began to fill some of that space, not as a replacement for clinical experience but as a way of creating controlled, repeatable practice environments where learners could make mistakes without consequences, receive consistent feedback, and build foundational competency before encountering the complexity and unpredictability of real clinical settings.

Skills labs expanded. Simulation centres were built. Curricula were redesigned to incorporate structured skills acquisition rather than leaving it to chance encounters on placement.

This was genuine progress, and it created a generation of healthcare educators who understood simulation not as a novelty but as a legitimate and necessary component of clinical preparation.

The things that didn't change

What didn’t change, and what couldn’t change, was the fundamental relationship between repetition and skill acquisition.

This is worth dwelling on because it sometimes gets lost in conversations about innovation in healthcare education. No amount of curriculum redesign, no investment in simulation technology, no shift in teaching philosophy alters the underlying neuroscience of how humans develop procedural skills. Competency in clinical techniques is built through physical repetition. Hands on equipment. Muscle memory. The small adjustments that happen unconsciously after you’ve performed a skill twenty times, fifty times, a hundred times. Watching a demonstration, however excellent, is categorically different from doing the thing yourself.

During my years working clinically, this was obvious to anyone paying attention. The learners who developed genuine procedural confidence were the ones who got more attempts, not the ones who got better explanations. The ones who struggled were often perfectly capable of describing what they needed to do. They just hadn’t done it enough times for it to feel automatic. In high-pressure clinical environments, skills that aren’t automatic tend to deteriorate precisely when they matter most.

This hasn’t changed. What has changed is how difficult it has become to provide every learner with sufficient repetitions.

The numbers problem

Healthcare education has grown substantially in scale over the past two decades. Nursing programs in particular have expanded to meet workforce demand, and the result in many institutions is significantly larger student cohorts moving through the same skills labs with the same number of faculty and the same amount of scheduled lab time.

The mathematics of this are challenging. If a cohort doubles in size but lab hours remain constant, each student gets roughly half the practice time. If faculty numbers don’t keep pace with enrolment growth, the supervision-to-student ratio changes. These aren’t hypothetical pressures. They’re the daily reality for skills lab coordinators and clinical educators at institutions I’ve worked with over the years.

Scheduling alone can consume an extraordinary amount of administrative energy. Getting large cohorts through structured skills sessions, accommodating variation in student progress, managing remediation for those who need additional attempts, coordinating with placement schedules and assessment timelines: the logistical complexity has increased substantially from the relatively informal arrangements that characterised earlier models of clinical training.

Faculty workload has become one of the more pressing concerns in healthcare education conversations. The expectation that academic staff will simultaneously maintain their own clinical currency, teach across multiple modalities, develop curriculum, supervise skills sessions, and engage in research is, in many institutions, an expectation that outstrips realistic capacity. Something gets compressed, and skills supervision time is often one of the casualties.

What educators are actually trying to solve

When I talk with simulation directors and nursing faculty about what keeps them up at night, it’s rarely a philosophical question about educational models. It’s practical: how do we give every student enough practice to develop genuine competency, when we have limited lab time, limited faculty capacity, and larger cohorts than our infrastructure was designed to support?

The interesting responses to this challenge have generally involved thinking about when and where practice happens, rather than only how it’s structured during scheduled sessions.

Hybrid learning models, which were already evolving before the disruptions of recent years accelerated their adoption, represent one part of this shift. The idea that learning has to happen in a single location, during a single scheduled block of time, under direct faculty supervision, has given way to more distributed approaches. Not because direct supervision isn’t valuable (it is, especially for initial skill acquisition and assessment), but because insisting on that model exclusively puts a ceiling on how much practice students can accumulate.

There’s a growing recognition in healthcare education that the skills lab doesn’t have to be the only place where skills practice happens. That students who have developed foundational technique under supervision might benefit from additional, lower-stakes repetitions in environments where the primary purpose is consolidation rather than instruction. That genuine procedural confidence often builds in the space between formal teaching sessions, through the kind of quiet, repeated practice that doesn’t require a faculty member standing at the shoulder for every attempt.

This isn’t a new idea. It’s closer to rediscovering something that was always true: that getting good at something requires doing it more than a curriculum schedule typically allows.

The gap between knowing and doing

One of the more honest conversations I’ve had with clinical educators over the years is about what students are actually experiencing when they arrive at their first clinical placements. The consistent theme is a gap between theoretical knowledge and procedural readiness. Not because the knowledge component of preparation has been neglected, but because the doing component has been constrained by the practical realities described above.

Students can answer questions about clinical procedures correctly. They’ve watched the demonstrations. They’ve read the guidelines. What many of them lack is the physical familiarity with equipment and technique that comes from having performed a skill repeatedly until it no longer requires conscious attention to every step. That physical familiarity is what allows a clinician to maintain awareness of the patient, the environment, and unexpected developments while performing a procedure. Without it, cognitive load spikes at exactly the moments when clear thinking is most important.

The educators who understand this most clearly are, in my experience, those who came through clinical practice themselves and remember what it felt like to develop competency under the old model, with all its inefficiencies and inequities, but also with a higher volume of hands-on exposure than many students accumulate today.

Where things stand

Healthcare education today is more rigorous, more structured, more safety-conscious, and more evidence-informed than it was when I was learning to set up an anaesthetic machine and draw up drugs in the late 1990s. The shift away from unstructured learning-on-patients toward deliberate, supervised skills acquisition has been overwhelmingly positive. Simulation has matured from a novelty into an established and respected component of clinical preparation.

And yet the educators doing this work are navigating a more complex environment than any previous generation. They’re managing larger cohorts, constrained resources, faculty capacity limits, and scheduling pressures that would have been unrecognizable to the clinical tutors who trained us by pointing at something and then stepping back to let us try.

Organizations such as the International Nursing Association for Clinical Simulation and Learning (INACSL) continue to advocate for evidence-based simulation and competency-focused education practices that better align with modern healthcare requirements.

The challenge isn’t a lack of understanding about what good clinical skills training looks like. Most experienced healthcare educators know exactly what it looks like. The challenge is creating the conditions for it to happen at scale, for every student in the cohort, not just those who happened to get more time on placement or more attempts in the skills lab.

That challenge doesn’t have a single clean solution. It requires thinking carefully about curriculum design, about how practice opportunities are structured and distributed, about what faculty time is best spent on and what can be supported in other ways, and about the kinds of environments where consolidation and confidence-building can happen outside of formal scheduled sessions.

What remains constant, through all of this evolution, is the primacy of the physical. Clinical competency is built in the hands and in the body, through repetition that exceeds what observation alone can provide. The best healthcare educators have always known this. The question that occupies their thinking now is how to honor it within the constraints of a training environment that looks very different from the one in which most of them learned.

That’s a harder problem than “See One, Do One, Teach One” ever had to contend with. It’s also, I think, a more honest one.

About the Author

Lucas Tomczak is the founder of 3T Competence. He trained and worked as an Anaesthetic Technician before moving into healthcare simulation, clinical skills training, and education product development.