Rethinking skills training: less instruction, more action

In the calm and controlled environment of the classroom, clinical skills can seem simple. But everything shifts in real-life settings—where pressure mounts, patients are unpredictable, and multitasking is the norm.

That contrast is exactly what a group of researchers set out to explore: can nursing students still apply their skills when it truly matters?

What they discovered may challenge the way you approach teaching. Their results also reveal why rigid, step-by-step protocols might not be the most effective path to real-world readiness.

Focusing on outcomes instead of checklists

In many nursing programs, students are taught clinical skills through detailed, structured protocols. For example, a skill like bandaging. Think multiple pages of instructions, followed by demonstrations and lots of repetition. This is what experts call explicit learning: you consciously learn each step.

But what if students could learn just as well—or even better—without memorizing all the details?

Enter implicit learning. It's when students pick up skills without thinking through every motion. Instead of remembering 12 steps, they focus on the outcome: wrapping the leg so the bandage stays in place, feels comfortable, and doesn’t cause pain. Think of it like riding a bike—you don’t recite instructions; you just do it.

The research: bandaging with less instruction

In the Netherlands, researchers ran three experiments to test a simple idea: can less really be more? They randomly split nursing students into two groups:

1. One group received detailed, explicit instructions—the kind you’d typically find in a training manual.
2. The other group got an instruction card with just the essentials and practiced based on that minimal guidance.

All students practiced wrapping a bandage around a peer’s lower leg. They first pulled on a soft, stretchy sleeve to protect the skin, then added padding around bony areas, like the ankle, to prevent pressure spots. Finally, they wrapped two layers of bandage to apply gentle, even pressure. The bandage needed to stay in place, feel comfortable, and allow the leg to move freely, without causing any discomfort.

A smart way to observe skills in action

The classroom was equipped with cameras connected to the Viso system—a multi-camera setup that recorded the practice sessions for detailed review and analysis. For educators, Viso offers a powerful way to observe behavior, spot mistakes, and see how students improve over time—all without disrupting the flow of training.

Here’s what surprised the researchers: students who practiced with minimal instructions performed just as well as those with full protocols. In fact, in situations where they had to multitask (like communicate with the patient and perform the task at the same time), the minimally instructed group performed more consistently.

Want to see how you can setup a space for practice sessions? Explore the story of AIXTRA - Competence center for training and patient safety - which has multiple simulation rooms, comprehensive debriefing spaces, and a dedicated control room equipped with Viso, all designed to create a realistic learning environment.

Why performance consistency matters

If you're an educator or trainer, switching to minimal instructions is a game-changer. Here’s what it means:

• You don’t always need a detailed script. Students can learn effectively with simpler guidance.
• Less instruction frees up cognitive space. When students aren’t focused on remembering steps, they can concentrate on adapting to the patient, thinking critically, or communicating clearly.
• You save time and increase practice opportunities. Students using minimal instructions spend less time reading and more time doing.

And when you're using a tool like Viso, you can capture these subtle improvements on video. This helps you reflect, assess, and fine-tune your teaching approach without hovering over every student.

Student feedback highlights learning outcomes

Here’s something else the study uncovered: students in the explicit learning group remembered more rules about how to bandage—but that didn’t make them better at doing it. In real-life scenarios, being able to act smoothly and adapt matters more than being able to recite instructions.

What’s more, many of the students using the full protocol started ignoring the instructions by the second attempt. That’s a red flag—too much information can overwhelm, especially for beginners.

How to bring implicit learning into your classroom

If you’re ready to experiment with implicit learning, here’s how to get started:

• Simplify your materials | Strip your instructions down to the essentials. Focus on the goal, not the steps.
• Use analogies and visual cues | A metaphor like “wrap the leg like a smooth tube” gives students a clear mental image without a list of tasks.
• Encourage self-assessment | Ask students, “Did the toes stay pink? Is the bandage slipping?” That shifts the focus from following steps to evaluating outcomes.
• Record and review | Tools like Viso let you and your students watch performances later, spot patterns, and make adjustments without the pressure of real-time feedback.
• Build in time for reflection | After practice, let students talk through what felt right or difficult. Reflection helps solidify learning, especially when instruction is minimal and experience is the main teacher.

Change takes practice

Switching from step-by-step teaching to a more intuitive, learner-driven approach takes time. That's why the researchers noticed bigger improvements in the second year, when both teachers and students had gotten used to the new method.

But the payoff is worth it: more confident students, better performance under pressure, and a smoother transition from the classroom to clinical practice.

References

Van Brakel-Van Lobenstein, N.; Van Leeuwen-Prins, S.T.; Verdoes, L. et al. (2025). Teaching nursing skills without detailed protocols: effects of an implicit learning strategy in nursing education. Advances in Health Science Education. https://doi.org/10.1007/s10459-025-10421-y