An exploration of Simulation Based Medical Education (SBME) innovation through the COVID-19 pandemic: A comparative case study of two medical schools (Scotland and Thailand)

  • Tanongson Tienthavorn

Student thesis: Doctoral ThesisDoctor of Philosophy


Simulation-based medical education (SBME) is an essential component of undergraduate medical programmes, providing a secure environment for teaching and evaluating practical knowledge and clinical skills. Research on SBME has predominantly come from North America and Europe where researchers focus more on the effectiveness of and the experiences of learners and tutors. However, there is limited knowledge regarding how SBME is integrated into curricula, as well as how it is normalised and innovates, particularly in the Southeast Asian context. The outbreak of the COVID-19 pandemic from 2019-2022 disrupted healthcare education worldwide and gave rise to new perspectives and approaches to SBME. As a result, it provided a valuable opportunity to gain insights into the understanding and potential evolution of SBME.

This research explores the transformative innovation of SBME using a comparative case study design. A qualitative, interpretive approach is used to compare a case study of an established SBME user in Western Europe, specifically in Scotland to a case study of a SBME user in Southeast Asia, specifically in Thailand where the technology is relatively new. Data were generated by conducting interviews with the staff involved in SBME design and implementation, along with the analysis of educational policy, guidance, and teaching documentation. The data collection period included both pre-pandemic and pandemic times, aiming to gain insights into how the unprecedented disruption has affected the understanding and practices associated with SBME in both Scottish and Thai contexts.

Results find that in Scotland, there is a significant correlation between healthcare and medical education needs and SBME integration in the medical curriculum. The availability of a clinical skills centre and related infrastructure further supports a systemic, embedded approach to SBME, which facilitates innovation agility. In contrast, the Thai site primarily emphasises SBME for assessment purposes, rather than incorporating it into the broader curriculum. Support for infrastructure and divergent perspectives on educational theory were found to be linked with a less cohesive SBME approach and a reduced number of innovations.

The significance of these findings lies in their ability to highlight the importance of healthcare service-medical education interactions and contextual trajectories for medical schools, particularly in terms of the implementation and innovation of SBME. Furthermore, there are important implications to consider regarding the transfer of SBME theory, principles, and findings between different contexts and cultures in the field of medical education. This study uncovers novel and significant insights that reveal critical disparities that may exist among curricula, institutions, and broader medical education environments. These disparities are likely to affect the advancement, creativity, and significance of SBME in undergraduate medicine.
Date of Award2023
Original languageEnglish
SupervisorMandy Moffat (Supervisor), Stella Howden (Supervisor) & Stuart Cable (Supervisor)


  • Simulated based medical education,
  • Medical education
  • Blended learning
  • COVID-19
  • Innovation
  • Normalisation

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