Medical simulation is a global trend that improves disease interpretation, diagnostic skills and clinical abilities (1,2). Proficiency and expertise in clinical abilities are acquired through repetition and are necessary for clinical practice; expert performance in medicine develops through sustained, deliberate practice with feedback (3). Learning procedures for the first time on real patients exposes patients to avoidable risk and exposes learners to anxiety, which is why simulation-based training has been described as an ethical imperative. Clinical skill laboratories were created to help learners overcome this fear and gain knowledge without upsetting patients, and they give medical personnel and students the opportunity to practise clinical skills before using them on patients (4,5). The recent incorporation of skill laboratories into medical curricula represents an innovative approach to improving clinical procedure training. Skill laboratory training follows a structured teaching concept, takes place under supervision and in consideration of methodological and didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills. Systematic reviews identify feedback, repetitive practice, curriculum integration and a range of difficulty levels as key features of effective simulation and simulation-based education with deliberate practice has been shown to yield better results than traditional clinical education (6). Technology-enhanced simulation is associated with large benefits for knowledge, skills and behaviours when compared with no intervention (7). In India, the introduction of the Competency Based Undergraduate Curriculum for the Indian Medical Graduate shifted undergraduate training from a knowledge-based to a skill-based, competency-driven model in which procedural skills must be demonstrated and certified (8). The subsequent regulations of the National Medical Commission continue this emphasis on early clinical exposure and skill acquisition (9). At the same time, Indian medical colleges face large student numbers and limited opportunities for supervised hands-on practice, which have long been recognised as challenges in the country’s medical education system (10). Skill laboratories are therefore an increasingly important means of delivering the mandated skill training. Evidence on how students themselves experience skill laboratory training is available from several settings. A cross-sectional study from a private medical college in South India reported that 90.7% of students agreed that simulation supports the development of clinical skills (11), and an Indian study using a high-fidelity simulator for first-year students found that most students reported improved decision-making, communication and teamwork (12). Studies from Pakistan and Nepal have likewise reported that students favour skill laboratory training over learning directly on patients and perform better after it (13,14). However, data from North India that cover students across all phases of the MBBS programme, including interns, are limited, and little is known about what students want from the future of skill labs. This study was therefore undertaken to assess the perception, perceived impact and future scope of skill laboratory training among MBBS students of a teaching institution in Punjab. Objectives Primary objective: To assess the student perception of skill lab training. Secondary objectives: (i) To explore the perceived impact of skill lab training on confidence, communication, teamwork, reflection and career aspirations; and (ii) to identify student views on how skill lab training can be improved in future

Study design: An anonymous, questionnaire-based observational study was conducted to assess the student perception and perceived effectiveness of skill lab training. It focused on the impact of skill lab training on students and on how they perceive that impact. Study setting: The study was conducted among undergraduate MBBS students of Gian Sagar Medical College & Hospital, Ramnagar, Rajpura, Punjab. Study period: July 2026 to September 2026 Study population: Students from all phases of the MBBS programme (Phase I, Phase II, Phase III part 1 and Phase III part 2) and interns. Inclusion criteria: All MBBS students from Phase I to the final phase who were willing to participate in the study. Exclusion criteria: MBBS students not willing to participate. Study tool and data collection: Data were collected using a structured, anonymous questionnaire administered. The first section recorded demographic details (age, gender and phase of study). The second section contained 15 statements on perception of skill lab training, to which students responded Yes or No. The statements covered fear of mistakes, feeling respected as a learner, self-paced learning, repetitiveness, integration of virtual/AI-based simulation, effect on patient interaction, a safe space to fail, linkage with case-based discussions, emphasis on rare emergencies, leadership and teamwork confidence, peer feedback, self-reflection, advanced optional sessions, influence on career aspirations, and missing real-life stressors. For the last four statements, a “no answer” option was recorded. Ethical considerations: Institutional Ethics Committee approval was obtained & participation was voluntary, responses were anonymous, and no personal identifiers were collected. Statistical analysis: Responses were entered into a spreadsheet and analysed using descriptive statistics. Categorical variables are presented as frequencies and percentages and age as mean ± standard deviation. For each statement, percentages were calculated among students who answered that statement.

A total of 265 students responded. There were 165 (62.3%) females and 100 (37.7%) males. The largest group was in Phase III part 2 (125, 47.2%), followed by Phase II (42, 15.8%), Phase III part 1 (39, 14.7%), Phase I (35, 13.2%) and interns (24, 9.1%). Age was recorded for 247 students (range 18–25 years; mean 21.8 ± 1.8 years), and the most frequent ages were 22 years (58, 21.9%) and 23 years (54, 20.4%) (Table 1). Table 1: Demographic characteristics of the respondents (N = 265) Characteristic Number (n) Percentage (%) Gender Male 100 37.7 Female 165 62.3 Phase of MBBS Phase I 35 13.2 Phase II 42 15.8 Phase III part 1 39 14.7 Phase III part 2 125 47.2 Interns 24 9.1 Age (years) 18 years 13 4.9 19 years 21 7.9 20 years 29 10.9 21 years 27 10.2 22 years 58 21.9 23 years 54 20.4 24 years 38 14.3 25 years 7 2.6 Age not recorded 18 6.8 Total respondents 265 100.0 Percentages are calculated out of 265 respondents. Confidence, psychological safety and learning environment Almost all students agreed that skill lab sessions reduce their fear of making mistakes in front of real patients (97.3%) and make them feel more respected as learners (98.4%). Nearly all (96.1%) agreed that the skill lab provides a safe space to fail, which strengthens learning, and 91.8% felt that they could learn at their own pace without judgment (Table 2). Table 2: Perception of confidence, psychological safety and learning environment No. Statement Yes n (%) No n (%) No response (n) 1 Skill lab sessions reduce my fear of making mistakes in front of real patients. 251 (97.3) 7 (2.7) 7 2 Practicing in the skill lab makes me feel more respected as a learner. 253 (98.4) 4 (1.6) 8 3 Skill labs allow me to learn at my own pace without judgment. 236 (91.8) 21 (8.2) 8 4 The skill lab gives me a “safe space” to fail, which ultimately strengthens my learning. 246 (96.1) 10 (3.9) 9 Percentages are calculated among students who answered the statement. Unanswered responses are shown separately (265 minus respondents). Communication, teamwork, reflection and career influence Most students (93.8%) reported that skill lab practice changes how they interact with patients during history-taking and communication, and 94.6% felt more confident in leadership and teamwork roles after group practice. Skill lab exposure made 98.1% of respondents reflect on their strengths and weaknesses as a future doctor, and 93.2% reported that it had influenced their career aspirations, such as choosing a hands-on specialty (Table 3). Table 3: Perceived impact on communication, teamwork, reflection and career aspirations No. Statement Yes n (%) No n (%) No response (n) 5 Skill lab practice changes the way I interact with patients during history-taking and communication. 240 (93.8) 16 (6.3) 9 6 I feel more confident in leadership and teamwork roles after group practice in the skill lab. 244 (94.6) 14 (5.4) 7 7 Skill lab exposure makes me reflect on my strengths and weaknesses as a future doctor. 256 (98.1) 5 (1.9) 4 8 Skill lab training has influenced my career aspirations (e.g., choosing a hands-on specialty). 245 (93.2) 18 (6.8) 2 Percentages are calculated among students who answered the statement. Curriculum design and future scope Nearly all students (96.5%) preferred skill lab sessions interlinked with case-based discussions rather than stand-alone sessions, and 97.0% would benefit from optional advanced sessions beyond the regular curriculum. A large majority supported a greater focus on rare emergency scenarios (91.4%) and integration of virtual/AI-based simulation with physical training (89.8%). Peer feedback was considered more relatable than teacher-only feedback by 85.6% of students. On the other hand, 79.8% felt that training is sometimes repetitive and could be made more engaging, and 88.2% felt that the present training misses real-life stressors such as time pressure and patient emotions (Table 4). Table 4: Student views on curriculum design and future scope of skill lab training No. Statement Yes n (%) No n (%) No response (n) 9 I sometimes feel skill lab training is repetitive and could be made more engaging. 206 (79.8) 52 (20.2) 7 10 Virtual/AI-based simulations should be integrated with physical skill lab training. 230 (89.8) 26 (10.2) 9 11 I would prefer skill lab sessions to be interlinked with case-based discussions (not stand-alone). 248 (96.5) 9 (3.5) 8 12 Skill labs should focus more on rare emergency scenarios (e.g., cardiac arrest, anaphylaxis). 235 (91.4) 22 (8.6) 8 13 Peer feedback during skill lab is more relatable to me than teacher-only feedback. 85.6% 14.4% – 14 I would benefit from optional “advanced skill lab sessions” beyond the regular curriculum. 256 (97.0) 8 (3.0) 1 15 The current skill lab training misses some real-life stressors (e.g., time pressure, patient emotions). 232 (88.2) 31 (11.8) 2 Percentages are calculated among students who answered the statement. For item 11, only percentages were available; counts were not recorded. Overall agreement Agreement exceeded 90% for 11 of the 15 statements and ranged from 79.8% to 98.4% across all statements (Figure 1). Mean agreement was highest for the domain of confidence and psychological safety, followed by communication, teamwork and reflection, and lowest for curriculum design, where students also voiced the most suggestions for change (Table 5). Table 5: Domain-wise mean agreement Domain Items Mean agreement (%) A. Confidence, psychological safety and learning environment 1, 2, 3, 4 95.9 B. Communication, teamwork, reflection and career influence 5, 6, 7, 8 94.9 C. Curriculum design and future scope 9,10,11,12,13,14,15 89.8 Mean of the percentage agreement (Yes) of the items within each domain, unweighted.

This study explored how 265 MBBS students and interns at a teaching institution in Punjab perceive skill laboratory training. Perceptions were strongly favourable: agreement exceeded 90% for 11 of 15 statements. This is in line with the South Indian study in which 90.7% of students agreed that simulation supports clinical skill development (11) and with the Indian high-fidelity simulation study in which about three-quarters of students reported self-perceived gains in decision-making, communication and teamwork (12). Students in Pakistan favoured skill laboratory training over practising on real patients (13), and Nepalese students trained in a skill lab felt more confident and performed better in examination (14). A recent Indian interventional study within the CBME framework further showed significant gains in task performance after simulation (15). Our findings, drawn from students of every phase of training, add North Indian evidence to this literature. The most consistent finding was the psychological value of the skill lab. Reduced fear of mistakes before real patients (97.3%), feeling respected as a learner (98.4%) and having a safe space to fail (96.1%) match the central rationale for simulation in the first place. These perceptions fit Bandura’s concept of self-efficacy, in which mastery experiences gained in low-risk settings raise learners’ belief in their ability to perform later in real settings (16). They also reflect the importance of establishing a safe container for learning through clear briefing and a non-judgmental climate (17). The slightly lower agreement for learning “at my own pace without judgment” (91.8%) may reflect group sessions with fixed time slots and observers, although this interpretation needs to be tested. Students also reported that skill lab practice changed how they interact with patients (93.8%) and strengthened leadership and teamwork confidence (94.6%). Almost all (98.1%) said the sessions led them to reflect on their strengths and weaknesses. This resembles Kolb’s experiential learning cycle, in which a concrete experience becomes learning through reflection, conceptualisation and further practice (18), and it underlines the role of structured debriefing and feedback in simulation-based education, as discussed in Indian work on the subject (19). A similar pattern was seen in the Indian CBME study, where almost all students agreed that simulation improves team performance and communication. That 93.2% felt skill lab training had influenced their career aspirations, for example towards hands-on specialties, is an interesting observation; however, it reflects stated perception and not actual specialty choice, and it should be followed up longitudinally. Peer feedback was found more relatable than teacher-only feedback by 85.6% of students, the lowest agreement among the items on learning processes. Peer teaching is widely advocated because peers share the learner’s level of knowledge and anxieties, and it benefits both the learner and the peer teacher (20,21). Nevertheless, about one in seven students did not share this view, and peer feedback should therefore supplement and not replace structured faculty feedback. Notably, students did not merely endorse the current training; they identified what they wanted changed. A large majority (79.8%) felt sessions were sometimes repetitive, yet 96.5% wanted skill labs linked to case-based discussions. Repetition is indispensable to skill acquisition, but it is most effective when practice is deliberate, with clear goals, progressive difficulty and feedback. Simulation-based mastery learning, in which learners practise until a defined standard is met, has reduced complications in real procedures such as central venous catheter insertion (22). Varying scenarios, embedding procedures within clinical cases and defining mastery targets could therefore keep repetition purposeful and engaging. Such vertical integration is also consistent with the competency-based design of the Indian curriculum. Support for integrating virtual/AI-based simulation with physical training (89.8%) and for optional advanced sessions (97.0%) shows an appetite for technology-enabled and learner-paced extension of the curriculum. Systematic evidence shows that virtual reality is at least as effective as traditional education for knowledge and skills in health professions education (23). In resource-constrained Indian colleges with large cohorts blending virtual modules with manikin-based practice may widen access to repeated practice. Students also asked for more rare emergency scenarios (91.4%) and felt that current training misses real-life stressors (88.2%). Emotional arousal and cognitive load influence learning during simulation (24), so adding controlled time pressure, interruptions and emotionally charged patient interactions, with careful debriefing, may improve transfer of skills to the wards. Emergency scenarios such as cardiac arrest and anaphylaxis are infrequently encountered by undergraduates in real settings and are ideally suited to simulation. Implications and future scope Taken together, the results suggest that future skill lab programmes should (i) link stations to case-based discussions, (ii) vary scenarios and set mastery targets to reduce repetitiveness, (iii) add emergency and stress-based modules, (iv) blend virtual or AI-based simulation with manikin training, (v) offer optional advanced sessions, and (vi) combine peer feedback with trained faculty debriefing. Principles of simulation design summarised in best-evidence guidance may help structure these changes (25). Future studies should link perception to objective skill performance, follow students longitudinally, and compare phases and genders. Strengths and limitations The strengths of this study are its relatively large sample and the inclusion of students from all phases of training, including interns. Its limitations are as follows. It was conducted at a single institution, which limits generalisability. Perceptions were self-reported using Yes/No responses, which cannot capture the degree of agreement, and many statements were positively worded, which may have encouraged agreement. The study did not measure actual skill performance or retention. Respondents were unevenly distributed across phases (nearly half were in Phase III part 2) and genders, and some students did not answer all items or record their age. Comparisons between subgroups were not undertaken.

MBBS students perceived skill laboratory training as a safe, respectful and effective setting that reduces fear of mistakes, builds confidence, improves communication and teamwork, and encourages reflection on their strengths and weaknesses as future doctors. They also asked for less repetitive sessions linked to case-based discussions, more emergency and stress-based scenarios, optional advanced sessions and the integration of virtual or AI-based simulation. Responding to these views while aligning with the competency-based curriculum can strengthen skill labs as a core component of undergraduate medical education

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