Skills-based learning environments are used to promote the acquisition of practical skills as well as decision making, communication, and problem solving. It is important to provide feedback to the students from these sessions and observations of their actions may inform the assessment process and help researchers to better understand the learning process. Through a series of prototype demonstrators, we have investigated the use of semantic annotation in the recording and subsequent understanding of such simulation environments. Our Semantic Web approach is outlined and conclusions drawn as to the suitability of different annotation methods and their combination with ubiquitous computing techniques to provide novel mechanisms for both student feedback and increased understanding of the learning environment.

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Current difficulties in the assessment of practice of qualified nurses undertaking courses in critical care nursing are outlined and discussed. The evaluation and development of previously identified core competencies for intensive care nurses is discussed.The use of the National Health Service Knowledge and Skills Framework as a framework for the assessment of practice of nurses undertaking courses in intensive care nursing within one higher education Institution is presented and examined. The potential implications of these developments for practice and education are outlined.

Demonstrating the impact and effectiveness of educational interventions, including medium and high-fidelity simulation, has long been fraught with methodological challenges and ambiguities. This is particularly the case when there are several confounding factors and variables operating in situations where control trials are inappropriate, and investigative costs can be high. Current theoretical and empirical evidence, while emerging, is parsimonious and fails to take account of the characteristics of different modes of simulation, their contested theoretical models of learning and the opportunities presented by cutting edge computer science. Medium and high-fidelity simulations, situated within technology-rich environments, generate new forms of complex data that have the potential to provide insights into 'real-world' practices. Drawing on a range of locally based studies, we argue that until the methodological questions and data management Downloaded from systems can be addressed, the evidence to determine the judicious and optimal use of simulation to improve student and practitioner performance and patient outcomes will remain primarily reliant on proxy measures of self-efficacy and competence.

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