A completed e-learning module tells you one thing: someone finished it. It does not tell you whether the knowledge moved anywhere. For organisations rolling out IV Cannulation, venepuncture and phlebotomy training at scale, that gap between "completed" and "changed practice" is where most of the real risk sits.

A 2022 systematic review by Giannakos, Mikalef and Pappas, published in Information Systems Frontiers, looked across 47 empirical studies of e-learning in organisational settings to ask a more useful question than "did people finish the course?" Their answer: learning has to move through three levels to matter — individual, team and organisation — and most of the research they reviewed measures only the first one. The review found that effectiveness is most often assessed through usage, satisfaction and perceived value: did people log in, did they enjoy it, did they say it was worthwhile. Whether that learning changed what a team does, or whether it moved the organisation's strategic capability, was, in their words, "not always clear." They also flagged something we think is worth VeinTrain and HALO paying close attention to: a "surprisingly limited use of big data and analytics" in tracking e-learning's organisational impact, despite platforms increasingly generating the learner data that could answer the question.

That is a systems-leadership problem as much as a training one. It is also, for a specialist clinical skills provider, a governance problem — because the level that matters most in healthcare is the one hardest to measure from a learning platform: what a learner actually does at the bedside.

What "transfer" means, and why it doesn't happen automatically

Recent healthcare education research gives a more direct answer than Giannakos et al.'s organisational-learning lens, because it looks specifically at what carries knowledge from a training environment into clinical practice.

A 2026 realist review examining how simulated patients enable, or fail to enable, transfer of learning into clinical practice (drawing on 43 studies from an initial pool of nearly 2,700) identified four mechanisms that matter: realism, authenticity, spontaneity and safety. Where those four were present, learners showed measurably improved self-efficacy, confidence and skill, and — the review's authors were explicit about this — those gains were transferable into clinical practice. Where the mechanisms were weak (an unrealistic scenario, no room for spontaneity, or a learner who arrived unprepared), the same training format produced far less durable change. Prior clinical or simulation experience, and how well a learner was prepared for the scenario, mattered as much as the simulation design itself.

A parallel 2025 systematic review of clinical simulation in nursing education (15 studies, 2010–2025) reached a compatible conclusion: simulation-based education can meaningfully reduce the theory–practice gap, particularly for technical skills, decision-making and confidence — but the review's authors also flagged that the weight of positive findings raises a real question about publication bias, and that success depended heavily on structured debriefing, realistic scenario design, repeated exposure and properly trained faculty. Simulation is not a switch that turns knowledge into competence; it is a mechanism that works well under specific conditions and can under-deliver when those conditions are missing.

A 2026 editorial on blending simulation and e-learning in medical education puts the two roles side by side rather than in competition: e-learning does the work of theoretical preparation and scalable, repeatable knowledge delivery; simulation does the work of practising the skill itself, under safe and repeatable conditions. Used together in sequence, they support each other. Used as substitutes for each other, they don't. The same editorial is explicit about the limit that matters most here: simulation and e-learning "should remain complementary adjuncts to real patient-based clinical training" — not replacements for it.

Where the responsibility actually sits

Put together, this evidence base supports a position VeinTrain has held since the Structured Learning Programme was built, not a new one manufactured to fit it: e-learning prepares knowledge, simulation and structured practice build and rehearse the skill, and workplace competency sign-off is a separate, necessary step that belongs to the employer and the local clinical governance process. None of the studies above suggest that a training certificate — however well the underlying course was designed — can stand in for that local, supervised assurance. If anything, the organisational-learning literature makes the opposite case more strongly: if a provider cannot show what happens after course completion, they cannot claim the training changed practice, only that it was delivered.

This is also why the "how do we know it worked" question cannot be answered by completion data alone. Giannakos et al.'s point about learner-generated data being underused is directly relevant to how HALO's evaluation architecture should be built: not just tracking who finished which module, but building the capacity to see — with appropriate governance and consent — what happens at the individual, team and organisational levels afterwards. That is a design question for HALO's next phase, not a claim this article is making about current capability.

What this means in practice

For a learner, course completion is the beginning of a competency pathway, not the end of one. For a trainer or Train the Trainer graduate, the evidence points toward structured, repeated, well-debriefed practice opportunities as the mechanism that actually moves knowledge into skill. For an organisation adopting VeinTrain training or the HALO deployment model, the practical implication is to build in — and ask for — visibility on what happens after the certificate: local supervised practice, competency sign-off, and, where possible, some way of seeing whether the training changed what people do.

None of this diminishes the value of well-designed e-learning. It reframes what it can honestly claim to deliver: preparation, consistency and access at scale, feeding into a practice-and-governance pathway that only the employer and the learner's own clinical environment can complete.

Built before today's standards landscape

This approach was not retrofitted to match recent guidance. In 2006, Collins, Phillips and colleagues documented a structured venepuncture and cannulation learning programme developed across four NHS trusts, with shared assessment intended to reduce repeated retraining as staff moved between organisations. In 2011, Phillips, Collins and Dougherty brought the clinical, educational and patient-safety foundations together in Venepuncture and Cannulation. The Royal College of Nursing's fourth-edition infusion standards followed in 2016, and the first NIVAS Standards for Infusion Therapy and Vascular Access was published in 2026. VeinTrain now checks its established approach against the current standards as they develop. This chronology shows continuity of practice and learning; it is not a claim that no earlier guidance existed.

References

1. Giannakos MN, Mikalef P, Pappas IO. Systematic Literature Review of E-Learning Capabilities to Enhance Organizational Learning. Information Systems Frontiers. 2022;24:619–635. DOI: 10.1007/s10796-020-10097-2.
2. Within healthcare education how do simulated patients enable (or not) the transfer of learning into clinical practice: A realist review. Nurse Education Today (in press/2025–26; PubMed ID 41317425).
3. The impact of clinical simulation on bridging the theory–practice gap in nursing education: a systematic review. PMC, 2025.
4. Blending simulation and e-learning in medical education to enhance professional competence and skills acquisition. BMC Medical Education, 2026.
5. Phillips S, Collins M, Dougherty L, editors. Venepuncture and Cannulation. Wiley-Blackwell; 2011. ISBN 978-1-4051-4860-3.
6. Collins M, Phillips S, Dougherty L, de Verteuil A, Morris W. A structured learning programme for venepuncture and cannulation. Nursing Standard. 2006;20(26):34–40. DOI: 10.7748/ns2006.03.20.26.34.c4086.
7. Royal College of Nursing. Standards for Infusion Therapy. 4th ed. RCN; 2016.
8. National Infusion and Vascular Access Society. Standards for Infusion Therapy and Vascular Access. 1st ed. NIVAS; 2026.

Explore the Structured Learning Programme

Continue from e-learning into structured practice and organisational implementation with VeinTrain's Structured Learning Programme booklet.