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Traditional approaches to skills training are insufficient for developing competency in a safe and ethical manner. There is a need for the evaluation of novel skills training approaches. Simulation Based Education (SBE) has emerged as a popular solution allowing learners to perform procedures, make mistakes and receive feedback in an environment that replicates real life. Many institutions are investing heavily in the purchasing of simulators. However, there is a lack of consensus regarding best practice for employing simulation technology to teach skills and the frequent lack of consideration given to educational framework, or instructional design, may be criticised. Behavioural fluency has been described as ‘that combination of accuracy plus speed of responding that enables competent individuals to function efficiently and effectively in their natural environment.’ Behaviour that is learnt to fluency is R etained for longer periods of time, individuals can E ndure performing the skill for longer durations, can A dapt the behaviour learnt by performing it as part of a new, more complex, compound behaviour, can P erform the skill at a rate that makes it functional and their performance is S table regardless of distraction (REAPS). Precision teaching (PT) has been defined as ‘a system for defining instructional targets, monitoring daily performance, and organising and presenting performance data in a uniform manner to facilitate timely and effective instructional decisions. The crucial difference between other educational interventions and interventions including PT is the focus on the speed of performance, as the ‘flow’ of behaviour is the hallmark of fluency and high accuracy alone is insufficient for producing the outcomes of behaviour fluency (ie, REAPS). This presentation describes our experience and research in using PT to teach technical skills in a simulated environment and describes an effect of training in the lab, in practice and on patient outcomes.