Simulation-based medical education (SBME) has become a cornerstone in technical skills training. SBME is associated with large effects on trainees' learning and behaviours in the clinical setting but has proven difficult to adopt and implement for all relevant technical procedures. This is a review of evidence-based principles for effective learning in the simulated setting, and based on these, some of the challenges associated with the successful implementation of SBME for different types of technical skills training in Denmark are discussed.