Simulation Activity Leader or Owner Name
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SIGs and student-run groups should list the primary contact here and the required faculty or resident sponsor under additional faculty.
First Name
Last Name
Simulation Activity Leader or Owner Email
*
Additional faculty or facilitator name
First Name
Last Name
Additional faculty or facilitator name 2
First Name
Last Name
Additional faculty or facilitator name 3
First Name
Last Name
Simulation Educational Rationale
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Describe the needs assessment or gap analysis determining simulation training as an effective education modality. What led you to consider simulation-based education for this course/session? What knowledge, psychomotor, affective, or team training gap(s) are you trying to address?
Simulation Learners
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Select all learner types who will participate in the simulation session.
Expected number of learners per session
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Num sessions planned per year
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Length of session in hours
*
Start Date
How urgent is this curriculum? Is there a date that the session must be run by?
MM
DD
YYYY
Simulation session description
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Describe the session in as much detail as you currently know. Will there be didactic lecture, video demonstration, facilitator demonstration, hands-on procedural skills stations, team-based scenarios, pre or post knowledge tests, assessments (we can help plan these), debriefing (again, we can help here), program evaluations? If you are running scenarios, will it be a custom one we need to program and test? Give as much details as you currently know. If there are things you would like to do, but are unsure, let us know that too and our simulation experts can help plan any elements of simulation-based education.
Education elements
Check all elements needed for sessions.
Knowledge, Procedural, or Team-based Skills
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Check all skills / procedures that will be taught, practiced, or assessed during the simulation session. The list may be long, especially for year-long curriculums. If any planned skills are not listed, select Other and describe in next field.
Instruments and Supplies
List any specific instruments or supplies needed. Be as detailed as possible.
Will sessions include any assessment?
See top of page for online resources on simulation-based education assessments.
Program evaluation
All simulation sessions end with a standardized post simulation session evaluation that is facilitated by Sim Center staff and results reported back to you. Check any other evaluation types the session will utilize. See top of page for online resources on simulation-based education evaluation.
Simulation outcome measures
Select any where simulation will have the greatest impact on outcome measures. See top of page for online resources on outcome measures for medical education.
Potential Scholarly Activity
Check the box for any potential or planned scholarly activities that may result from these simulation education sessions.