Preliminary Program Request Form
Please do not use this form to submit patient-related information. If you have a medical emergency, please do not use this form. Please call your doctor or go to the nearest emergency room immediately.
The amount of time and preplanning for a successful simulation program can vary and depends on the complexity of the event, available resources, existing programs, and competing demands. Ideally, it is best to allow 6 weeks to plan, develop, and pilot the program. Unusually complex programs may require additional time. The Simulation Institute may not be able to schedule your program if insufficient time is provided for program development.
Course materials are expected to be submitted in a timely manner. All pertinent materials must be developed with the Simulation Institute staff and are due 3 weeks prior to your program, e.g. cases in final form, checklists, student schedules, and course/program and faculty evaluations. Facilities, equipment/simulators and program staff support is not scheduled/reserved until you have received a confirmation email from the Simulation Institute staff.
Below is a project workflow for simulation program development. Each step is dependent on the prior step so skipping steps could adversely affect and delay your program.
- Submit this completed Preliminary Program Request Form
- Meet with Simulation Institute staff about program
- Become familiar with simulation resources and devices
- Develop course curriculum, course and faculty evaluations with Simulation Institute staff
- Submit curriculum to Simulation Institute for feedback and approval
- Develop final scenario, script, case, debriefing content
- Practice the pilot scenario
- Conduct simulation event
- Debrief with Simulation Institute faculty and staff
* - Indicates the field is required.