Simulation Session Development Form

Thank you for your interest in scheduling a simulation session at the Duke Human Simulation and Patient Safety Center. Please fill out the questions below to the best of your ability and email to let us know you have requested a training session. A new course must be submitted at least three months in advance of the intended session date to allow for adequate preparation. Please allow extra time if you have specialized equipment or supply needs. The email above can also be used to address any questions you have regarding medical simulation, the facilities, and existing programs and research projects. We look forward to working with you!

i.e. assistant professor, director of education, chief resident
If applicable.
Has the course director or any faculty had experience teaching with simulation?
i.e. 2nd year medical students, 3rd year cardiology fellows, respiratory therapists
Include frequency of course and total sessions per year. Please no requests more than a year in advance.
Course structure: (select all that apply)
Simulation environment requirements: (select all that apply)
Staff and personnel requirements: (select all that apply)
Will you be conducting research or collecting any outcomes for your course?
Is your simulation project funded by: (select all that apply)
Will you require any media for your course? (i.e. videos, photographs, echo loops)
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.