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INFORMATION FOR

Yale Center for Medical Simulation (YCMS)

The mission of the Yale Center for Medical Simulation (YCMS) is to provide excellent patient care through innovative medical education, assessment, research and outreach. Our state-of-the-art center promotes the acquisition of basic and advanced clinical skills that are essential for medical students and residents to master, and are integral to the educational mission of Yale School of Medicine. It provides an ideal learning environment for supervised and independent practice. YCMS contributes to the medical school’s research mission by identifying more effective educational methods and evaluation tools. The Center is available to all members of the Yale School of Medicine community for educational research opportunities.

Facilities and Procedures

Yale Center for Medical Simulation uses mannequin-based fully interactive simulators in the fields of emergency medicine, surgery, internal medicine, pediatrics, obstetrics and gynecology, neurology, anesthesia and other clinical settings. The facility occupies 4,950 square feet and contain replicas of an ED/ICU/ward, trauma resuscitation bay, pediatric/newborn unit and operating room. Simulation scenarios include critical actions in both clinical management and communication skills. Dedicated simulation faculty with expertise in scenario design and debriefing skills guide students through scenarios. Students have the opportunity to address end of life issues, informed consent, and disclosure of medical errors. Each simulation room allows for sophisticated video recording to enable participants to have the opportunity to reflect on their performance in an interactive debriefing session following the simulation scenario. The center has a conference room and debriefing room designed to encourage reflection and feedback.

Students learn a wide range of invasive procedures from insertion of IVs, nasogastric tubes and urinary catheters to more advanced procedures such as central venous catheter insertion, chest tube insertion, and difficult airway management. Bedside ultrasound simulators assist students in developing technical skills as well as learning how to interpret point-of-care ultrasounds. Partial task trainers allow the acquisition of these technical skills prior to entering the clinical setting thus increasing patient safety.

Educational Research

The Yale Center for Medical Simulation offers the opportunity to advance knowledge through educational research. All members of the Yale medical community have access to the simulation lab for research purposes. Current research projects include the transfer of invasive procedural skills from the simulation lab to the clinical setting, skills decay, live tissue vs simulator training for invasive procedures, development of communication and leadership skills during acute resuscitations.

A former Yale medical student best described the goals of simulation when he wrote about his experience during the third year clinical simulation course: “I could go on and on about how much I learned from this ten minute SimMan scenario. But, in short, I found it to be one of the most powerful experiences in medical school thus far. I learned the absolute necessity of leadership, communication, and accountability during a crisis…I had the privilege to feel what it’s like to have to think quickly and critically under the pressure of an unstable patient, as well as experiencing a team that needs a leader to guide proper management. I now appreciate how important it is to be confident in the team, and balance that with the appropriate leadership to make certain that tasks are getting done correctly. I’d rather be safe than sorry. I am so thankful that I was able to learn this valuable lesson in a simulation laboratory rather than at the bedside of an unstable patient, whose chance of survival depends on the critical actions of a well-trained physician. Students are rarely, if ever, given the opportunity to lead a team, be accountable for every decision made in managing a patient, and learn what it feels like to make a mistake you never want to happen again.”

Education

Medical Students

The Yale School of Medicine is home to the largest medical student curriculum of its kind in the country and is entering its 10th year. Yale medical students have the opportunity to practice the art and science of medicine at the Yale Center for Medical Simulation (YCMS) from the first week of medical school. All one-hundred incoming first year students participate in the Introduction to the Professions course at YCMS, where they have their first opportunity to participate in a simulated patient encounter early on in their medical training.

During their clerkship year, students participate in simulation sessions during the Surgical Approach to the Patient Clerkship (Emergency Medicine/Surgery), Women and Children’s Health Clerkship (OBGYN/Pediatrics), Medical Approach to the Patient Clerkship (Medicine/Neurology) and the Biopsychosocial Approach to the Patient Clerkship (Psychiatry/Primary Care). Students work in teams to evaluate, manage, and treat simulated patients in an acute care environment. Our simulations emphasize clinical management, communication with patients and families, and hand-offs to consultants. In addition to performing an H+P and ordering any tests or interventions, patients speak to physician actors that serve as family members and have a discussion with an actual attending consultant for each case. During the debriefing session, a debriefer offers formative feedback to students on their performance and helps students to bridge what was learned in the session to their future patient encounters. An attending physician with expertise in the topic serves as the content expert for the case and discusses clinical management.

During the third-year simulation curriculum, students participate in over 30 simulated encounters and have the opportunity to diagnose and treat a wide variety of pathology. Students also have the opportunity to engage in difficult conversations with simulated patients and family members. They manage critically ill simulated patients and perform life-saving procedures.

Prior to starting their clinical clerkship year, all one-hundred third year students are trained in: foley catheter placement, nasogastric intubation and bag-valve mask ventilation at YCMS. During specialty-specific precede sessions for the Surgery, Emergency Medicine, Medicine and Neurology clerkship components, students learn and practice important procedures, such as: orotracheal intubation, suturing, IV placement, FAST exams, ABG sampling, lumbar puncture. A scrub station allows students to practice scrubbing in for the operating room. Students also practice normal and complicated vaginal deliveries and management of OB/GYN emergencies using high-fidelity mannequins during the OB/GYN clerkship component.

Students undergoing the YSM Emergency Medicine Sub-Internship also participate in an EM-based simulation curriculum at YCMS.

A 2–4-week simulation elective is available to interested MS4/5's. This elective allows students to create and program simulation cases on the SimMan3G programming software, have the opportunity to serve as a participant, actor, or the voice of the simulated patient for other medical student simulations, and to have guided practice on procedures related to their chosen specialty. During the Medical Education elective, PGY4/5's also have the opportunity to create and run simulated cases and to learn and practice debriefing.

Motivated students also have the opportunity to participate in a number of ongoing research projects under the mentorship of YCMS faculty. Projects result in publication-quality manuscripts and are encouraged for submission to local, regional, or national meetings.

Resident Education

Emergency medicine residents spend dedicated time in the Yale Center for Medical Simulation during each of their four years of residency.

  • PGY-1 residents spend 2 weeks in the afternoon during their ultrasound rotation
  • PGY-2 and PGY-3 residents spend 2 full weeks
  • PGY-4 residents spend part of their administration rotation in YCMS.
  • Most PGY-4 residents chose to spend an additional 2-4 weeks in the center as an elective

During each rotation, core simulation faculty create daily schedules for residents which includes formative ACGME milestone assessment, post-graduate year specific case participation, medical student teaching, procedural training, simulation case creation and programming, debriefing course and debriefing, difficult obstetric deliveries, and mini-courses in ventilation management, sepsis, toxicology, ophthalmology, and general emergency management

EM residents spend additional time at YCM learning suturing, airway management, central venous catheter insertion, and other emergency procedural training. The simulation faculty participate in the Education/Simulation area of concentration (AOC) and present topics on adult learning theory, simulation scenario creation, and lead an all-day SimWars.

YCMS is open 830am-5pm 5 days a week and is available to all Yale New Haven Hospital (YNHH) residents. Simulation faculty also participate in resident milestone evaluations for various Yale residency programs in conjunction with their program directors. Additional educational opportunities for YNHH residents include a “Resident as Teacher” curriculum: senior medicine residents learn and practice scenario creation, execution and debriefing during this elective. Faculty are available to work one on one with residents who perceive deficiencies and will run scenarios or supervise procedures to remediate these deficits in training.

Each year, several emergency medicine residents choose to participate in research projects with the YCMS faculty and under the guidance of faculty, present at local, regional and national conferences. All projects result in publication-quality manuscripts.

Community Outreach

Yale Simulation Academy

Developed by Drs. Bonz and Gusberg, the Yale Simulation Academy (YSA) is an innovative outreach program that exposes local, inner city high school students to a broad variety of careers and professional opportunities in the healthcare field. Offered free of charge, YSA is a mentor-based, hands on, interactive experience that provides a pathway for broadening access to, and engagement in STEM learning experiences. YSA focuses on a diverse student body, including students from economically disadvantaged families who might otherwise not have an opportunity to participate in this type of program.

Center for Medical Simulation Faculty

Center for Medical Simulation Faculty Staff