Yale Center for Healthcare Simulation

Based on needs analyses, we collaborate with clients to design educational initiatives tailored to meet learner needs and achieve intended outcomes that emphasize patient safety. Together, we develop curricula, create scenarios, construct evaluation and assessment tools, and support clients through implementation in the simulation laboratory or in-situ.

Our education and training programs reach all levels of learners, from students and residents learning new skills, to expert professionals practicing high-risk, low frequency procedures. Inter-professional training offers the opportunity to practice both clinical and critical teamwork and communication skills. Our safe, structured learning environment fosters the development and maintenance of all of these skills, and supports our goal to become a high reliability organization.

The YCHS also offers a variety of simulation-based systems analysis services. Human factors engineers apply simulation strategies to new facility design and testing, perform environmental and workflow analysis, and integrate new systems into an already complex health care system. These programs target the identification of latent safety threats and our team works with clients to produce system improvements. Simulations range from table-top workflow analysis and physical environment mock-ups, to patient care scenarios. Simulation-based systems analysis is recommended for testing changes in system components including new device integration, environment design/redesign, and changes in workflow.

Dedicated simulation faculty with expertise in scenario design and debriefing skills guide users through scenarios. In addition, our team has created solutions to bring simulation to the actual clinical environments allowing native teams to practice in-situ.

To further support clients in utilizing simulation, we provide instructor education and coaching to enhance debriefing skills and maximize the benefits of simulation-enhanced teaching.

The Yale Center for Healthcare Simulation occupies 13,000 square feet and our flexible simulation environments contain replicas of an ED/ICU/ward, trauma resuscitation bay, pediatric/newborn unit and operating room and can be configured to recreate all types of clinical care areas, including both inpatient and outpatient care areas. Each space is outfitted with mannequin-based fully interactive simulators and advanced professional audiovisual equipment to record simulation activities for onsite or remote review. A conference room and adjacent classrooms with a real-time video feed from the simulation rooms accommodate large group debriefings and are designed to enable participants to have the opportunity to reflect on their performance in an interactive debriefing session following the simulation scenario.

The simulation team is proud to feature a comprehensive array of part-task trainers and full-body human patient simulators including neonatal, infant, pediatric, adult and birthing patient simulators. All simulators are fully portable. During the design process, our team of experts helps clients determine the most appropriate technology, equipment, and location to achieve intended goals.

Trainees and other health professionals have the opportunity to address end-of-life issues, informed consent, and hands-on training in a safe space.

• Proposals are reviewed on a weekly basis by the Executive Director of the YCHS, educators, and specialists. If the proposal is accepted, one of the educators will contact you within 10 business days to coordinate an initial meeting.
• If a program is accepted, those who will be teaching are required to participate in our faculty development class to learn how to effectively utilize the YCHS. This class should be completed prior to implementing a simulation. Visit our Faculty Development page for more information.

This Faculty Development series reflects our firm commitment to support you in your efforts to provide experiential learning opportunities for clinicians throughout the Yale New Haven Health System and Yale School of Medicine. Using simulation as an education tool is a dynamic process that requires:

• technical expertise in simulator equipment
• knowledge of how to create an environment conducive to learning
• keen awareness of and ability to observe specific behaviors within clinical scenarios and at the bedside
• an acumen of debriefing strategies to prompt self-reflection on the part of the learners
• tools to assess the impact of your educational interventions

We have created a step-wise curriculum that will provide the skills you need to succeed. To ensure quality of our training programs, we require all faculty to participate in Introduction to Simulation and Debriefing.

(CME credits are available)

This one-day course builds from the ground up, beginning with the elements of simulation-based education with adult learning principles in order to provide the clinician educator with a strong foundation and structure for creating experiential learning opportunities. Other course objectives cover practice simulation, including scenario design and implementation, as well as effective debriefing. The course is interactive and allows opportunity for practice and prompt application.

Courses may be held virtually via Zoom from 8:30 a.m. - 12:30 p.m., or live at the YCHS (728/730 Howard Avenue, New Haven), from 8:30 a.m. - 4:30 p.m. A decision will be made prior to each course.

Please email simulation@yale.edu or call 203-688-2231 or 203-688-9565 for a list of upcoming courses or more details.

Debriefing requires skill and lots of practice. To provide more practice opportunities, we have developed a seminar series that includes five three-hour sessions which examine several debriefing models and delve deeper into specific skills and strategies. Learners may participate in any or all sessions, in any order, following completion of Introduction to Simulation and Debriefing. Come explore with us.

• Promoting Excellence and Reflective Learning in Simulation Framework (PEARLS)
  This session introduces Promoting Excellence and Reflective Learning in Simulation Framework (PEARLS) and reinforces the importance of observation skills to prompt reflection. PEARLS is a blended learning approach that can be used flexibly for novice to expert learners.
• After Action Review (AAR)
  This session presents the AAR for health care debriefing model. It also reinforces the importance of observation skills to prompt reflection. Participants will also practice incorporating video into debriefing.
• Deliberative Practice and Coaching
  This session teaches the technique of reflection-in-action, as opposed to reflection-on-action. Participants explore techniques and considerations for pausing simulations to reflect on decision-making in the moment.
• Engaging the Challenging Learner
  This session explores techniques and strategies for engaging the challenging learner. A guest faculty member from the IFE will discuss skills from Crucial Conversations that can be applied to debriefing in simulation.
• Video-Based Debriefing
  This session will explore techniques for using video to augment debriefing discussions. Learners will have opportunities to practice incorporating video using several debriefing models.

• All incoming Yale medical students have their first opportunity to participate in a simulated patient encounter at YCHS in their first week of medical school, through their Introduction to the Profession course.
• Prior to starting their clinical clerkship year, all MD students are trained in: foley catheter placement, nasogastric intubation, and bag-valve mask ventilation at YCHS.

• MD students participate in simulation sessions in all of their clerkships, working 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, 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.

• 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, and 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 in the YSM Emergency Medicine Sub-Internship participate in an EM-based simulation curriculum at YCHS.
• A two-to-four week simulation elective is available to interested fourth and fifth-year medical students. 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 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.
• During students’ final course, Capstone, they have the opportunity to participate in a simulation that provides the experience of being the only intern on the floor while taking care of patients on an overnight rotation—before starting residency in a few months.
• Motivated students also have the opportunity to participate in a number of ongoing research projects under the mentorship of YCHS faculty. Projects result in publication-quality manuscripts and are encouraged for submission to local, regional, or national meetings.
• 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.

The Center is a safe space for learning, where mistakes can be a learning tool.

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

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

During each rotation, core simulation faculty create daily schedules for residents, which include:

• Formative ACGME milestone assessment
• Post-graduate year-specific case participation
• Medical student teaching
• Procedural training
• Simulation case creation and programming
• Debriefing course and debriefing practice
• Difficult obstetric deliveries
• Mini-courses in ventilation management, sepsis, toxicology, ophthalmology, and general emergency management

EM residents spend additional time at YCHS 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.

YCHS is open Monday through Friday, 8:30 a.m. to 5:00 p.m., and is available to all Yale New Haven Health (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 YCHS faculty and under the guidance of faculty, present at local, regional, and national conferences. All projects result in publication-quality manuscripts.

The Yale Medical Simulation Fellowship in Emergency Medicine is a one-year fellowship offered to a qualified Emergency Medicine residency graduate. Fellows will have the opportunity to learn simulation-based education and scholarship in our Yale Center for Healthcare Simulation (YCHS), a joint venture between Yale School of Medicine and Yale-New Haven Health. The 13,000 square foot simulation center includes immersive space for hands-on practice as well as didactic classroom environments.

Learn more on the Emergency Medicine department website.

Yale School of Medicine’s Simulated Participant (SP) Program provides learners at any level with a safe and effective space in which to acquire and practice their skills. We also work with investigators as a resource to promote innovation and scholarship in simulated education research. The SP Program has expertise in designing and implementing training scenarios as well as case and character development to meet your learning objectives and program goals. We aim to deliver an authentic and effective experience for your learners. Our Simulated Participants are trained specifically for your program and committed to excellence in all they do.

Since 1993, the Standardized Patient Program at YSM has provided learners with a supportive environment in which to engage in realistic simulated encounters with trained health care educators. In Winter 2022, we changed the Program’s name to Simulated Participant (SP). Our new name is an accurate expression of the varied roles our SPs are trained to portray, as well as our commitment to serve the diverse needs of our clients, and to advance research in education and training using human simulation pedagogy. We employ a diverse population of SPs to ensure learners receive training on engaging with the wide range of people they will interact with in practice. The term Simulated Participant reflects contemporary language and is inclusive of every area in which our SPs are trained.

We encourage your interest and are available to consult and brainstorm with you about how you might use the SP Program to meet your educational or research goals.

SPs are trained extensively to portray their character’s role to fulfill specific learning objectives. In standardized sessions, SPs bring a consistent, measurable portrayal of their character so that each trainee receives the same experience. In simulated work, the SP is given a character with guidelines of their chief concern and social and medical histories; the SP then responds in an improvisational manner while remaining in character.

Our Program follows the Association of SP Educators' (ASPE) Standards of Best Practice in the field of human simulation, our SPs portray a wide variety of roles: from patient, to parent, to clinician. Our educational encounters are primarily sought to enhance communication skills, offering a safe, supportive, and controlled learning environment for trainees to grow in their clinical abilities.

If you have questions about how SPs may be used in your work, please contact Barbara Hildebrand, the SP Program Manager, who will consult with you. To secure your program’s use of SPs, you must complete the SP Program Online Request Form. Once the Request Form is received, we will contact you to discuss your request.

Developed by James Bonz, MD, assistant professor of emergency medicine, and Richard Gusberg, MD, professor emeritus of surgery (vascular); director, surgical clerkship, 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 health care 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.