Request Program

Submitted by admin on Thu, 06/28/2018 - 12:05

Please be advised that NYSIM is requesting that all faculty complete didactics or lecture portion of their teaching remotely. NYSIM is directing all learners and faculty directly to simulation spaces in order to comply with NYULH Covid19 Classroom Policies. Please plan accordingly.

Is this is a new program that has never taken place at NYSIM? *

Yes it is a new program

No it has taken place before

For new programs that have never taken place at NYSIM, PLEASE USE our Simulation Education Consultation form.

Last Name *

First Name *

Contact Email *

Please add my email to the NYSIM Community Email Distribution List

Yes

Please add my email to the NYSIM Community Email Distribution List

Phone Number *

Are you the lead faculty for this program? *

YES

Who is the lead faculty for the program? *

Is this a CUNY or NYULH educational program? *

If unknown, please briefly describe *

Location *

If “In-situ”, specify location here *

Program Type *

In-Situ Program Type

Any program held off NYSIM premises

OSCE Program Type

Any Standardized Participant-based program

Other Program Type

Any programs that do not fit the above categories

Remote OSCE Program Type

Any Standardized Participant-based program held remotely via a conferencing app

Remote SIM Program Type

Any simulator-based program that is held remotely via a conferencing app

SIM Program Type

Any simulator-based program

SIM/OSCE Program Type

Any program that involves Standardized Participants AND a simulator

Please see descriptions below:

SIM Program Type: Any simulator-based program
Remote SIM Program Type: Any simulator-based program that is held remotely via a conferencing app
OSCE Program Type: Any Standardized Participant-based program
Remote OSCE Program Type: Any Standardized Participant-based program held remotely via a conferencing app
SIM/OSCE Program Type: Any program that involves Standardized Participants AND a simulator
In-Situ Program Type: Any program held off NYSIM premises
Other Program Type: Any programs that do not fit the above categories

Program Name *

Total Number of Learners *

Total Number of Faculty *

Number of Faculty

Do you know how many learners you will have?

Enter amount here

Describe your program: What is being taught? If you have learning objectives, list them here. *

Will you be using Standardized Participants (actors)? *

Will your program be using equipment supplied on loan by outside vendors? *

Yes

Please list all vendors and equipment *

Requested initial program date?

Date *

Month

Day

Year

Start Time *

Hour

Minute

End Time *

Hour

Minute

If this is a recurring program, please enter additional dates

Date

Month

Day

Year

Start Time

Hour

Minute

End Time

Hour

Minute

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The mission of NYSIM is to provide simulation education and research that fosters quality care, patient safety, and effective communication with patients and among health care professionals.

Request Program

In-Situ Program Type

OSCE Program Type

Other Program Type

Remote OSCE Program Type

Remote SIM Program Type

SIM Program Type

SIM/OSCE Program Type

Contact Info

Drop US A LINE!

Search form

Request Program

In-Situ Program Type

OSCE Program Type

Other Program Type

Remote OSCE Program Type

Remote SIM Program Type

SIM Program Type

SIM/OSCE Program Type

Contact Info

Drop US A LINE!