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Overview

Brief History of the Rector CSSC

Gross

The Dr. Robert and Dorothy Rector Clinical Skills and Simulation Center (Rector CSSC), formed in January, 2002, initially was comprised of one Sim-man, one Harvey, five clinical exam rooms and one classroom. Dean Thomas Nasca, MD, issued the charge to develop both human and electromechanical simulation support for undergraduate medical education across the entire medical school curriculum as well as to develop a multi-station, formal high stakes Objective Structured Clinical Examination (OSCE) for all third-year medical students.

For the next four years, the focus was on maximizing and optimizing simulation support for the Jefferson Medical College (JMC) curriculum and on improving evaluation. The SP program increased to over 100 actors; scores for standardized cases and checklists were developed for teaching and evaluation; the Co-Directors worked intimately with the JMC Curriculum Committee and by 2004, a 10-station OSCE was in place, that by 2005 every student was required to pass to enter into 4th year. This program was integrated into each class and almost every course, preclinical and clinical at the Medical College. More than 1600 students have gone through the OSCE which consists of simulation components and structured checklists for Anatomy, History-taking, Basic Physical Examination, Foundations of Clinical Medicine, and rotations in Surgery, Medicine, Family Medicine, OB/GYN and Pediatrics. An Advanced Physical Examination Course, a one-month immersion course for 4th year students, is currently approaching 1000 alumni.

By 2004, the program had outgrown its facilities and moved to a floor in a medical office building which permitted the facility to expand to 12 clinical rooms, two classrooms, and two simulation rooms (one for Harvey and the other for Sim-man). The program further expanded to include the ability to video record teaching and evaluation; to use administrative software systems in support of the logistics behind these programs; and to further evolve simulations using electro-mechanical and plastic models. More low fidelity models were purchased in order to teach and provide structured practice of minor procedures and to develop post-rotation OSCE for clinical rotations.

Building upon the close relation with the late Philip Wolfson, then, Program Director of Surgery, the first post-rotation OSCE in surgery was developed. In 2005, the UCSSC further diversified and expanded teaching and evaluation into Graduate Medical Education developing a pilot OSCE for Jefferson surgery interns as well as the development of simulation support for other residency programs. In 2006, the UCSSC was renamed the Dr. Robert and Dorothy Rector Clinical Skills and Simulation Center (Rector CSSC) with a gift from the Estate of Mrs. Rector. Dr. Rector was a 1948 graduate of Jefferson Medical College. This growth necessitated another move as the programs of Rector CSSC had expanded beyond the capacity of these facilities.

The Dorrance Hamilton Building (aka the Hamilton building) was built, in part, to support the expansion of the Rector Clinical Skills and Simulation Center ("Rector CSSC"). The 3rd, 4th and 5th floors were designed to support and foster the development and implementation of simulation in teaching and evaluation.

Since the Hamilton building opened in October 2007, the Rector CSSC has continued to support and refine all of its pre-existing programs, but now has markedly increased the amount of Graduate Medical Education simulation training, practice and evaluation sessions. These GME venues of skills attainment and structured practice have further expanded, evolved and diversified the programs of Rector CSSC.

With monies from the Measey Foundation and under the charge given by then interim Dean Michael Vergare, and current Dean Mark Tykocinski, the Rector CSSC has developed and implemented a curriculum which, in a structured manner, teaches all incoming house staff basic clinical procedures including, but not limited to central line placement (with and without ultrasound guidance), arterial lines, and orotracheal intubation.

In addition, the Center supports simulation programs across the campus including programs from Occupational Therapy (OT), Physical Therapy (PT), Family Therapy, Nursing, both in the School of Nursing and hospital-based as well as the new School of Pharmacy have been given support to develop simulation for teaching in their programs and to, in as many ways as possible, develop interdisciplinary training at both the undergraduate and graduate levels. Although the School of Nursing simulation program is administratively separate from the other programs, Rector CSSC works with individual hospital-based nurses and leaders, including the Co-Directors of JCIPE, from all other disciplines to develop AAMC and ABIM competency-based simulation driven interdisciplinary teaching and evaluation programs. As a result of Rector CSSC, faculty from OT and PT teach undergraduate medical students clinical skills in collaboration with faculty from the Medical College.

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General Description of the RCSSC

The overall goals of the Rector Clinical Skills and Simulation Center (Rector CSSC) at Thomas Jefferson University are to provide simulation support for all teaching and assessment activities at the University; to develop programs to teach and assess skills as well as the core competencies across all levels of education including, but not limited to Undergraduate Medical Education (UME), Graduate Medical Education (GME), Continuing Medical Education (CME), and Faculty Development; to begin to perform research on these educational interventions; to work with Jefferson Center for Inter-professional Education (JCIPE); to provide simulation support to interdisciplinary programs at the University and finally to become a national and international leader in teaching and assessing clinical skills using human and mechanical simulation.

As such, the Rector CSSC team produces implements and evaluates a multitude of teaching and evaluation programs, but also has developed a method for faculty from all disciplines to access UCSSC and more importantly its tools, curricula and innovative faculty. The Rector CSSC is a major player in the teaching and evaluation of clinical skills in every discipline across the University and the Hospital. Rector CSSC contributes time, models and model support, medical and non-medical supply support to simulation teaching. In addition, the Team supports a robust standardized patient program and has the ability to produce OSCEs on a large and small scale. Furthermore, Rector CSSC faculty can, and does, write cases for simulation and standardized patients and provides faculty who are expert teachers in clinical skills and in the design of simulation curricula while serving as innovative and enthusiastic leaders who role model professionalism and endeavor to make the Rector CSSC the best.

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Resources

Hamilton Night

The resources of the Rector CSSC consist of three floors in the Dorrance Hamilton Building which was built in 2007, as a state-of-the-art simulation facility, designed with direct input from the co-directors, the director of operations and faculty involved in simulation teaching. The Rector CSSC has over 60,458 square feet of teaching and assessment space. There is state-of-the-art audiovisual (AV) and IT support for the facility which uses the Arcadia system for scheduling and supporting all OSCEs, structured teaching sessions and data storage. There are 20 fully equipped AV supported clinical exam rooms, eight  inpatient rooms and five large simulation rooms for high fidelity simulation scenarios. There are five intermediate size classrooms for debriefing and didactic teaching sessions. Although, administratively not a part of the Rector CSSC, the first two floors of the building has 19 classrooms and a 300 seat auditorium, all of which the Rector CSSC utilizes in support of its teaching activities. The Rector CSSC currently has more than 125 Standardized Patients (SPs) that are trained by the co-directors and by three Standardized Patient Trainers (SPTs). The three SPTs also assist with maintaining the quality of performance of our SPs and teaching and evaluative scenarios. The Rector CSSC has a multitude of low and high fidelity models which are used for teaching and skills assessment. The high fidelity models include four Sim men, two NOELLEs, two Harveys, one endoscopic trainer, five Box trainers, and one laparoscopic trainer gynecologic and abdominal surgical procedures. These models support programs across the University and are maintained and assembled by the two Simulation Program Coordinators (SPC).

In addition to the aforementioned staff, all of which are full time employees (FTE) working at the Rector CSSC, the remaining FTE include, the Director of the Surgical Simulation (Assistant Director of the Rector CSSC), the Director of Professional Development, the Director of Disaster preparedness and the Director of Basic Physical Diagnosis for the medical school. A statistician for grading and research purposes also provides services to Rector CSSC.

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Learners

The learners include virtually every student and faculty at the University. These include more than 1000 medical students at Jefferson Medical College, all Occupational Therapy and Physical Therapy students, all students from the School of Pharmacy as well as those from Family Counseling. Although under a different administrative design, the RCSSC is also home to simulation support for the Jefferson School of Nursing. RCSSC supports teaching and assessment using simulation to Graduate level medical programs that involve over 300 residents and fellows from all training programs including Pediatrics, Internal Medicine, Family Medicine, Emergency Medicine, OB/GYN, Psychiatry, General and Sub-specialty Surgery. RCSSC also provides support for faculty development, remediation and continuing medical education programs.

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Educational & Assessment Programs

These include more than 47 different programs in Undergraduate Medical Education (UME); 20 different programs in Graduate Medical Education; and ten  different programs each in Occupational Therapy (OT), Physical Therapy (PT), School of Pharmacy, the School of Nursing, and Family Counseling. Rector CSSC provides support for multiple programs in residencies across campus. Training programs include Pediatrics, Internal Medicine, Family Medicine, Emergency Medicine, OB/GYN, Psychiatry, General and Sub-specialty surgery. In UME, from day 2 of the first year, students are taught clinical correlations to anatomy course. Basic history and physical examination skills are taught in the first and second year. The 11 station, high stakes OSCE is conducted at the end of third year. An advanced physical examination course and post clerkship OSCEs are available and/or required for 4th year students. The average student spends in excess of 400 hours at the Rector CSSC during their medical school tenure. There are skills attainment simulation teaching sessions for more than 127 interns on invasive clinical skills (IJ, subclavian, LP, etc.), and the Center provides opportunities for structured practice of ongoing skills development. Sessions exist for various residencies on Rapid Response Teams and emergent/code situations for structured practice and skills refinement. The Rector CSSC has multiple programs for other ACGME defined core competencies of residency including feedback, professionalism, and end-of-life issues. Programs for more senior surgical residents in laparoscopic and endoscopic training incorporate the high-fidelity models.

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Leadership

Sanborn Sculpture

Katherine Berg, MD, Associate Professor of Medicine and Dale Berg, MD, George Fritz Blechschmidt, MD Chair in Clinical Skills Education and Professor of Medicine, have been the Co-Directors of Rector CSSC since its inception eight years ago. As such, they are responsible for curriculum, evaluation and assessment tools, research programs and for coordinating as well as supporting simulation programs across all schools of the University except for the Jefferson School of Nursing. Among the schools included are UME, GME and the schools of OT, PT, and Pharmacy. The co-directors, who founded the Standardized Patient Program at Jefferson and the JEFF Players, report directly to the Senior Vice President for Academic Affairs, Michael Vergare, MD.

Carol Trent, the Director of Operations for the Rector CSSC, is the chief of staff and supervisor for all staff and standardized patients. She has served in this position since the inception of Rector CSSC, eight years ago. Mrs. Trent is the administrator for all programs with the exception of those through the Jefferson School of Nursing. In conjunction with the co-directors, she oversees schedules and maintenance of equipment in addition to developing, submitting and following the budget for Rector CSSC.

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The Strengths of RCSSC include:

  1. The Physical Platform of Rector CSSC. Rector CSSC was designed by educators to optimize multi-use in each room. There are a multitude of venues and platforms for teaching and evaluation purposes on three floors of the Dorrance Hamilton education building here on campus. On two separate floors are 20 clinical outpatient simulation offices and four inpatient clinical simulation rooms, all with AV support for high quality audio and video monitoring and recording. Thus, two major OSCEs can be performed concurrently. There are 5 multipurpose, low fidelity support classrooms for introductory didactic and end of session debriefing function. These classrooms are designed to hold 5 to 40 learners. Five ultra-sophisticated teaching rooms exist in which high fidelity equipment is used. These rooms include a virtual operating room, a virtual trauma bay or anesthesiology bay, two 6 bed virtual ICU’s or step-down units, and two multipurpose high sophisticated simulation rooms, one mainly for diagnostic simulation (Harvey Room) and the other for procedural (Sim-man and Noelle), ultrasound guided central line placement, laparoscopic and endoscopic simulation.
  2. The Standardized Patient Program. More than 125 SPs work at Rector CSSC. They are used for teaching medical students at every level of training and for assessment of medical student skills at every level of training. They are also used to teach skills to OT, PT, pharmacy students and to house staff. Scores of cases and checklists for standardized teaching and evaluation of skills have been created for medical students, health care professionals and residents. Three full-time SPTs train SPs as well as coordinate and support all programs that use SPs at the University.
  3. The High and Low Fidelity Models for Simulation. RCSSC has 2 NOELLEs, 4 Sim-men, 4 ultrasound machines, 2 Harveys, 10 LP models, 20 IV/arterial line arms, 4 chest tube insertion models, 4 thoracentesis models, 10 torsos for central line placement, 6 pelvises for femoral line placement, an Immersion upper and lower endoscopic model and a Simbionix laparoscopic simulator for Gastrointestinal and OB/GYN procedures. It also has 4 METI lap trainers and a host of other simulation model equipment along with storage for the supplies to support simulation training. Two full-time SPCs maintain, coordinate and support specific simulation programs using this equipment.
  4. Easy Access to the Center. A simple and proven method for University faculty from any School who desire simulation (either human and/or non-human simulation) support for teaching programs to access RCSSC and its Faculty. This includes the mechanism to facilitate access and the development of a standardized template to organize all of the scheduling, supplies, AV, SP and model needs for the program. The Co-Directors and Director of Operations meet with faculty regarding every new program, the Director of Operations assigns an SPT or SPC as the program coordinator and a template is made to detail the needs of the program. As such, there is a built in educational consult and, from the outset, a potential to ask about educational research and interdisciplinary aspects of the program.
  5. The Interdisciplinary Aspects of RCSSC.  In this center, faculty gives simulation support to every school in the University. This, along with the fact that the core Rector CSSC faculty knows every non-nursing simulation program, affords the opportunity for interdisciplinary activities, teaching and evaluation. Working with JCIPE, Rector CSSC has supported no less than 12 programs that are interdisciplinary in nature and has faculty from OT/PT working with medical school faculty to teach student physicians.
  6. The Close Relationship Between the Curriculum of each School and Simulation Support.  The faculty and co-directors are teaching faculty at the medical school and residency program. As such, they are very knowledgeable about the specific classroom teaching and the curriculum extant and able to optimize simulation support. This is particularly manifested in the second year medical school course, Foundations of Clinical Medicine (FCM), in which the co-directors and faculty of Rector CSSC run the Basic Physical Diagnosis course for second year students and work directly with the FCM course director to support simulation programs for the course.
  7. The Innovative and Enthusiastic Faculty in RCSSC. Clearly, a simulation center without knowledgeable faculty is one that is plastic and lifeless. The faculty here breathes life into the simulators and simulations. The faculty writes, produces and creates almost every checklist and scenario and either directly or indirectly supervises the training of SPs. Faculty provides the context and detail to allow a learner to suspend disbelief during the simulation scenarios. Faculty asks the educational research questions and sees the potential sites for interdisciplinary training. In an effort to make teaching and evaluation even more powerful, the faculty is working zealously on hybrid.

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