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Types of participants (check as many as applies) *

Undergraduate medical education

Undergraduate healthcare provider education (SOD, SOP, SON, SHRP)

Graduate medical education

Healthcare team (postgraduate)

CME

From UMMC

External

Interprofessional

Other (please specify)

Other type of participants

Level of participants *

Number of participants *

Proposed session dates:

Learning objectives/educational rationale (e.g. learn to intubate, teamwork in OR crisis) *

Simulation environment

Simulation center (SIEC)

In-situ

Other (please specify)

Other simulation environment

Research & evaluation

Potential for research (please describe)

Patient outcome or quality initiatives

Educational metrics/assessment

Other

Simulation and Interprofessional Education Center