Contact the Simulation and Interprofessional Education Center

• Simulation and Interprofessional Education Center (SIEC)
  University of Mississippi Medical Center
  2500 N. State St., SM409
  Jackson, MS 39216-4505
  (601) 815-9082
  siec@umc.edu

Simulation Session Request Form

* = Required Fields

Faculty
Full Name:*
Email Address:*
Department(s)
Participants
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*
Education session
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
Potential for research description
Other research & evaluation
Funding (if applicable)