Clinical Skills and Simulation Center (CSSC)

Early adopters of simulation included high risk industries such as aviation and the military, but the field of medicine was slower to use simulation in training. Medical students might have learned to give an injection to an orange, or practiced CPR on Resusci-Anne, but were otherwise learning skills on real patients. Over the past several decades, however, simulation has been increasingly used in medical education. It has been shown to improve clinical training and promote patient safety, and is seen as a method of risk-free learning.

Types of simulation used in Boston University School of Medicine’s Clinical Skills and Simulation Center (CSSC) vary from low tech role-plays to use of standardized patients (patient-actors) to high tech full body simulators.  The CSSC is a place of instruction and evaluation of clinical skills from interview, communication, physical examination, and presentation to procedural skills. BUSM students practice basic interviews in the first year, learn to perform physical examinations in the second, and practice procedural skills and team work in BUSM III and IV. It is also a testing site where students complete formative and evaluations across all years of medical school including the End of Year Assessments after the first, second, and third years of medical school. For more information about the mission, history, activities, or scheduling of the CSSC follow the corresponding links.

Address
Boston University School of Medicine
Clinical Skills and Simulation Center
Evans Building  EB11
72 East Concord Street
Boston, MA  02118
Phone: (617) 638-5113
Fax: (617) 638-5326

Directions
Evans Building  EB 11
Take the stairs located next to Keefer Auditorium down one flight

CSSC Staff and contact information

Lorraine Stanfield, MD
Director, Clinical Skills and Simulation Center
(617) 638-5110
Patricia Ward
Administrative Coordinator
(617) 638-5113
pward@bu.edu

Office of Medical Education
Phone: (617) 638-5110
Fax: (617) 638-5326

I. Mission

The CSSC is the medical school’s learning center for a variety of clinical skills. It provides a setting for faculty to instruct, give feedback on, and evaluate clinical skills including:

  • Interview
  • Communication
  • Physical examination
  • Oral presentation
  • Written presentation
  • Procedural skills
  • Team work

While designed for use by medical students the facility is available to groups within and outside the BUMC community.

cssc 1

II. History

    Boston University School of Medicine students have been interviewing and performing physical examinations on standardized patients as part of their Introduction to Clinical Medicine course since the 1970’s.

    In the fall of 2003 Dr. John McCahan (former Associate Dean of Academic Affairs) created Clinical Skills Center a short walk from campus as a place for students to work with standardized patients. Standardized End of Year testing began in 2004 with the End of Third Year Assessment, and in 2005 an End of Second Year Assessment was instituted. In 2007, clinical instruction and testing was moved on campus by Dean Karen Antman and renamed the Clinical Skills and Simulation Center (CSSC).

    The End of First Year Assessment began in the spring of 2009, and the first full body simulator, SimMan 3G, arrived in December of that year. Currently the CSSC boasts three full body simulators, two torso auscultatory simulators, and a wide variety of partial body simulators. It houses the training and evaluation of medical students in interview, communication, physical examination, and procedural skills from BUSM I to BUSM IV.

    III. Activities

    Medical School

    • BUSM I:
      • First year students have interview practice sessions in the CSSC, and then complete the End of First Year Assessment (EOFYA) here. As part of the EOFYA, students interview a standardized patient (patient actor), perform a targeted physical examination on their patient, then check the blood pressure on a full body simulator.
    • BUSM II:
      • ICM-2
        • basic training in physical examination with classmates
        • Heart Sounds Session – use of the simulators to learn about heart sounds
        • Standardized Patient: Substance Abuse – a three station formative exercise in which students interview patients who have been programmed with substance abuse problems
        • Standardized Patient: Physical Examination – evaluative complete physical examination. Students need to correctly demonstrate at least 80% of the items in order to pass
        • Breast and Pelvic Practicum – GTAs (gynecology teaching associates) instruct students in the breast and pelvic examinations
      • End of Second Year Assessment – All second year students complete a three station test in the CSSC. For students who do not do well on this assessment remediate reviewing the video recordings, checklists that the standardized patient used to score the student.
    • BUSM III:
      • FM Clerkship – formative and evaluative sessions with Standardized Patients (SPs), and a team session with SimMan
      • Medicine Clerkship – instruction in thoracic auscultation, and formative team-based learning using SimMan
      • Surgery Clerkship – instruction in male and female catheterization and male rectal and prostate examinations
      • Ob/Gyn – instruction in female catheterization
      • End of Third Year Assessment – In spring of the third year all students take the EOTYA, a six-station Observed Structured Clinical Examination (OSCE) with cases developed from each of the required third year clerkships. The EOTYA allows for measurement of various clinical skills, and also helps prepare students for the USMLE Step 2 CS examination. For students who do not do well on this assessment remediation using the videotapes, checklists and write-ups, is accomplished in the CSSC.
    • BUSM IV:
      • Neurology – instruction in lumbar puncture

    Graduate Medical Sciences

    • Conduct interviews and review their videotapes in the CSSC

    Continuing Medical Education (CME)

    • Taping of CME modules

    IV. Standardized Patients

      Standardized patients (SPs), also known as patient actors, are people trained in interview, communication, physical examination, and feedback techniques. They memorize the script of a patient, including symptoms and past medical history, family situation, and even physical examination findings. Then they act out the patient’s story for a student. After the encounter they give feedback on how well the student communicated during the encounter, comment on the quality and breadth of data, and evaluate the student’s physical examination skills.

      The CSSC has a cadre of standardized patients available for hire, but also contracts with UMass Medical School’s Standardized Patient program. In addition the CSSC trains and hires gynecology teaching associates (GTA). GTAs are women who use their bodies to instruct students in proper breast and pelvic examination techniques.

      cssc 3

      V. Equipment

        Audio and visual data from all twelve examination rooms feed to a central monitoring room. All twelve rooms can be videotaped, and up to seven of the rooms can be observed at one time. In fall 2011 an additional simulation room was equipped with AV equipment including wireless audio feed, one way mirror, control room, and flat screen monitor.

        The CSSC houses a kitchen/ meeting room, and student lounge/ classroom. In addition the largest examination room doubles as a classroom.

        VI. Simulation

          Pelvic and breast simulators have been used in the CSSC since its inception, and in December 2009 the CSSC welcomed the first of two chest simulators called SAM (Student Auscultation Manikin). SAM’s high fidelity heart and lung sounds help second year students enhance their auscultatory and chest examination skills. The first of three full body SimMan simulators joined the CSSC in October 2009. SimMan, complete with heart and lung sounds, pulses, EKG tracings, blood pressure, and the ability to speak, is used in the second and third year curricula.

          In addition to SimMan and SAM, the CSSC has partial body simulators for instruction in the pelvic examination, nasogastric tube insertion, rectal and prostate examinations, lumbar puncture and phlebotomy simulators, among others. Since 2011 many clinical clerkships have used simulators as a standard part of their clinical skills teaching.

          cssc 8

          The following is a list of the current simulators:

          • SimMan Essential (3)
          • SimMan 3G
          • SAM (Student Auscultation Manikin)
          • Lumbar puncture and epidural simulator
          • Rectal Examination Simulator Mk2 (male, complete with a variety of prostate findings)
          • NG Tube and Tracheostomy Care Trainer
          • Catheterization Simulator (male)
          • Catheterization Simulator (female)
          • Catheterization model  (male)
          • Catheterization model  (female)
          • Pelvic Trainer (2)
          • Multi-venous IV Training Arm Kit (10)
          • IV Training Arm (10)
          • Breast models (silicon) (14)

          Other available equipment:

          • EKG machine

            VII. Scheduling the CSSC

            The CSSC schedule is visible via R25 (an internal scheduling system). Scheduling the center can be done by contacting Ms. Patricia Ward (contact information below). To make a reservation please download the Reservation Form and e-mail or fax to Ms. Ward.

            E-Mail pward@bu.edu
            CSSC Phone Number (617) 638-5113
            OME Phone Number (617) 638-5110
            Fax Number (617) 638-5326

            R25

            Reservation Form