The Start of a New Era in Clinical Education

For more than a decade, life’s critical moments have unfolded in the controlled environment of the CSSC, where medical, physical therapy, and dental students, along with residents and physicians as well as other community health care providers, are taught and assessed on their clinical and procedural skills by faculty and simulated patients. A cornerstone of modern medical education, the CSSC has undergone a significant renovation in both its physical structure and its role within the College’s curriculums. Reimagined to resemble a hospital setting, the facility has expanded by approximately 5,000 square feet, becoming 27,000 square feet of cutting-edge, high-tech learning space. The upgrades consist of seven medical suites, classrooms, and labs; the addition of two standardized patient exam rooms, bringing the total to 22 rooms; and inclusive technology reflecting marginalized communities, including patients with disabilities; and an additional dedicated CSSC entrance.

THE EVOLUTION OF EXPERIENTIAL LEARNING

“Students want and need hands-on experiential learning,” says Katharine Yamulla, M.H.E.A., CHSE, director of the CSSC and assistant dean for Clinical Skills Education and Assessment, who oversaw the facility expansion since it started in November 2024. “As one of the founding directors that came here when the CSSC opened its doors in 2014, I am so proud that this came to fruition. Here, students are not just sitting in lectures. From day one, whether it's the School of Medicine (SOM), School of Health Sciences and Practice (SHSP) Doctor of Physical Therapy (D.P.T.) Program, or the dental students at Touro College of Dental Medicine (TCDM), we've been integrating the CSSC into every aspect of all the curriculums we serve on campus. That's been the biggest evolution. It's not just that they come here for a test and leave. They come here for practice.”

The innovative facility allows students and physicians to learn in clinical training environments that accommodate advanced simulation equipment, allowing for expanded access for clinical skills practice, and increases the scope and scale of the College’s programs. Increasing more opportunities for instructional integration between the basic and clinical sciences, the addition of the suites, classrooms, and labs create a realistic hospital simulation, mirroring the environments where many of its learners will one day work. “We wanted to make sure that we had suites that are dedicated to the specialties that our students and residents either rotate through or match into and expose them to different types of simulated medicine,” explains Yamulla.

The newly designed CSSC, which serves more than 5,000 learners annually, features an ultrasound education and procedural skills classroom, a three-bed ward replicating a hospital inpatient care unit for interprofessional simulations, including trauma and triage care, emergency training, post-operative/recovery care, and advanced life support; a labor and delivery suite with the pediatric suite adjacent to the room to facilitate hand-off care; an orthopedic suite that offers advanced simulation for surgical techniques using robotics; interconnected critical care and operative simulation suites that simulate operating rooms, ICUs, and catheterization labs for critical care and procedural practice with advanced simulators; and a surgical and procedural skills lab that features high-tech stations and interactive monitors for hands-on learning and tutorials. The Leadership in Energy and Environmental Design (LEED) gold-certified Center features sustainable materials throughout and incorporates advanced technological upgrades to enhance learning capabilities.

“It's very important to me that we are staying in line or ahead of national trends in patient care and clinical skills training, and that is directly what influenced what we wanted the expansion to ultimately look like,” says Yamulla, the first non-M.D. to serve as president of the Directors of Clinical Skills Education (DOCS), an affiliate organization of the American Association of Medical Colleges. DOCS shapes clinical skills training at a national level by promoting scholarship, establishing best practices, and encouraging the exchange of ideas across the continuum of clinical skills education.

The Center also includes stations equipped with world-class, high-fidelity manikins that simulate a wide range of medical scenarios and procedures to represent patients from premature infants to adults, along with a newborn incubator, scrub sink stations, medical-grade gases for procedures, and advanced task trainers. These enhancements transform the Center into a state-of-the-art training hub, preparing learners for realistic and complex health scenarios in a low-stakes environment. Yamulla is also working with the Society for Simulation in Healthcare to acquire accreditation status. The expansion plays a pivotal role in this mission, which will help the CSSC become a regional leader in first class training. 

“The renovation allows for more real-life scenarios,” says Joshua Lee, M.D. ’25, and a former member of the SOM Education and Curriculum Committee. “The expansion has the spaces that exist in a hospital and allows for students to get acclimated to the hospital setting, gaining experience beforehand. The CSSC will help develop skills needed to navigate various medical situations to better prepare students and residents to understand potential outcomes, express empathy, and collaborate with the members of a medical team before we step foot in a hospital.” 

CREATING A REPRESENTATIVE LEARNING ENVIRONMENT

The facility is also designed to incorporate patient populations of various backgrounds into the simulated training, including people with mental and physical disabilities. Of the facility’s 22 spacious standardized patient exam rooms, six are accessible for people with disabilities, consisting of electronic beds, Hoyer lifts, and large doors to accommodate wheelchairs to ensure learners deliver culturally competent health care. The Center also includes manikins in light, medium, and dark skin tones to encourage social awareness and provide a more representative learning environment that reflects the patient populations health care professionals will encounter throughout their careers.

“There's a great deal that students need to learn today, more than ever before,” explains David E. Asprinio, M.D., chair and professor of the Department of Orthopedic Surgery and professor of pharmacology, who sponsored the orthopedic suite. “They need to develop a strong knowledge base, technical skills, and behavioral attributes, as well as learn how to interact effectively with patients. Our clinical skills facility has been invaluable in developing all these skills, and the new upgrades will only enhance its effectiveness. Take orthopedic surgery, for instance – it's technically very demanding, and with current work hour restrictions, it's crucial that students' time is utilized effectively."

The facility has more than 15 integrated smart boards that link directly to student devices for in-session activities and to continue projects once they leave the CSSC, as well as new audio-visual equipment for the classrooms and technology to communicate between rooms. 

Students can train on advanced manikins and task trainers, including SimMom, which accurately simulates various birthing scenarios and provides real-time feedback on student performance via a software platform; SimNewB for advanced pediatric training, and ultrasound-guided task trainers. The Center also houses the next-generation maternal and birthing simulator, MamaAnne, designed for high-fidelity training in critical obstetric emergencies. NYMC is the first institution in the Northeast to introduce MamaAnne. The facility will also implement advanced surgical skills trainers that can augment laparoscopic and robotic surgeries in the orthopedic suite in the future.

“Students will start to fade off if you teach in a traditional lecture-style way,” says Chrisia Noulas, M.D. ’92, assistant professor of pediatrics and pediatrics clerkship director for the SOM. “Getting students involved and having them be hands-on is the best way to teach. Students are less likely to make mistakes with real patients if they have practiced and received feedback on clinical skills in a simulated environment.”

TRANSFORMING CLINICAL SKILLS EDUCATION 

The physical environment has evolved but so has the clinical skills education. Yamulla has had a hand in the SOM curriculum redesign and partnered with TCDM and the SHSP’s D.P.T. Program to help create educational opportunities that also use the resources provided by the CSSC. “The Center is never sitting empty because there's always a need for experiential learning,” she says.

In 2021, the Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination, an exam for medical students to become licensed physicians, was officially discontinued during the COVID-19 pandemic, opening the doors for medical schools, like NYMC, to create innovative opportunities instead of teaching to a test.

“Not having to teach to a test such as Step 2 CS has provided us with the freedom to reimagine simulation using standardized patients and manikins by more accurately simulating the continuity of patient care they will experience in real medical settings,” explains Yamulla. “For example, in our pediatric clerkship, students can experience treating a young teen throughout the course of their formative years and then have to oversee the care of same patient, now in manikin form, who came into the ER due to an opioid overdose.” 

Erica Ball Winn, a professional actor and standardized patient educator, has been an integral part of the CSSC since its inception, portraying various ailments to help students refine their physical exams, history taking, and communication and empathy skills. She says the renovations are not just exciting for the students, but also for the standardized patients.

“I am blown away,” says Winn. “The facility is state-of-the-art. The renovations are enhancing what the CSSC has already been doing, while also taking the facility to the next level of training. Now, we can replicate and write scripts for more complex real-life scenarios to help NYMC students become well-equipped professionals.”

INTERPROFESSIONAL LEARNING OPPORTUNITIES

The new space creates an additional opportunity for expanded interprofessional education (IPE) training. Students in different disciplines learn the same skills in the Center, with physical therapy students utilizing the facility to learn cardiology skills including auscultation, like their medical student counterparts. Students also participate in collaborative classes, such as dental students partnering with medical students and working alongside speech-language pathology (SLP) students. The newly designed Center allows for tailoring more classes to incorporate cohesive lessons to enhance skill sets for a deeper understanding of the collaboration students will encounter in their fields.

“I’m excited about the endless possibilities of IPE,” exclaims Vikas Grover, Ph.D., CCC-SLP, chair of the Department of Rehabilitation Sciences and chief and professor in the Division of Speech-Language Pathology in the SHSP. “We are conducting more IPE activities, which allow students from different disciplines to come together and learn from each other's discipline so that when they go out in the field, they are aware of each other’s role, as well as the different ways that the other health care professional thinks in the same situation.”

The Division of Speech-Language Pathology is also looking to integrate the CSSC into its curriculum to better prepare students for the medical aspects of the profession. In the medical management courses, SLP students already learn about tracheostomy and ventilator dependence, acute care, bedside evaluations for swallowing disorders, and flexible endoscopy. “With the Center, students would be able to use the skills they learned in the classroom and apply them in a realistic, simulated environment to build their confidence,” says Dr. Grover.

EXPANDING CLINICAL TRAINING

The Center offers additional programming and certifications that strengthen ties between academia and clinical practice to enhance patient safety and health care outcomes. Approved by the American Heart Association (AHA) as a certification site, the CSSC has provided Basic Life Support training, and now will be able to include Advanced Cardiovascular Life Support and Pediatric Advanced Life Support courses for students, faculty, and community health care providers with the addition of space. The new trainings have been offered to the SOM Class of 2026, certifying the students before they get into residency. “A lot of residency programs aren't necessarily providing those certifications anymore,” says Yamulla. “We realize that it is a financial ask for these students who are just starting out in the profession.”

Looking ahead, the CSSC hopes to expand the volume of training programs it offers and emerge as a regional training site extending its reach beyond the students, residents, physicians, and high school programs the facility currently serves one simulated heartbeat at a time.