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Request CTAC Resources

Any group interested in teaching or assessing interactions between learners and standardized patients can request Clinical Teaching and Assessment Center (CTAC) room reservations and/or standardized patient time. On a case-by-case basis, rooms and standardized patients are also available for marketing, research, or educational filming purposes.

Clinical Teaching & Assessment Center About CTAC Standardized Patient Program Contact CTAC

New to working with CTAC? If you would like to discuss possible event design or dates before completing the request form, email Jenna Patenaude, CTAC director.

Request Room and/or Standardized Patient Time

All events, room reservations, and requests to engage with standardized patients must be approved by CTAC staff. Fees may apply.

After receiving your request, CTAC staff will send you a copy of the completed request form, confirm event details, and provide a cost estimate if applicable. Please submit your request at least six weeks in advance to allow adequate time for planning and standardized patient (SP) recruitment.

"*" indicates required fields

Event Details

Reservation Type*

Standardized patient time and CTAC space (3rd floor, Health Sciences Learning Center)

Standardized patient time only (non-CTAC location)

CTAC space only

Event Title*

Event Dates and Times*

Use the plus sign to add more dates. SPs = Standardized Patients

Date

Event Start Time

Learner Start Time With SPs

Learner End Time with SPs

Event End Time

Event Dates and Times*

Use the plus sign to add more dates.

Date

Event Start Time

Event End Time

Event Location*

Standardized Patient Parking and Check-in Instructions

Department or Program Sponsoring the Event

Learner Group*

Medical students

Other students

Residents/fellows/faculty

Other

Course Name and Number*

Description of Residents, Fellows, or Faculty Group*

Event Contact(s)*

Use the plus sign to add more contacts.

Name (First and Last)

Phone Number

Number of Learners Attending*

Brief Event Description*

Learners, purpose, format, etc.

How long is each learner/standardized patient encouter in minutes?

Event Schedule Details

Describe the schedule including arrival times for learners and standardized patients, start and end times for cases, SP-to-learner feedback time, transition times, learner group orientations or debrief sessions, etc. Alternatively, upload a PDF of this information in the next field.

Upload Additional Documents (as PDF)

Schedule grids, learner lists, detailed session agendas, miscellaneous documentation, etc.

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

CTAC Space Requests

Do you need an orientation room?*

Capacity=25

Yes

Number of CTAC Clinic Exam Rooms Needed*

Maximum=24

Please enter a number less than or equal to 24.

Room Set-up Special Instructions

Is video recording needed?*

Yes

List of Learner Names and Emails (as PDF)

Attach a list of all learner names (first/last) and emails ending in wisc.edu. This allows the software to tag videos with learner names. You may also email this to ctac@med.wisc.edu no later than seven days before your event.

Accepted file types: pdf, Max. file size: 2 MB.

Will faculty assessors need access to the videos?*

Yes

Date Range of Access for Faculty

Will learners need access to their videos?*

Yes

Date Range of Access for Learners

Standardized Patients

Number of Standardized Patients Needed*

Total per event day

Would you like to book backup Standardized Patient(s)?*

Backup SPs train for the case, arrive with the scheduled SPs and are paid for one hour if not needed to cover an absence.

Yes, schedule 1 backup per distinct role.

No, I can adjust my plan if an SP is absent.

I'm not sure (CTAC will follow up)

How many stations/SP interactions will each learner rotate through?

Maximum=6

Please enter a number less than or equal to 6.

Station/Standardized Patient Interaction 1

Station/SP Interaction 1 Description*

Describe each distinct standardized patient role for station 1.

Number of SPs Needed for Station 1*

Requested Attributes of SPs for Station 1*

Age range, sex/gender, relevant physical characteristics, skills or abilities etc.

The SP in this station will be expected to:

Select all that apply.

Learn a case

Undergo a physical exam

Undergo an ultrasound

Provide feedback to learners

Brief Case Description

Including clinical scenario and any SP emotional expression.

Upload Case(s) (as PDF)

If cases are not available today, they are due no later than 4 weeks before the event to allow adequate time for recruitment and training of SPs. Please email cases to CTAC staff or ctac@med.wisc.edu.

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

I agree to send case(s) to CTAC at least 4 weeks in advance.

I agree.

Describe the Components of the Physical Exam

Describe the Components of the Ultrasound

Describe Feedback Components, Format (Written/Verbal) and Timing

Station/Standardized Patient Interaction 2

Station/SP Interaction 2 Description*

Describe each distinct standardized patient role for station 2.

Number of SPs Needed for Station 2*

Requested Attributes of SPs for Station 2*

Age range, sex/gender, relevant physical characteristics, skills or abilities etc.

The SP in this station will be expected to:

Select all that apply.

Learn a case

Undergo a physical exam

Undergo an ultrasound

Provide feedback to learners

Brief Case Description

Including clinical scenario and any SP emotional expression.

Upload Case(s) (as PDF)

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

I agree to send case(s) to CTAC at least 4 weeks in advance.

I agree.

Describe the Components of the Physical Exam

Describe the Components of the Ultrasound

Describe Feedback Components, Format (Written/Verbal) and Timing

Station/Standardized Patient Interaction 3

Station/SP Interaction 3 Description*

Describe each distinct standardized patient role for station 3.

Number of SPs Needed for Station 3*

Requested Attributes of SPs for Station 3*

Age range, sex/gender, relevant physical characteristics, skills or abilities etc.

The SP in this station will be expected to:

Select all that apply.

Learn a case

Undergo a physical exam

Undergo an ultrasound

Provide feedback to learners

Brief Case Description

Including clinical scenario and any SP emotional expression.

Upload Case(s) (as PDF)

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

I agree to send case(s) to CTAC at least 4 weeks in advance.

I agree.

Describe the Components of the Physical Exam

Describe the Components of the Ultrasound

Describe Feedback Components, Format (Written/Verbal) and Timing

Station/Standardized Patient Interaction 4

Station/SP Interaction 4 Description*

Describe each distinct standardized patient role for station 4.

Number of SPs Needed for Station 4*

Requested Attributes of SPs for Station 4*

Age range, sex/gender, relevant physical characteristics, skills or abilities etc.

The SP in this station will be expected to:

Select all that apply.

Learn a case

Undergo a physical exam

Undergo an ultrasound

Provide feedback to learners

Brief Case Description

Including clinical scenario and any SP emotional expression.

Upload Case(s) (as PDF)

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

I agree to send case(s) to CTAC at least 4 weeks in advance.

I agree.

Describe the Components of the Physical Exam

Describe the Components of the Ultrasound

Describe Feedback Components, Format (Written/Verbal) and Timing

Station/Standardized Patient Interaction 5

Station/SP Interaction 5 Description*

Describe each distinct standardized patient role for station 5.

Number of SPs Needed for Station 5*

Requested Attributes of SPs for Station 5*

Age range, sex/gender, relevant physical characteristics, skills or abilities etc.

The SP in this station will be expected to:

Select all that apply.

Learn a case

Undergo a physical exam

Undergo an ultrasound

Provide feedback to learners

Brief Case Description

Including clinical scenario and any SP emotional expression.

Upload Case(s) (as PDF)

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

I agree to send case(s) to CTAC at least 4 weeks in advance.

I agree.

Describe the Components of the Physical Exam

Describe the Components of the Ultrasound

Describe Feedback Components, Format (Written/Verbal) and Timing

Station/Standardized Patient Interaction 6

Station/SP Interaction 6 Description*

Describe each distinct standardized patient role for station 6.

Number of SPs Needed for Station 6*

Requested Attributes of SPs for Station 6*

Age range, sex/gender, relevant physical characteristics, skills or abilities etc.

The SP in this station will be expected to:

Select all that apply.

Learn a case

Undergo a physical exam

Undergo an ultrasound

Provide feedback to learners

Brief Case Description

Including clinical scenario and any SP emotional expression.

Upload Case(s) (as PDF)

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

I agree to send case(s) to CTAC at least 4 weeks in advance.

I agree.

Describe the Components of the Physical Exam

Describe the Components of the Ultrasound

Describe Feedback Components, Format (Written/Verbal) and Timing

Comments/Questions About This Event

I understand that by submitting this form, my information will be used to contact me regarding my interest in the Wichman Clinical Teaching and Assessment Center.*

I agree.

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