VROC Scenario Request Form

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Material Information

Title:
VROC Scenario Request Form
Series Title:
VROC Forms
Physical Description:
pdf Form
Creator:
Willoughby, Twyla

Notes

Abstract:
This is a pdf form for any physician to request a patient for the VROC system. The scenario request form requires a user to create objectives for each scenario.
Acquisition:
Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Twyla Willoughby.

Record Information

Source Institution:
University of Florida Institutional Repository
Holding Location:
University of Florida
Rights Management:
All rights reserved by the submitter.
System ID:
IR00003660:00001


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Full Text

PAGE 1

VROC Scenario T emplate: Patient Design Section 1: DemographicsCase T itle V irtual Patient Name Scenario Name Simulation Developer Date of Development Learning Groups Diagnosis V irtual Patient MR # Reference ID # Section 2: Curriculum DevelopmentEducational Rationale: List Learning Objectives Below: Use ACGME Core Competencies and abbreviations as follows: Medical Knowledge (mk) Patient care (pk), Practice-bsed learning and improvement (pli), Interpersonal and communication skills (cs), Professionalism (pr), systems-based practice (sbp) Objective 1 Guided Study Question 1 Reference 1

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Objective 2 Guided Study Question 2 Reference 2 Objective 3 Guided Study Question 3 Reference 3 List any additional didactive Information (references, Powerpoint presentations, lectures, books) Assessment Instruments: Section 3: Preparation

PAGE 3

Choose the following Image Datasets that are required Tx planning CT Scan PET Images MRI images Pre-Op studies Other Please check any Documents that will be Required Rad Onc Consultation Pathology Results Surgical Notes Radiology Reports Referring Physician Pulmonology Note Other Prescribed T reatment Site Prescribed Tx Dose and Fractionation Describe the overall treatment scenario. If specific planning errors are required please describe them below If specific treatment errors are required please describe them below ( include how the error is to be detected and what fraction it should occur on.

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Please indicate if there is anything specific required or requested in the debriefing.