Southern Illinois University School of Medicine employs simulated patients in the training and evaluation of medical students, residents and other professionals. A Simulated/Standardized Patient is a person who has been coached to accurately and consistently recreate the history, personality, physical findings, and emotional structure and response pattern of an actual patient isolated at a particular point in time. Simulated patients are interviewed and examined (just as you would be by your family doctor) by male and female medical students.

In the patient role, simulators may see several (1 to 12) students on a one-to-one basis during an evaluation session or there may be a group of students (4 to 7) working with you in a controlled teaching session.

If you think you may be interested in being a simulated patient for SIU School of Medicine, please complete and submit the questionnaire below. Once received, you will be invited to an informational session at which we will explain the program in detail. If you have questions prior to this time, Springfield area candidates may call Dr. Amelia Frank at  217-545-7126. Carbondale candidates may call Vicky Dasher at 618-453-1674.

For which campus are you in interested in becoming a standardized patient?

Please complete the following information so we can add you to our Simulated Patient Database. Details like ethnic background, date of birth, height/weight, and number of children, are used only in matching simulators to available cases. Your information will be kept confidential.

Sex
If unemployed or retired, please list your former occupation.
What days of the week are you available for work?
Are you interested in participating as a patient instructor in the male genital/rectal examination program?
Are you interested in participating as a patient instructor in the female pelvic and breast examination program?
Signature
I hereby certify that all the above information is true and correct to the best of my knowledge and belief.
Please list as much information as you can, including names, addresses, email addresses and phone numbers.
Are you currently employed by SIU?
How are you employed by SIU?
Do you collect a SURS (State Universities Retirement System) pension?
Do you currently have an SIU parking permit or are you planning to purchase one?
Have you ever been convicted of a misdemeanor?
Have you ever been convicted of a felony?
A conviction record will not necessarily be a bar to employment. Factors such as age and recency of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account in terms of the position’s responsibilities.