Curtin Medical School: simulated patient expression of interest

If you are interested in being a simulated patient, please fill in and submit the form below.

Important information

  • A completed expression of interest form will assist the Curtin Medical School to determine your suitability to participate in specific simulated patient sessions. Questions marked with an asterisk (*) are compulsory.
  • You will be asked to sign a Simulated Patient Consent Form on the morning of your session. Each scenario or assessment will be video and audio taped and will form part of the student’s assessment portfolio. Additionally, these recordings may be stored in ‘cloud’ locations in Australia or overseas.
  • Simulated patient scenarios can comprise a history taking scenario and/or a physical examination. During a history taking scenario no physical examination is required. However, during physical examination scenarios students will be required to examine the simulated patient (e.g. shoulder, knee). Note: physical examinations will NEVER involve intimate areas or invasive procedures.

Personal information collected via this form will be stored in a database accessible only to Curtin Medical School staff involved in organisation and management of simulated patient sessions.

Your details







PhoneEmail


History takingPhysical examinationBoth








Medical / disability needs


GoodFairPoor


YesNo


YesNoNot sure


Experience, availability and conflict of interest


YesNo
Previous acting experience or experience acting as a simulated patient is not required. However, if you have any experience this can assist with our planning and scheduling for specific sessions.



YesNo



YesNo


Other information


Curtin University is well serviced by public transport. However, if you require parking to attend a simulated patient session, please provide your vehicle registration number so parking fees can be pre-paid by Curtin Medical School. Please note, car parking availability can be limited and may be located some distance from the Curtin Medical School building, so plan your trip accordingly. If required, ACROD bays are located in close proximity to the Curtin Medical School building.



Personal information collected is handled in accordance with the Australian Privacy Principles. Further information is available on Curtin University’s privacy webpage.

Contact Curtin Medical School

If you have any questions, please contact our Teaching Support Officer Mark Kerr at CMSTeachingSupport@curtin.edu.au or +61 8 9266 2332.