SCARLET Provides an Interprofessional Approach to Simulation Education

Rutgers students in medical fields gain critical experience by making mistakes - and learning from them - in a controlled, safe environment

When it comes to cutting-edge simulation in health care, Rutgers Health is seeing SCARLET.

Short for Simulation Collaboratory Advancing Research, Learning, Education and Technology and developed in partnership between the Ernest Mario School of Pharmacy, Robert Wood Johnson Medical School, the School of Nursing and the School of Health Professions, SCARLET provides simulation-based innovations across Rutgers Health schools and clinical affiliates.

Amanda Sallemi practices a direct laryngoscopy for endotracheal intubation (or, in other words, placing a breathing tube) on an airway task trainer manikin.

Les Barta, the director of simulation technology at the school of pharmacy and the acting executive director of SCARLET, described the initiative as a "virtual hub," connecting with multiple simulation labs in the New Brunswick and Newark campuses of Rutgers serving as spokes. Originated from the collaborations that started during the pandemic, SCARLET aims to empower students, medical residents, fellows and faculty members to practice both critical technical and nontechnical skills in curated clinical scenarios in simulated exam rooms, trauma bays, or a patient's hospital room.

"SCARLET is envisioned as this catalyst to bring together all the different professions at creating highly immersive health care simulation," said Barta, adding the immersive training allows students to make mistakes - and learn from them - in a safe and controlled setting.

"The easiest way to describe it is living experiences that are as close to real life as possible, while being in a safe environment for learners to have a productive struggle," Barta said. "If a mistake or error is made, it doesn't reach a patient. This allows them to be as ready as they can be before they actually get to real patients."

Trainees work with medical manikins - advanced, electronic patient simulators - as well as medical actors called standardized patients, some of whom are trained for simulation education in partnership with the Mason Gross School of the Arts. In addition, Barta said students learn together in simulated scenarios such as a trauma resuscitation, forming interprofessional teams, including pharmacy, medicine, nursing and related health professions side-by-side, just as they would in real-world settings.

An advantage of simulation education is psychological safety, "allowing our students to experience conditions and situations that they may never get to experience until they're in front of a real-life patient so that they understand how they react to those things," Barta said. "It also allows them to engage with the expert way of thinking. They can follow a faculty member and understand the decisions."

Alex Bell prepares a syringe in a simulation lab within the Ernest Mario School of Pharmacy.

After a training session, students and educators go through a debriefing, which Barta said "is usually a very intimate time" when "they take apart the decisions, the communications, the process of thinking, the clinical reasoning that students went through, and they get to explicate the expert way of thinking."

"By giving you real-life experience and giving you a place to mess up, I think that that's one of the biggest advantages" of simulation education, said Rutgers student Alex Bell, who graduated in May after completing a six-year doctor of pharmacy program at Ernest Mario, which she entered directly from high school.

The 23-year-old from Marlboro, N.J., said, "I've taken a lot of clinical-heavy rotations, and having a full year of simulation experience helped me know what to expect when I walked into the room of a patient in the hospital."

Amanda Sallemi, a 22-year-old Rutgers student who is pursuing a master of science degree in physician assistant studies from the School of Health Professions, said simulation education "is embedded" into her coursework and that the training has helped her "a ton."

"I think the jump from being a student to then entering the real world as a provider is a huge learning curve," said Sallemi, who earned a bachelor of arts degree in biological sciences from Rutgers School of Arts and Sciences. "The beauty of simulation is that it puts you into that provider mindset while still being in a very friendly learning environment. Being in a simulation allows you to establish that confidence and workflow that you would have as a provider in the real world which is something that is difficult to learn in a classroom setting."

Sallemi, of Emerson, N.J., said simulation training "allows you to bring in pharmacy, nursing students, the medical doctors as well as the physician assistants, and ensures that all of the strengths that these different scopes have the attention they deserve."

I think it's beneficial to everyone because it doesn't matter what level playing field you're in. Everyone is equalized in simulation because we all have things to learn constantly.

Ashley Asensio

Emergency medicine physician and a simulation fellow

Simulation training is "a great educational tool," said Ashley Asensio, an emergency medicine physician and a simulation fellow in the Rutgers Health Simulation Fellowship program, which is designed to cultivate the next generation of leaders in emergency medicine through simulation training.

The 33-year-old, who completed her emergency medicine residency at Rutgers Robert Wood Johnson Medical School in 2025 and then continued on as one of three physicians in the inaugural class of simulation fellowship at Rutgers and RWJBarnabas Health, runs simulations in clinical scenarios as well as outlines the goals and objectives of specific training.

"I think it's beneficial to everyone because it doesn't matter what level playing field you're in," Asensio said. "Everyone is equalized in simulation because we all have things to learn constantly. I love simulation because it allows you a space to grow as a person without having the ramifications of making mistakes on real people."

Asensio added, "It's all just learning. Truly, it just boils back to we want to be better for all our patients."

Marisa Merrigan Robertazzi, a simulation operations specialist and standardized patient educator for the Rutgers School of Nursing in Newark, recruits and trains actors who portray patients.

The easiest way to describe it is living experiences that are as close to real life as possible, while being in a safe environment for learners to have a productive struggle.

Les Barta

Acting executive director of SCARLET

The goal involves building a team of standardized patients who represent "a lot of the demographics that the students would interact with in a true clinical setting," said Merrigan Robertazzi, who has been doing standardized patient work and education for about 35 years and earned a bachelor of fine arts degree in painting and a minor in theater from Montclair State University.

She added, "now we have really broad age ranges," including 18-year-olds who can play older to younger teenagers as well as standardized patients "who are well into their late 70s and early 80s."

Merrigan Robertazzi said "the standardized patient is really part of the team to help the students improve their skills. Their value is immeasurable."

She added simulation education is "finally taking root" as one of the best ways for "the experiential skills building of individual students. Simulation provides a safe, low-risk environment for students to develop their skills, identify gaps while encouraging continued process improvement."