Denise Romano From Classroom To Clinic: Building Physical Therapy Skills With Simulation

What happens when a movement-first profession steps into a simulation lab built for physiology and decision-making under pressure? We sit down with Denise Romano, an assistant professor leading physical therapy simulation at Binghamton University, to unpack how PT learners can safely practice high-stakes mobility long before they enter acute care. From AFib in the ICU to COPD patients whose vitals shift during transfers, Denise maps out realistic scenarios that force students to balance safety, lines and tubes, and evolving clinical data while communicating clearly as a team.

We walk through a full landscape of PT-focused simulations: early infection control adapted from nursing with Glow Germ, mobility checkoffs in hospital-like spaces, ventilator cases requiring careful progression, and standardized patient interviews for differential diagnosis. Denise explains why PT relies heavily on SPs for authentic movement, where mannequins still shine for physiologic fidelity, and how thoughtful debriefs convert messy moments into durable clinical judgment. Her use of entrustability scales tied to EPAs gives faculty a shared framework to chart each learner’s path from novice to entry-ready clinician, with formative feedback that guides safer practice.

The conversation also tackles the big barrier: unlike nursing, PT lacks the large-scale evidence to replace a portion of clinical hours with simulation. Denise makes a compelling case for a multi-site study to unlock that recognition, particularly as acute care placements tighten and risk tolerance narrows. She also shares a favorite classroom memory that turned a tangled SCD mistake into a lifelong safety cue, highlighting why simulated missteps are often the most memorable teachers. If you care about physical therapy education, clinical placements, competency assessment, or the future of healthcare simulation, you’ll leave with concrete ideas and renewed urgency to give PT a stronger seat at the table.

Subscribe for more conversations on simulation, clinical education, and the skills that move patient care forward. Share your thoughts, leave a review, and tell us which PT competencies you think simulation should tackle next.

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Transcript

Welcome And Guest Introductions

Disclaimer/ intro 0:00

The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors. Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions. Join our host, Deb Tauber and co-host Jerrod Jeffries as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in and learn something new from The Sim Cafe.

Deb Tauber 0:54

Welcome to another episode of The Sim Cafe. And today we're here with Dave Biffar, who's going to be the co-host. So thank you, Dave, for uh agreeing to be here with me today. And we are going to interview Denise Romano. So welcome, Denise. And why don't you tell our listeners a little bit about yourself?

Denise Romano 1:13

Thank you, Deb, for having me. So I am an assistant professor in the division of physical therapy at Binghamton University in upstate New York. I have been really the one person designated in charge for our division to develop and implement simulation for our PT students.

Deb Tauber 1:33

Okay. Great. Dave, why don't you share with the audience how we met? Denise.

Dave Biffar 1:38

Sure, no problem. And I'm Dave Afar. I'm the director of operations at the Arizona Simulation Technology and Education Center. We call it Aztec. And I am, like Deb, one of the Ascend mentors. And they put a bunch of ping pong balls into a machine, and Deb's name and my name came up with Denise's name. And so I imagine that's how it all went down. I'm not exactly sure. There's, but we got assigned to Denise to be mentors. She's a rising star and provided a lot of information about herself and the goals, her goals over the next couple of years. We'll work with her on that, be a sounding board for the most part. But I think the most exciting part of all of this is that, in my opinion, she's part of an area of simulation that is underrepresented and in and needs more representation in the simulation community, and that's simulation for physical therapy.

Denise’s Path Into Simulation

Deb Tauber 2:36

Yes, I completely agree. Thank you. Thanks. And Denise, why don't you tell us how you got into simulation, how your journey from physical therapy and then into simulation?

Denise Romano 2:46

So I had decided to make the transition to academia in 2019. I went back to school to get my education doctorate and was able to, at Binghamton University as well, where I work, I was able to see their simulation center. And this was something I was not exposed to as a student. I graduated PT school in 1998, which feels forever ago now. We weren't utilizing simulation in PT education, definitely not at my school. And I really don't believe in any widespread way at the time. So I was very taken with this. I was amazed at what they were doing with the nursing students. And I could just envision this how this could be amazing for PT education. So I wanted to know more. I wanted to learn more about this. And I decided to be a graduate assistant and worked in the what we call the Innovative Simulation and Practice Center, our simulation center, the ISPC at Binghamton University for two years and learned so much. And uh in the end, decided to get my cheszy, or I know as you say, Dave Cheesy potato potato, I don't know how you pronounce that. No, but decided to become certified as a simulation healthcare educator and was eventually hired on by Binghamton to join their faculty in a new program. We actually are graduating our first cohort of students this May, but at the time I was brought on, we were we had a blank slate. I was able to really take a look across the curriculum and identify the needs relative to simulation and be able to work with our faculty to develop those activities. And it was really an exciting opportunity. And that's kind of what's brought me to where I am today.

Deb Tauber 4:50

So, Denise, you're a pioneer essentially in using simulation in physical therapy. How do you see your learners enjoying it and appreciating it?

Denise Romano 5:03

So far, they've been incredibly appreciative. We provide them with surveys after our simulation-based experiences, as well as our typical, so it's our student learning surveys that are sent out for instructors at the end of each course. And they've all definitely praised simulation experiences. They find them to be very valuable. So far, the feedback has been really good.

Deb Tauber 5:32

Thanks. Now, because this is new to me as well. Can you enlighten me to what some of the scenarios you do in physical therapy look like? How do you do them? What are the stories? You know, being in nursing, it's you know, oh yeah, chest pain, introduction to the patient, CHF.

Early Wins And Student Feedback

Inside PT Scenarios And Methods

Denise Romano 5:48

And it might not look that different. I know obviously with PT, I think the largest difference in talking with my nursing colleagues is that we're the movement people, right? So there's not a lot of mannequins as patients, though we do use two simulations that have mannequins, one of which we are running this week. It's a cardiac simulation where a patient is in the cardiopulmonary ICU environment and they go into AFib while the students are working through an evaluation with them. So we do use a mannequin as a patient for that. But the vast majority do involve SPs who are moving, and a lot of it has to do with mobility. So we also use simulation for both kind of experiential learning experiences in our courses and for assessments in courses, and then also outside of courses as competency-based assessments. So we do utilize it in a variety of ways. But for those kind of more experiential simulations in class, like I said, we have the cardiac simulation. We have also in the same course a pulmonary simulation with a patient that has COPD, that is with a standardized patient that has a physiologic change during mobility, and the PT students have to determine the best course of action with the patient and monitor throughout. We also have uh early on an infection control simulation that we adapted from our nursing program that they have used with the nursing students for many years, and we modified it so that it would be appropriate for our PT students using uh Glow germ. So that is the other mannequin as patient experience that we have because of using that. We do a mobility in the acute care environment where the students are having to navigate the hospital environment and to manage line and tubes. And then another kind of in the next semester, on a more difficult level, a critical care simulation where there's a patient in the ICU with multiple trauma injuries, and they are attached to a ventilator, and they have to do safe mobilization with that patient. We also use it for, like I said, assessment. We have an interview assessment with an SP for our differential diagnosis course, another mobility-based assessment in the acute care environment, and a whole series of ASCIIs that we use, like I said, outside of courses, where we're having the students work with an SP once in the fall and once in the spring semester. And instead of grades being used for assessment, we use entrustability scales. We assess entrustable professional activities. And it's more of a formative assessment so that we can show the students and faculty where each student is on their trajectory, starting from that novice level upward toward competent, capable, where they're will they be capable of being an entry-level clinician upon graduation.

Dave Biffar 9:13

I imagine folks would be really interested to see like an overview of all the things you do in SIM, like a like a simulation curriculum for PT overview, I think would be well received. I was going to save this question towards the end, but since you got to some of the details about what you do, which is great, a great explanation of the different things, the different objectives that you're trying to achieve with the students. But it made me think from a PT perspective, if you had a magic wand, is there a simulation technology that you like if you had your say, what could they make for you to really help teach PT? Like is there something that the technologies that exist right now aren't really doing a good job addressing a certain or a series of PT competencies?

Denise Romano 10:04

I think the hardest thing with PT, again, we're the movement people. And there are certain elements of movement that an SP, no matter how well trained, cannot do, or it cannot be done consistently, right? And so I guess if there was an animatronic something, you know, you could have a mannequin robot that was capable of reproducing limitations in range of motion, differences in tone, true weakness, gait deviations, right? That that would be, I guess, amazing that you could do that on a in a consistent way, especially for assessment.

Dave Biffar 10:46

That's I feel like we're not that far off. They just they need to have you at the table explain exactly the type of functions that are needed from that robot. But I feel like we're knocking on that door right now.

Denise Romano 11:00

Yeah, that's my and far is the largest difference when I talk with colleagues that are working with both our pre-licensure and advanced practice nurses, nursing students, and even the medical students that are using our space. That's the largest difference, is that movement component. And I guess we're still trying to figure out the best way, the best strategy to address that.

Deb Tauber 11:26

Denise, do you have a favorite moment, a favorite simulation that you could like to share with our group?

Tech Gaps For Movement Simulation

Denise Romano 11:32

I think my favorite was my first. It was our our first cohort of students, my first simulation that I had developed, my my baby. The students were so excited about it, and it just was there was wonderful energy. It was the mobility in the acute care environment simulation. And I still remember, and the students still the ones that were participating still joke about the line and tube management. They had left on sequential compression devices on the patient and tried to just take the entire unit off the bed to get them up and out. And they said they'll never, never forget it. Really good sports, but I think that will always be my fondest memory, was my first.

Deb Tauber 12:25

Yeah. Now, for our listeners, if you are a program and you have a physical therapy program, maybe have them take a listen to this episode and maybe connect with Denise, because once again, we can always, you know, share our knowledge with uh with each other. Or if you have a program that deals with physical therapy and you want to reach out and connect, how can our listeners reach you?

Denise Romano 12:51

Email is typically the best, and that is D Romano D-R-O-M-A-N-O at Binghamton, B-I-N-G-H-A-M-T-O-N dot Edu.

Deb Tauber 13:05

Perfect. Thanks. What about any social media at LinkedIn or I am on LinkedIn.

Denise Romano 13:10

I'm fairly new to that, so I'm still learning. Uh I admit I am not a great social media person, so I don't have much of a presence there. Admittedly. But I have just started learning to use LinkedIn, but I'm a newbie.

Deb Tauber 13:29

Now we're gonna switch switch courses here a little bit and talk about the Ascend program. So how did you apply for it? How did you find out about it? Why don't you share your journey into the Ascend program? Because we are definitely honored to have you as our mentee.

A Favorite ICU Mobility Moment

Denise Romano 13:46

I believe it was via email or something that I had seen online that brought my attention to it. And I had discussed it with my director and assistant director of our simulation center and asked their opinion. And they were very supportive. They said, yeah, absolutely, you know, go for it. I think that would be an amazing opportunity. And so I was very excited to be accepted. And so far, I know I'm still new in the in the program, as we really just officially kicked off last month, but it really seems like it's going to be a wonderful opportunity for professional and even personal growth. Today was a big step for me. This was a big undertaking. I would never have thought I would do a podcast. So thank you for pulling me out of my shell and out of my box. And we appreciate you. But I definitely look forward to what's to come with the educational components. I definitely appreciate both of you, your time and your experience, and the feedback that you'll be able to give me is very valuable. There are others in PT education who are doing simulation. There was a group that was convened, uh I think back in 2018, to kind of look at the state of simulation in PT education, and uh they put out a report as to what they found, and they came together to come up with some solutions to issues that they had identified. But that group disbanded about the time that I came into academia. So, in terms of PT sim educators, there wasn't so much an opportunity to really connect in a formal way with them anymore. I know they have a discussion group virtually, it's just it's not quite the same as something like this is a wonderful formal way to connect with with you, with as my mentors, with peers in the program who share similar goals and challenges. And so this is really valuable to have a more formal opportunity to connect and learn. So I appreciate that a lot.

Dave Biffar 16:10

Yeah, I sort of begged, we talked about it, it begs the question of an affinity group or a committee of some kind that deals with not just PT, but some of the others, maybe occupational therapy as well. Would do you have ones, and you might have just described this sort of do you have one specific thing that you think is the biggest impediment or hurdle for growth with simulation and PT?

How To Connect With Denise

Denise Romano 16:32

I feel like what I see in in nursing, that's I guess the discipline that I work closest with in simulation, and and arguably is probably one of the most present, right, in the simulation greater community. The acceptance of simulation as a replacement for part of clinical education time formally, I think has been huge. It's really helped to us to in a in a formal way establish the significance, the importance, the necessity of simulation-based learning. We don't have that. In that report that our profession put out, you know, they had mentioned there is not the evidence at this time to say that we could replace any clinical hours with simulation. But as any health profession faces uh challenges with clinical education placements, quality, you know, we do as well, especially in the acute care environment. We struggle across the board. And I think if we could come together and do the research, large-scale study like nursing did, to see if maybe there is the research that we could use simulation as a replacement for a portion of clinical education time, A, it would solve some of the issues that we're having with clinical education placements. And B, I think it would really just formally give that importance to simulation use in PT education.

Deb Tauber 18:05

Yeah. So you're referring to the NCSBN study. Correct. The one that demonstrated the clinical hours being utilized for clinical uh simulation hours being utilized for clinical, and that did have a really big impact on nursing. One of the things that's interesting, and I think we talked about this, we touched on it. In the in the United States, every state has a certain number of hours that can be used to count for clinical. Whereas in physical therapy, you guys have a bigger umbrella, so it's every physical therapist needs X amount of hours. Am I understanding that correctly?

Denise Romano 18:43

Yes, we are required by our accreditation body. And I should know this because we've just been through the accreditation process very recently, but the number right now is eluding me. But we are all to be accredited. Each program needs to offer a certain number of clinical education hours.

Deb Tauber 19:02

And they all have to be done in clinical, they can't be done in simulation.

Denise Romano 19:07

In clinical, correct. Okay.

The Ascend Mentorship Experience

Deb Tauber 19:10

Yep. Yeah, that is interesting.

Dave Biffar 19:12

Which begs the question is can how much can you help from a formative standpoint in simulation to prepare students to be better prepared for their clinical rotation? So, and which we which we see all over across the board in terms of if assessment is becoming more and more a thing at one institution from the next, and to what extent are we allowing students to practice before they get tested?

Deb Tauber 19:36

And how much would you say, if you were to guess, would be a good amount?

Denise Romano 19:42

Gosh, there were some studies, smaller scale studies that had taken a look at this, and I believe there were two or three of them, and I think their suggestions were approximately 25%, I think a quarter. And so to wager a guess without looking at it in a formal way.

Deb Tauber 20:02

And I think the part of nursing that made that such a so important was a lot of the clinical placements were refusing to let learners practice or do anything with their patients. And legitimately, legitimately so from a legal perspective, there was just way too much risk to have a student working with a patient. So I think for that reason, it could be a little bit more difficult to say, I could see with high-risk clients like your you know, patients in the ICU to start having new student work on them. But you know, right.

Denise Romano 20:45

We we definitely are seeing just in general, in the acute care environment, that they are less likely to take students. I know that would be a hope, maybe a dream as well, that somehow we could maybe demonstrate to potential clinical instructors, sites out there, the benefit of simulation. And maybe somehow that would convince them. I don't know. But we definitely that is the setting where we have difficulty placing students, those higher acuity settings, absolutely. But are needed because we do see that a lot of students, if they're not getting that experience coming out of school when they graduate, they're less likely to go into that setting.

Deb Tauber 21:34

And schooling is long, like how long does it take you to become?

Denise Romano 21:38

So for PT, our students come in with a four year degree, a bachelor's degree, and then our program is three years long to get their doctorate beyond that.

Deb Tauber 21:49

Yeah, that's a long journey.

Denise Romano 21:51

It is a long, expensive journey.

Deb Tauber 21:53

Right, a true commitment.

Denise Romano 21:56

Yeah, absolutely.

Deb Tauber 21:58

Any closing thoughts either?

The Big Barrier: Replacing Clinical Hours

Dave Biffar 22:00

I had one and then I can let you go, Denise, since you're the star of the show. So I want to just bounce back to Ascend really quickly. Um it actually was again, you know, we don't quite know how folks are matched. And if if there is a rubric, I I missed it somehow, but not that that's important. But the point I'm trying to make is when I started out in SIM back in 2008, the only way to survive was to see if you could get to some of the conferences that were out there, IMSH being one of them, and networking as much as possible. And so that's what I see this, see this as. You know, I know there's a mentor-mentee relationship, but a little bit of a blessing in disguise. We just started our new PT program this year at the University of Arizona. So I think it's more bi-directional than we think because sim champions or whatever you want to call it, we're all dealing with our own unique institutions in our own unique specialties. And there's always something to learn from someone, no matter what, where they are in their professional development continuum, right? So for me, Denise is a valuable mentor for me. You could see it as a value, her being a valuable mentor to me when it comes to PT and simulation. And so I think an important point is to sort of keep an open mind and look for the opportunity to have like a bi, it's more of a bi-directional networking opportunity as much as it is a mentor-mentee relationship.

Deb Tauber 23:25

Yeah, thank you. Because I think even some of the other programs like uh radiography and respiratory and other different areas of practice are probably in the same situation that you are, not having as widely accepted as you know, nursing has been embracing it.

Denise Romano 23:44

I'm sure. Absolutely. And that's another reason uh that I was drawn to the Ascend program. And I hope to learn about opportunities where uh I can participate with the greater simulation community to help to give PT that seat at the table where simulation decisions are being made on a greater scale. Uh that was part of the draw here was to learn more about where you can go, where you can lead. So I'm excited to learn. Thank you.

Dave Biffar 24:18

Thanks, Denise.

Denise Romano 24:19

Thank you very much for all of your time for having me chat with you today. Thank you.

Deb Tauber 24:25

It has been our pleasure. And with that, happy simulating.

Disclaimer/ intro 24:38

Thanks for joining us here at The Sim Cafe. We hope you enjoyed. Visit us at www.innovative simsolutions.com. And be sure to hit that like and subscribe button so you never miss an episode. Innovative Sim Solutions is your one stop shop for your simulation needs. A turnkey solution.