Cate Nicholas: A Legacy of Innovation and Impact in Medical Simulation Education

June 28, 2024 by Angela Ferrante

collage headshot of woman beside Clinical Simulations lab entryway
Cate Nicholas (left) and the entryway to the Clinical simulation Lab

Early Beginnings and Unexpected Paths

Growing up on Long Island, Cate Nicholas could not have imagined the legacy she would build at the Larner College of Medicine at the University of Vermont (UVM). “When I was in my twenties, the thought ‘Oh, I’ll be a simulation educator’ never crossed my mind. This method of teaching—and learning—didn’t even exist at that point.” More than 37 years later, Nicholas has seen thousands of future and current health care professionals pass through the doors of the Clinical Simulation Laboratory, a program she both founded and directed during her tenure at Larner.

From Lab to Leadership: A Journey in Reproductive Health Care

Nicholas’s journey to UVM began in New England at the University of Bridgeport, Connecticut, where she earned a bachelor’s degree in medical laboratory science. She then pursued a master’s degree in medical technology at UVM. One day after class, she noticed a flyer for a small women’s clinic seeking someone to run their lab. “It was a bastion for reproductive care and family planning,” said Nicholas. “They were looking for someone to run their lab, so I applied.” Realizing she needed to move beyond the lab to provide the necessary level of care, Nicholas advanced from a health care assistant to a physician assistant (PA), learning about abortion care, contraceptives, and performing colposcopies.

“In the beginning, [becoming a PA] was really an apprenticeship training program, meaning that you worked alongside an experienced clinician … you keep growing, under supervision, until that person decides that you’re able to be entrusted to attend to patient needs and care on your own,” stated Nicholas.

Developing Standardized Training Programs

From the ʼ70s through the ʼ90s, Vermont and Montana were the only states where PAs were allowed to provide abortions. When Vermont requested a formal and standardized curriculum for the apprenticeship training program, Nicholas wrote it—with the guidance of her mentor, Diane Magrane, M.D., then clerkship director for OB/GYN. Magrane and Nicholas’s professional compatibility led to an opportunity to enhance performance-based teaching and assessment at the Larner College of Medicine at UVM. Magrane asked Nicholas, “How would you like to start our Standardized Patient (SP) program?” Nicholas’s response was a characteristic, “Sure!”

Pioneering Simulation Education

Nicholas began by visiting SP programs in Virginia, New York, and Philadelphia to learn from their experiences. “Cate, in every sense, is a true lifelong learner,” remarked Senior Associate Dean for Medical Education Christa Zehle, M.D.’90. Nicholas and Magrane designed the Given Assessment Center and recruited family members as SPs until they established a professional cadre from the local community. The collaborative effort of the UVM Larner College of Medicine, the UVM College of Nursing and Health Sciences, and the UVM Medical Center led to something groundbreaking: the Clinical Simulation Laboratory (CSL).

Early Successes and Impact

The CSL’s first training involved a simulated case on central line insertion, a crucial procedure for delivering long-term treatment. Nicholas and her team saw the need to standardize central line kits and protocols, resulting in a significant reduction in complications. A robust paper co-authored by Nicholas, “A multitiered strategy of simulation training, kit consolidation, and electronic documentation is associated with a reduction in central line-associated bloodstream infections,” published in the American Journal of Infection Control, highlighted the real-world impact of simulation education.

Over the years, there were many other victories and success stories coming out of Nicholas’s work at the CSL. “We did a simulation session with some emergency departments in rural areas—specifically around central line insertion and recognizing early sepsis,” recalled Nicholas. “Two weeks after that session, at four a.m., I received an email from one of the individuals on the emergency medicine team we trained. They told me that thanks to the recent training, they were able to successfully recognize early sepsis in a patient, stabilize them, and get them to UVMMC for more robust care.”

Leadership and International Recognition

Under Nicholas’s leadership, the Clinical Simulation Laboratory achieved full accreditation from the American College of Surgeons (ACS) and the Society for Simulation in Healthcare (SSH). At the time, Larner’s CSL was one of only nine simulation centers worldwide to receive this level of recognition. In 2021, SSH inducted Nicholas into the SSH Fellows Academy, recognizing her role in establishing a world-class facility and program.

Her innovations were also acknowledged by the Association of Standardized Patient Educators, which named her Standardized Patient Educator of the Year in 2011. In 2015, she was inducted into the Larner College of Medicine Teaching Academy as a Distinguished Educator. Demonstrating her expertise, Nicholas co-edited the influential work Comprehensive Healthcare Simulation: Implementing Best Practices in SP Methodology in 2020. In 2024, Nicholas was honored by the Northeast Group on Education Affairs (NEGEA) as a recipient of their Distinguished Educator Award.

Additionally, Nicholas serves as the associate editor for SP methodology for MedEdPORTAL, an open-access journal of teaching and learning resources published by the Association of American Medical Colleges (AAMC). She is also an editorial board member for The International Journal of Healthcare Simulation. In 2022, she was named MedEdPORTAL Associate Editor of the Year by the AAMC.

“Cate brings tremendous expertise on standardized patient scholarship to her work as an associate editor for MedEdPORTAL,” said Grace Huang, M.D., who held the title of editor in chief of MedEdPORTAL for almost a decade. “The work is detailed, rigorous, evidence based, and it strikes the right balance between upholding standards while providing constructive and thoughtful feedback to authors. Anyone receiving her peer review gets the privilege of learning from a true expert.”

Nicholas’s achievements extended beyond borders when she chaired the HEAL (Health, Education, Advocacy, Linkage) Simulation Based Education Subcommittee, an international organization promoting simulation-based learning for identifying, treating, and referring victims of human trafficking.

A Legacy of Student and Patient Impact

Despite her many accolades, Nicholas’s ultimate goal has always been to help others. The words of students like Cliff Reilly, Class of 2024, are as meaningful to her as any award. “I really appreciate the way we were trained over the past four years,” Reilly wrote to her. “I can really see the difference that it makes for us and for the patients. I feel ready to go out into my residency.” Reilly will carry all that Nicholas has taught him as he begins his emergency medicine residency at Emory Healthcare in Atlanta, Georgia, this summer. Many former students have echoed similar sentiments about how the CSL has enhanced their clinical and bedside skills, feedback that Nicholas never tires of hearing. At her core, Nicholas has always valued helping others. “At the end of the day,” she stated, “everything we do is for the patient.”