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  • Simulation provides a safe, risk-free, experiential learning environment where emergency department (ED) practitioners can develop their skills with no potential for adverse consequences to real patients.

  • The acquisition and retention of skills requires hands-on practice complemented by feedback and robust assessments. This has been described in the learn, see, practice, prove, do, maintain framework. However, external forces and intolerance for medical errors, have significantly reduced the number of opportunities to practice procedures in the ED. Simulation can be used to provide these experiences “on-demand” and guide decisions about when a provider can be entrusted to safely perform a procedure on a patient.

  • Effective simulation-based training interventions have a range of difficulty customized to the individual practitioner’s skill level.

  • Postgraduate medical education systems are combining competency-based educational frameworks involving focused and rigorous evaluations to entrustable professional activity (EPA) frameworks that involve global assessments of performance.

  • The extended duration between performance of many pediatric emergency medicine (PEM) skills leads to deterioration in even the most expert providers. Just-in-time (JIT) training is a training scheme in which the required knowledge and skills are imparted for immediate application to avoid loss of retention due to a time gap.


Simulation-based education (SBE) has continued to evolve, with an increasing breadth of applications in the field of pediatric emergency medicine (PEM).1–7 Educators have recognized that simulation can provide a safe, risk-free experiential learning environment where emergency department (ED) practitioners can develop and maintain their skills with no potential for adverse consequences to real patients. PEM is an ideal field for applications of simulation, as outcomes from pediatric cardiac arrest are poor, and traditional methods of resuscitation skills training lead to poor retention of knowledge and skills.8 This chapter describes how SBE is being: (a) integrated into PEM training programs; (b) utilized for crisis resource management (CRM) training for ED healthcare teams; (c) used to teach novel PEM topics; (d) explored as a potential tool for assessment of ED skills; and (e) used to enhance procedural skills competency for ED procedures.


Simulation has become an integral part of many PEM residency and fellowship training programs.9 PEM fellowships have rapidly integrated simulation and are increasingly sharing curricula and assessment tools. SBE has been effectively integrated into pre-existing curriculum to better address PEM competencies and to provide trainees an opportunity to practice managing both common and rare conditions. Studies have shown that SBE improves the performance of emergency teams during simulated pediatric medical and trauma resuscitations.10–15 The majority of PEM training programs have integrated simulation as a key learning modality. Focused, frequent, and effortful instructional interventions are necessary to achieve substantial performance improvements.5 A longitudinal approach to the integration of simulation into the PEM curriculum was described by Cheng et al.,4 where 43 different acute care scenarios, packaged as 12 different ...

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