title: Simulation in Pediatric Emergency Medicine Fellowships.
abstract: OBJECTIVE
  Graduate medical education faces challenges as programs transition to the next accreditation system. Evidence supports the effectiveness of simulation for training and assessment. This study aims to describe the current use of simulation and barriers to its implementation in pediatric emergency medicine (PEM) fellowship programs.
  
  
  METHODS
  A survey was developed by consensus methods and distributed to PEM program directors via an anonymous online survey.
  
  
  RESULTS
  Sixty-nine (95%) fellowship programs responded. Simulation-based training is provided by 97% of PEM fellowship programs; the remainder plan to within 2 years. Thirty-seven percent incorporate >20 simulation hours per year. Barriers include the following: lack of faculty time (49%) and faculty simulation experience (39%); limited support for learner attendance (35%); and lack of established curricula (32%). Of those with written simulation curricula, most focus on resuscitation (71%), procedures (63%), and teamwork/communication (38%). Thirty-seven percent use simulation to evaluate procedural competency and resuscitation management. PEM fellows use simulation to teach (77%) and have conducted simulation-based research (33%). Thirty percent participate in a fellows' "boot camp"; however, finances (27%) and availability (15%) limit attendance. Programs receive simulation funding from hospitals (47%), academic institutions (22%), and PEM revenue (17%), with 22% reporting no direct simulation funding.
  
  
  CONCLUSIONS
  PEM fellowships have rapidly integrated simulation into their curricula over the past 5 years. Current limitations primarily involve faculty and funding, with equipment and dedicated space less significant than previously reported. Shared curricula and assessment tools, increased faculty and financial support, and regionalization could ameliorate barriers to incorporating simulation into PEM fellowships.
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas; cbdought@texaschildrens.org.
authors.forename: Cara B
authors.initials: CB
authors.lastname: Doughty
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York;
authors.forename: David O
authors.initials: DO
authors.lastname: Kessler
authors.affiliation: Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Noel S
authors.initials: NS
authors.lastname: Zuckerbraun
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, School of Medicine, University of Washington, and Seattle Children's Hospital, Seattle, Washington;
authors.forename: Kimberly P
authors.initials: KP
authors.lastname: Stone
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, School of Medicine, University of Washington, and Seattle Children's Hospital, Seattle, Washington;
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Reid
authors.affiliation: Department of Pediatrics, School of Medicine, University of Missouri, Kansas City, Missouri;
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kennedy
authors.affiliation: Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; and.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Nypaver
authors.affiliation: Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Auerbach
mesh_terms: D002648:Child; D003198:Computer Simulation; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010372:Pediatrics / Q000193:education*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires