title: Development and assessment of a pediatric emergency medicine simulation and skills rotation: meeting the demands of a large pediatric clerkship.
abstract: OBJECTIVE
  To implement a curriculum using simulation and skills training to augment a Pediatric Emergency Medicine (PEM) rotation within a pediatric clerkship.
  
  
  BACKGROUND
  PEM faculty are often challenged with a high learner to teacher ratio in a chaotic clinical setting. This challenge was heightened when our pediatric clerkship's traditional 1-week PEM rotation (consisting of 4 students completing four 8-hour ED shifts/week) expanded to 8 students every 2 weeks. We sought to meet this challenge by integrating simulation-based education into the rotation.
  
  
  METHODS
  Clerkship students from March to June 2012 completed our traditional rotation. Students between July and October 2012 completed the new PEM-SIM curriculum with 19 hours ED shifts/week and 16 hours/week of simulation/skills training. Pre/post-tests evaluated 1) medical management/procedural comfort (five-point Likert scale); and 2) PEM knowledge (15 multiple-choice questions).
  
  
  RESULTS
  One hundred and nine students completed the study (48 traditional, 61 PEM-SIM). Improvement in comfort was significantly higher for the PEM-SIM group than the traditional group for 6 of 8 (75%) medical management items (p<0.05) and 3 of 7 (43%) procedures, including fracture splinting, lumbar puncture, and abscess incision/drainage (p<0.05). PEM-SIM students had significantly more improvement in mean knowledge compared to the traditional group (p<0.001).
  
  
  CONCLUSIONS
  We have successfully integrated 16 hours/week of faculty-facilitated simulation-based education into a PEM rotation within our clerkship. This curriculum is beneficial in clinical settings with high learner to teacher ratios and when patient care experiences alone are insufficient for all students to meet rotation objectives.
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA; ekfielde@texaschildrens.org.
authors.forename: Elaine K
authors.initials: EK
authors.lastname: Fielder
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Lemke
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Cara B
authors.initials: CB
authors.lastname: Doughty
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Deborah C
authors.initials: DC
authors.lastname: Hsu
authors.affiliation: Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Middleman
mesh_terms: D002982:Clinical Clerkship / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D002983:Clinical Competence; D003479:Curriculum; D004635:Emergency Medicine / Q000193:education*; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D010372:Pediatrics / Q000193:education*; D015397:Program Evaluation
keywords: overcrowding; pediatric clerkship; procedural training; simulation