• Cara B Doughty, David O Kessler, Noel S Zuckerbraun, Kimberly P Stone, Jennifer R Reid, Christopher S Kennedy, Michele M Nypaver, and Marc A Auerbach.
• Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas; cbdought@texaschildrens.org.
• Pediatrics. 2015 Jul 1;136(1):e152-8.

Background And ObjectivesGraduate 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.MethodsA survey was developed by consensus methods and distributed to PEM program directors via an anonymous online survey.ResultsSixty-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.ConclusionsPEM 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.Copyright © 2015 by the American Academy of Pediatrics.

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