Materials and methods

Design setting

The curriculum was implemented within a four-year EM residency program at a large urban academic medical center. Morning report is a required, in-person, faculty-led, 30-minute daily case-based conference attended by residents, rotating learners, and faculty, with concurrent clinical coverage. Required resources were minimal and relied on existing conference time, low-fidelity equipment, and faculty facilitation. Low-fidelity pediatric simulation scenarios were incorporated into approximately one pediatric-focused morning report session per month, depending on conference scheduling.

Curriculum development and case selection

Curriculum development was guided by Kern's Six-Step Approach, which includes problem identification, needs assessment, goals and objectives, educational strategies, implementation, and evaluation. Cases were developed and selected by pediatric emergency medicine (PEM) faculty, based on identified gaps in pediatric clinical exposure and educational priorities within the residency program [9]. To enhance feasibility and scalability, cases were adapted from established, publicly available resources (e.g., ACEP SimBox [10]), including facilitator guides and video-based scenarios with evolving clinical data, thereby minimizing development time and cost.

Topics emphasized high-risk, low-frequency pediatric conditions aligned with board-relevant content and clinical practice needs, including pediatric seizure, anaphylaxis, non-accidental trauma, newborn resuscitation, supraventricular tachycardia, sepsis, respiratory distress, blunt abdominal trauma, toxidrome, status asthmaticus, and infectious cases such as measles.

Simulation format, participants, and facilitation

Simulation sessions were conducted within the existing morning report conference space as 30-minute, case-based exercises. Each session utilized either a scripted scenario or a web-based video platform [10] to present a structured case with progressively evolving clinical information. Low-fidelity mannequins or basic task trainers were used in combination with readily available emergency department equipment, including a standardized pediatric equipment box, to enhance realism while maintaining a low-resource model.

Participants included medical students, resident physicians, attending physicians, and other healthcare professionals (including physician assistant students, nurse practitioner students, and ED pharmacists) rotating in the department. Average attendance per session was consistent with routine morning report participation (approximately 8-10 learners), although attendance was not formally recorded for each session. Scenarios were typically led by junior learners serving as the designated team leader, responsible for directing the clinical approach, assigning roles, and verbalizing decision-making throughout the case. Sessions were conducted in interprofessional teams, allowing junior learners to practice leadership, communication, and task delegation in a structured environment. Senior residents and faculty provided real-time support as needed, offering prompts or clarification to maintain case progression while preserving the junior learner’s leadership role. This structure was designed to simulate real clinical team dynamics while providing a psychologically safe environment for skill development and guided learning.

Each session concluded with a focused, faculty-led debrief that emphasized principles of clinical reasoning, communication, and teamwork. Facilitators were board-certified PEM physicians with experience in clinical teaching who reinforced key clinical and teamwork principles during debriefing.

Survey design

Participants completed anonymous, voluntary post-session surveys via a QR code immediately following each session. Survey items were developed by faculty for this curriculum and were not previously validated. The survey assessed participants' perceived improvement in pediatric knowledge, comfort in managing pediatric emergencies, teamwork and communication, and likelihood of recommending the instructional model to colleagues. This evaluation aligns with Kirkpatrick Level 1 (learner reaction) and Level 2 (self-reported learning) and does not include objective measures of performance or patient outcomes.

Responses were collected using a three-point Likert scale (Disagree-Neutral-Agree) for most items, while the recommendation question used a five-point Likert scale (Strongly Disagree-Strongly Agree). A sample post-session survey instrument is provided in Appendix A.

Data analysis

Descriptive statistics were used to summarize participant characteristics and survey responses. Categorical variables are reported as frequencies and percentages. For selected analyses, Likert responses were dichotomized into “agree” versus “neutral/disagree” to facilitate comparison of response distributions. For these dichotomized outcomes, binomial tests were used to evaluate whether the proportion of participants reporting agreement exceeded an expected proportion of 50%. All statistical tests were two-sided, and a p-value of <0.05 was considered statistically significant. Statistical analyses were performed using GraphPad QuickCalcs (GraphPad Software; Boston, MA, USA).