Results

A total of 27 sessions were conducted between September 2021 and May 2025. Sessions were scheduled based on curricular availability. Of 194 participants who attended the simulation-enhanced morning report sessions during the study period, 138 (71.1%) completed the surveys.

Among respondents, EM residents comprised 103 (75%), medical students 15 (11%), attending physicians 12 (9%), and other healthcare professionals 8 (5%), including physician assistant students, nurse practitioner students, and emergency department pharmacists. No identifiable demographic data were collected. The project met institutional criteria for exempt educational research because it involved anonymous evaluation of an educational intervention and did not collect identifiable participant information.

Perceived educational impact

Participants demonstrated consistently positive responses. Using a three-point Likert scale (disagree-neutral-agree), 126 (91%) participants selected “agree” for improved knowledge of pediatric acute care, 121 (88%) reported greater comfort in managing pediatric emergencies, and 125 (91%) reported enhanced teamwork and communication following these sessions. The proportion of participants reporting agreement for each outcome significantly exceeded the expected proportion of 50% (all p < 0.001, binomial test).

Detailed item-level responses are presented in Figure 1. Agreement was consistently high across all domains. The highest levels of agreement were observed for opportunity to practice decision-making (129, 94%), confidence in prioritizing care (127, 92%), and preparedness for patient changes (127, 92%). High levels of agreement were also reported for understanding of pathophysiology (125, 91%) and confidence in providing safety-focused interventions (123, 89%). Agreement exceeded a neutral (50%) distribution for all Figure 1 items (all p < 0.001, binomial test).

Figure 1: Learner Agreement With Educational ImpactLearner perceptions of the educational impact of the simulation-enhanced morning report sessions. Bars show the distribution of responses, expressed as percentages, across the Agree, Neutral, and Disagree categories for each statement. Data labels are presented as n (%). Total respondents = 138. Agreement exceeded 50% for all items (all p < 0.001, binomial test).The figure was created by the authors using Microsoft Excel (no artificial intelligence (AI) tool or AI-assisted image-generation software was used to create it).

Domains related to communication and teamwork also demonstrated strong agreement, including confidence in communicating with patients and caregivers (116, 84%) and reporting information to team members (118, 85%). Lower, though still substantial, agreement was observed for understanding of medications (113, 81%).

Feasibility and acceptability

Acceptability of the intervention was high. A total of 126 respondents (91%) agreed that pediatric simulation should be incorporated into morning report on an ongoing basis. When asked whether they would recommend the sessions to a colleague using a five-point Likert scale (Strongly Disagree-Strongly Agree), 110 (80%) reported “strongly agree” and 15 (11%) reported “agree.”

Qualitative feedback

Narrative feedback during debriefings emphasized the value of practicing high-stakes pediatric scenarios in a low-pressure environment and highlighted simulation's role in reinforcing recent didactic content. Participants frequently described the sessions as highly valuable for improving clinical reasoning, structured approaches to patient care, and interprofessional communication.

Qualitative feedback from survey responses reflected strong enthusiasm for the simulation-enhanced morning report sessions, including several comments such as “excellent” and “extremely helpful." Learners valued junior-led scenarios with senior support and the realism of using actual pediatric ED equipment. They reported improved insight into clinical reasoning, structured approaches, and team communication.

Participants suggested enhancements, such as incorporating post-session summaries and expanding procedural practice opportunities. Overall, the sessions were perceived as highly valuable and effective for improving pediatric emergency preparedness. Detailed qualitative feedback themes are summarized in Appendix B.