An Asynchronous Curriculum: Learner Perspectives on Incorporating Asynchronous Learning Into In-Person and Virtual Emergency Residency Didactics.

Background  Didactic education in emergency medicine (EM) residencies has been impacted both by the advent of asynchronous learning and by the shift toward virtual, web-based conference education due to coronavirus disease 2019 (COVID-19). Studies have demonstrated the efficacy of asynchronous education, but few have explored resident opinions about how asynchronous and virtual modifications on conference impact their educational experience.  Objective This study aimed to evaluate resident perceptions of both asynchronous and virtual modifications to a historically in-person didactic curriculum. Methods This was a cross-sectional study of residents of a three-year EM program at a large academic center where a 20% asynchronous curriculum was implemented in January 2020. A questionnaire was administered online with questions assessing how residents perceived their didactic curriculum with regard to convenience, retention of information, work/life balance, enjoyability, and overall preference. Questions compared resident opinions of in-person vs. virtual learning, as well as how the substitution of one hour of asynchronous learning impacted residents' perception of their didactics. Responses were reported on a five-point Likert-type scale.  Results A total of 32 out of 48 residents (67%) completed the questionnaire. When virtual conference was compared to in-person conference, residents favored virtual conference with regard to convenience (78.1%), work-life balance (78.1%), and overall preference (68.8%). They favored in-person conference (40.6%) or felt that the modalities were equivalent (40.6%) with regard to retention of information and favored in-person conference with regard to enjoyability (53.1%). Residents felt that the addition of asynchronous learning to their curriculum increased subjective convenience, work-life balance, enjoyability, retention of information, and overall preference, regardless of whether synchronous conference was virtual or in-person. All 32 responding residents were interested in seeing the asynchronous curriculum continue. Conclusion EM residents value the addition of asynchronous learning to both in-person and virtual didactic curricula. Additionally, virtual conference was favored over in-person conference with regard to work/life balance, convenience, and overall preference. As social distancing restrictions continue to ease post-COVID-19 pandemic, EM residencies may consider adding or maintaining asynchronous or virtual components to their synchronous conference schedule as a means to support resident wellness.

Investigation on the core competency of residents during Coronavirus disease 2019 outbreak.

Objective To investigate the impact of the outbreak of coronavirus disease 2019 (COVID-19) as an intervention factor on residency training at different stages, and look into the enhancement effect of post-graduation medical training program based on competency of residency training, so as to provide reference for the optimization of medical education at the postgraduate stage. Methods After the initial success of COVID-19 prevention and control, 169 clinical postdoctoral trainess(clinical postdocs) and 515 graduate students specializing in clinical medicine(professional postdocs) were surveyed by an anonymous online questionnaire. To analyze the differences of cognition and self- evaluation of core competence between the two groups. Results There were 141 valid questionnaires collected from clinical postdocs (83.43%, 141/169) and 264 valid questionnaires collected from professional postdocs (51.26%, 264/515). In both groups, more than 85% of the students agreed or strongly agreed that they had a deeper understanding of the profession of doctors during the epidemic. The results of competency self-evaluation showed that, except for the items of "self-improvement", the self-evaluation scores of clinical postdoctoral students on other items were significantly higher than those of professional postdoctoral students (all P <0.05). Conclusions COVID-19, as a factor of emergency intervention, can improve the competency cognition of residents. The core-competency based post-graduation medical education model can comprehensively improve the students' comprehensive ability, which is an effective training program for residents. It is suggested that the vocational planning education for residents should be paid attention to in the stage of college education, and a new mode of college education that is closely combined with the post-graduation education should be further explored.Copyright © 2021 Thomson Reuters and Contributors.

Using a Modified Delphi Methodology to Identify Essential Telemedicine Skills for Pediatric Residents.

OBJECTIVE: Telemedicine use in pediatrics increased during the coronavirus disease-2019 (COVID-19) pandemic. Despite rapid uptake by pediatric residency programs, consensus on essential telemedicine skills for pediatric residents is lacking. We used a modified Delphi methodology to identify essential telemedicine skills and behaviors for pediatric residents. METHODS: A focused literature search was performed to identify items for review by pediatric telemedicine experts. A modified Delphi methodology consisting of iterative rounds of anonymous surveys was conducted until consensus for each item was reached. Consensus was defined as >80% of experts identifying a topic as "very important." All items were mapped to one of the Accreditation Council for Graduate Medical Education (ACGME) core competencies. RESULTS: Seventeen pediatric telemedicine skills and behaviors achieved a consensus of "very important." Most items mapped to the ACGME core competency domains of interpersonal and communication skills and professionalism. CONCLUSIONS: There was a high degree of agreement among pediatric telemedicine experts on the importance of 17 telemedicine skills and behaviors for pediatric trainees. These skills can inform pediatric telemedicine curricula and provide validity evidence for pediatric telemedicine assessment tools.

Virtual Interviewing for Radiology Residency: Pluses, Minuses, and A Review of the Literature.

This article reviews current medical literature to assess the benefits and drawbacks of virtual interviews for radiology residencies as well as the downstream effects of these changes, best practices, and potential future recruitment methods. Topics covered include the effects of remote recruitment in promoting accessibility and applicant diversity and equality as well as fiscal, environmental, and time savings in combination with technical challenges, the complications of over application, challenges in assessment of program culture and location, impact on morale, and hidden financial and emotional costs. Learnings from other medical specialties are highlighted in addition to the process of signaling, guidelines for conducting and participating in virtual interviews, and matters for future consideration.

The Early Effects of the COVID-19 Pandemic on Pediatric Resident Education: A National Assessment.

PURPOSE: Residency programs must ensure resident competence for independent practice. The COVID-19 pandemic disrupted healthcare delivery, impacting pediatric residencies. This study examines the impact on pediatric resident education. METHODS: The authors conducted a mixed methods national survey of pediatric residency program directors (PDs) from May- July 2020. Data analysis included descriptive statistics, χ2, Wilcox rank sum tests. Multivariable modeling identified factors associated with resident preparation for more senior roles. Thematic analysis was performed on open-ended questions about PD COVID-19 pandemic recommendations to peers, Accreditation Council for Graduate Medical Education and American Board of Pediatrics. RESULTS: Response rate was 55% (110/199). PDs reported the COVID-19 pandemic negatively affected inpatient (n= 86, 78.2%), and outpatient education (n=104, 94.5%), procedural competence (n=64; 58.2%), and resident preparation for more senior roles (n= 50, 45.5%). In bivariate analyses, increasingly negative impacts on inpatient and outpatient education were associated with an increasingly negative impact on resident preparation for more senior roles (p=0.03, p=0.008), these relationships held true in multivariable analysis. Qualitative analysis identified 4 themes from PD recommendations: 1) Clear communication from governing bodies and other leaders; 2) Flexibility within programs and from governing bodies; 3) Clinical exposure is key for competency development; 4) Online platforms are important for education, communication, and support. CONCLUSIONS: The COVID-19 pandemic negatively impacted inpatient and outpatient education. When these were more negatively impacted, resident preparation for more senior roles was worse. Highlighting the importance of competency based medical education to tailor experiences ensuring each resident is competent for independent practice. WHAT'S NEW: The COVID-19 pandemic negatively impacted inpatient and outpatient clinical education which negatively impacted resident preparation for more senior roles. This highlights the importance of competency based medical education to ensure each graduating resident is competent for independent practice.

Stressors and stress management strategies among young doctors amidst COVID-19 pandemic-Cross-sectional study

Introduction and Aim: The COVID-19 pandemic has caused a huge economic burden and impacted physical and mental health of the people. The young medical graduates are facing a lot of disappointments with regard to career, higher studies, personal life etc. The current research aims to assess the various stressors and their coping strategies among the young medical graduates during the COVID-19 pandemic. Material(s) and Method(s): The cross-sectional study was conducted in the Department of General Medicine at a tertiary care teaching hospital in South India. Undergraduate medical students of 228 in number of both genders who completed their residency training just before and during the COVID-19 pandemic were enrolled in the study. The data was collected through a preformed questionnaire. Ethics clearance was obtained from the Institutional Ethics Committee. Informed consent was obtained. Statistical analysis was done by SPSS software version 18.0. P value < 0.05 was considered statically significant. Result(s): The mean scores obtained in PSS-10 were found to be higher among males than females. Around 79.4% showed moderate stress while 20.6% showed high stress (P=0.001). Males showed more stress compared to females in general as well as academic stressors. Male doctors and female doctors had differing stress coping skills. Conclusion(s): The study highlighted the vulnerable state of mind of the young medical doctors. The best way to overcome stress is by providing adequate resources, training to cope stress and ambient conditions for study and work, social support and relaxation techniques at both individual and organisational levels to help them to achieve a reasonable work-family interface.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.

Teledental Consultations Using a Messaging Application during the COVID-19 Pandemic: Experience from a Singapore COVID-19 Community Care Facility

Introduction: During the 'Circuit Breaker' period of the COVID-19 pandemic in Singapore from April to June 2020, governmental policies restricted the practice of dentistry nationwide to the provision of emergency treatment only, regardless of the patient's COVID status. As such, teledentistry was used as an alternative means to continue providing some form of dental care to COVID-19-positive patients who were admitted to a COVID-19 Community Care Facility. Description: The patients were physically triaged by physicians who would send clinical photos to the author via a messaging application, who would in turn triage the patients and assess if they required referral for emergency dental treatment. For patients who did not meet the criteria for referral, the author would advise the physicians on the subsequent management plan which included, but was not limited to, the provision of symptomatic relief. Conclusion(s): This article shows the feasibility of undertaking teledental consultations using clinical photos transmitted via a messaging application. The practical implication is a reduced barrier for patients and healthcare professionals to access teledentistry, without having to resort to sophisticated equipment. Hopefully, this will translate into the continued provision of some form of dental care to patients during the ongoing pandemic as opposed to no care at all.Copyright © The Author(s) 2022.

Implications of Corona Virus Disease-19 Pandemic on Cytopathology Laboratory-Challenges and Solutions in Resource Limited Setting

Introduction: Corona Virus Disease-19 (COVID-19) disease which is still showing peaks and plateau with emerging new mutational variants led to modification of working of hospitals and medical institutes. The present study was conducted to study various measures adopted and changes made in the cytopathology laboratory during COVID-19 infection in resource limited setting but catering to large population of covid patients. It was also intended to study methods adopted for effective cytopathology residency training during corona times. Material(s) and Method(s): The study analyzed the working of cytopathology lab during corona times from March 2020 till December 2021 and compared it with pre corona times from March 2018 till December 2019. The different methods adopted for effective cytopathology residency training were also analyzed. Result(s): A decrease of 1.9% of cases was observed during corona with increase of 17.4% for samples of respiratory tract including aspergillosis, mucormycosis and tuberculosis (Table1). There was 10.3% increase in cytological diagnosis of malignant cases during corona times (Table 2). Use of 90% alcohol for fixation, avoiding of pneumatic tube, judicious use of PPE kit along with access of digital cytology slides database was included in the changes made in the lab (Table 3). Conclusion(s): There was marginal decrease of cytopathological diagnosis during COVID-19 with substantial increase in malignancy rate of 10.3% in cytological diagnosis of different organs. Diagnosis of mucormycosis, aspergillus and tuberculer infection in respiratory tract cytology increased during this period. Judicious use of limited available resources led not only to smooth functioning of the cytopathology lab but also prevented any infection in the working health personals. Newer online resources were explored and modified for continuous training of the Cytopathology residents. Emotional support with effective communication was the key to alleviate any psychological stress amongst health professionals in the Cytopathology laboratory.

Effect of coronavirus pandemic on oral and maxillofacial surgical education and training: Developing standards for effective online training

Oral and maxillofacial surgery deals with the diagnosis and treatment of dentofacial problems and usually requires a four year specialized training after a bachelor's degree in dental surgery. The COVID 19 pandemic in early 2020 led to disruptions in the training programs worldwide and urged the supervisors and faculty to devise ways and means to continue the residents' learning experience utilizing different online teaching modalities. An account of some strategies for developing standards for effective online training to equip oral and maxillofacial training programs for similar future emergencies.Copyright © 2022 The Authors

A Hybrid Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents-a Multi-center Pilot Program.

Purpose of Review: The increased use of musculoskeletal ultrasound (MSKUS) in clinical practice warrants achieving competency earlier in physiatrists' careers. Physical Medicine and Rehabilitation (PM&R) residency programs have started incorporating formal MSKUS training in their curricula; however, significant heterogeneity remains in MSKUS education. Recent Findings: Numerous barriers contribute to the lack of consensus for MSKUS training during residency, but the COVID-19 pandemic severely disrupted in-person learning. As an adjunct or alternative to in-person learning, teleguided technology is being utilized. Summary: This curriculum demonstrates the role of a hybrid MSKUS training with interinstitutional collaboration. Twenty PM&R learners, from two institutions, were divided into a fundamental or advanced track. Virtual didactic sessions alternated weekly with hands-on ultrasonographic scanning sessions. Following a 12-month longitudinal curriculum, an end-of-year practical examination was used for competency assessment, in addition to a survey assessing resident perceptions and feedback. To our knowledge, this is the first collaborative and hybrid MSKUS curriculum for PM&R learners that can be easily reproduced at most training institutions and circumvent some of the barriers amplified by the COVID-19 pandemic. Supplementary Information: The online version contains supplementary material available at 10.1007/s40141-023-00380-z.

Impact of Virtual Interviewing on Geographic Placement in the Cardiology Fellowship Match

Introduction: Virtual interviewing for cardiology fellowship was instituted in the 2021 fellowship application cycle due to the COVID-19 pandemic and restricted travel. It is unknown what impact this has had on geographic patterns of fellow-training program matching. Our aim was to determine if there was a significant difference in the geographic placement in the cardiology fellowship match based on virtual interviews compared to prior years with in-person interviewing. Method(s): All U.S. based accredited cardiovascular disease fellowship programs that participated in the 2019-2021 fellowship match cycles were identified. Those that had publicly available data regarding fellow residency training and training year were included. Each fellow was categorized based on their fellowship program and residency training as from the same program, from the same state, from the same region or from a different region. These were mutually exclusive categories. Result(s): Of the 236 eligible programs, 118 programs (50%) had available data for the 2019-2021 application cycles. Cumulatively n=1787 total fellows were identified. Compared to the pre-virtual cohort (n=1178 matched fellows) there was no difference in the geographic placement during the 2021 virtual cycle (n=609 matched fellows) including the proportion that matched at the same program (30.6% vs 31.5%, p=0.738), in the same state (13% vs 13.8%, p=0.719), same region (24.2% vs 19.7%, p=0.164), or different region (35% vs 33.1%, p=0.274). There was also no difference when stratified by small, medium, or large program size or geographic region. Conclusion(s): The use of virtual interviewing in the 2021 cardiology fellowship application cycle did not result in a significant difference in the geographic placement of fellows. Further study is needed to evaluate the impact of virtual interviewing and optimize its use in fellowship recruitment.

The Social Emergency Medicine Mini- Curriculum: A Novel, Multifaceted Immersive Approach to Resident Education in Social EM

Learning Objectives: 1) To design, implement and evaluate the feasibility of a replicable multifaceted Social EM curriculum for EM residents 2) To increase EM residents' level of awareness related to Social EM and increase their ability to identify/intervene on social determinants of health in clinical practice Background: Emergency Medicine (EM) physicians are in a unique position to impact both individual and population health needs. Despite this, EM residency training lacks a formalized education on social determinants of health (SDoH) and social EM (SEM). The need for such a curriculum has been previously recognized, however there is a gap in the literature related to the feasibility of such a curriculum addition. This innovation seeks to address this need. Curricular Design: A taskforce of EM clinicianeducators with expertise in SEM developed a 4.5-hour educational curriculum for use during a single Emergency Medicine resident didactic block (1/2-day session). The curriculum (Table 1) included asynchronous learning via a podcast, four SEM subtopic lecture didactics, guest speakers from ED social work and a community outreach partner representative, and a poverty simulation with interdisciplinary debrief. The curriculum was delivered via videoconference due to COVID-19 restrictions. Pre- and post-curricular intervention participant surveys were obtained. Impact: Post-survey results (Table 2) demonstrated improved awareness of SEM concepts and increased confidence in participant's knowledge of community resources and ability to connect patients to these resources following the curricular intervention. In addition, post-survey assessment demonstrated significantly heightened awareness and clinical consideration of SDoH among participants and increased comfort in identifying social risk in the ED. Overall, all components of the curriculum were evaluated as meaningful and specifically beneficial for EM training. The community partner presentation and subtopic lectures were ranked highest, followed closely by the poverty simulation, ED social services presentation, and asynchronous podcast component. This pilot curricular integration study demonstrates the feasibility and perceived participant value of incorporating a SEM curriculum into residency training.

THROMBUS IN TRANSIT CAPTURED BY BEDSIDE ULTRASOUND: A LIFE-SAVING TOOL

SESSION TITLE: Thrombosis Jamboree: Rare and Unique Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Point of care ultrasound used by the provider is rapidly expanding in internal medicine. Thrombus in transit (TIT) is defined on ultrasound as mobile echogenic material temporarily present in the right heart chambers to the pulmonary circulation via the tricuspid valve or systemic circulation via an atrial septal defect. In this case, we were able to identify echogenic material traversing the tricuspid valve into the pulmonary circulation, which confirmed the diagnosis of pulmonary embolus [1] CASE PRESENTATION: This is a 71-year-old female with a history of hypertension who presented to the emergency room with 4-day pleuritic chest pain, productive cough, fever, and exertional dyspnea. She was hemodynamically stable, afebrile, tachycardic, and tachypneic. Initial diagnostic workup demonstrated elevated cardiac enzymes and creatinine, ground-glass opacities on chest CT, positive COVID PCR, and sinus tachycardia with nonspecific T wave abnormalities. Given her renal insufficiency, CTA was initially held off. The patient was found to have right lower extremity deep venous thrombosis, and a heparin infusion was started while waiting for a V/Q scan. Shortly after admission, she had a syncopal episode after using the bathroom. CPR was initiated for suspected cardiac arrest, and a bedside ultrasound demonstrated a sizeable mobile thrombus in the right atrium traversing the tricuspid valve into the right ventricle. Given this finding, we elected to move forward with CTA chest, and this study confirmed extensive bilateral PE with right heart strain. DISCUSSION: TIT is a rare emergency in PE (4%) with a staggering mortality rate twice as high as PE without TIT [2]. The gold standard for diagnosis of PE is CT angiogram, and early echocardiography is a cornerstone in diagnosis and risk stratification. However, patients similar to the one discussed in this care may present with conditions preventing timely utilization of these tools. POCUS allows for the rapid assessment and implementation of time-sensitive treatments. Historically, it has been a must-have skill set among ER and critical care physicians. Only 35% of internal medicine residency programs have fully integrated formal diagnostic POCUS within the past decade despite increasing interest among trainees. The expeditious medical decision made for our patient was possible following a focused echocardiogram performed by an internal medicine resident. In patients with massive PE, only 35% of echocardiograms obtained within 24 hours were done in the ER, and still, 1 in 6 happened after 6 hours [3]. CONCLUSIONS: As with any operator-dependent skill, proficiency in POCUS is a prerequisite for reliable findings and time-sensitive medical decision-making. POCUS only becomes a lifesaving tool in experienced hands. Hence, it is imperative that internal medicine residency programs consider this tool an essential component of resident training. Reference #1: Arboine-Aguirre L, Figueroa-Calderón E, Ramírez-Rivera A, et al. Thrombus in transit and submassive pulmonary thromboembolism successfully treated with tenecteplase. Gac Med Mex. 2017;153(1):129–33. Reference #2: Casazza F, Bongarzoni A, Centonze F, Morpurgo M. Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism. Am J Cardiol. 1997;79(10):1433-1435. doi:10.1016/s0002-9149(97)00162-8 Reference #3: Torbicki A, Galié N, Covezzoli A, et al. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol. 2003;41(12):2245-2251. doi:10.1016/s0735-1097(03)00479-0 DISCLOSURES: No relevant relationships by Varinder Bansro No relevant relationships by Olayiwola Bolaji No relevant relationships by clarence findley No relevant relationships by Faizal Ouedraogo

Utilization of Instagram by ophthalmology residency programs in the era of COVID-19

Purpose : Social media has become an increasingly utilized tool in academic medicine and in ophthalmology, especially as COVID-19 pandemic restrictions limit in-person interactions. We performed a cross-sectional study of publicly available accounts on the social media platform Instagram to describe the use of Instagram by academic ophthalmology residency programs in the United States over time and analyzed the impact of the COVID-19 pandemic on ophthalmology's social media presence. Methods : Accredited ophthalmology residency programs as of November 2021 were identified using the Accreditation Council for Graduate Medical Education (ACGME) database and were reviewed to identify programs with an affiliated publicly available Instagram account. For each account, the number of posts, followers, and followed accounts were calculated, as well as the year of creation. For the top six ophthalmology Instagram accounts, as determined by number of followers, each post after 2018 was classified into one of six categories (Award/Publication, Department Highlight, Flyer/Holiday, Informal/Candid Group Photo, Medical, or Miscellaneous), and the number of likes and comments was calculated with assistance of a Python script. A two-tailed independent t-test was utilized to analyze user engagement by likes and comments before and after January 2020. Results : Of the 124 ophthalmology residency programs, 78 (62.9%) were identified as having an affiliated Instagram account, 60 accounts (48.4%) were created during the years 2020 or 2021, and 62 (50.0%) accounts focused specifically on promoting the residency training program. Of the top six accounts with the most followers, post categories that received the most engagement were “Medical” and “Informal/Candid Group Photo” while those that received the least engagement were “Flyer/Holiday” and “Miscellaneous.” User engagement on posts as measured by likes and comments increased across multiple post categories after January 2020. Conclusions : Social media presence of ophthalmology residency programs on Instagram increased substantially in 2020 and 2021. As a result of the COVID-19 pandemic restricting in-person interactions, residency programs have used alternative platforms to reach applicants. Given the increasing use of such applications, social media will likely continue to become an important aspect of professional engagement in ophthalmology.

Minimally Invasive Glaucoma Surgery WetLab: A Follow-Up Needs Assessment Survey for Ophthalmology Residents

Purpose : In 2012 Saheb and Ahmed found that minimally invasive glaucoma surgeries (MIGS) lower intraocular pressure, decrease dependence on medications, and have an excellent safety profile. In 2017 75.5% of glaucoma surgeries performed in the US on Medicare patients 65 years or older in the US were MIGS. A 2020 study surveyed US program directors and found that both didactics and wet labs are used for resident training in MIGS. However, 37% of program directors did not feel that the experience was adequate for independent practice and only 27% felt that MIGS should be an ACGME requirement.<span style='font-size:10.8333px'> </span>Since 2017 Loyola's citywide annual microsurgical wet lab for six Chicago residencies has focused on hands-on training in MIGS to meet the increasing interest amongst residents. During COVID-19, Loyola continued to host our annual wet lab, providing MIGS training virtually. The purpose of this study was to assess residents' perspectives of their current MIGS training and how residents' perspectives have changed since 2017. Methods : In 2017 and 2020 respectively, 31 and 44 residents of 6 Chicago programs attended our wet lab. Residents were given a pre-wet lab survey regarding their interest in MIGS and training satisfaction. The data collected was anonymous and de-identified. In 2017 data was collected in-person on iPads using RedCap software and in 2020 the data was collected remotely using Qualtrics data collection platform. In both wet labs residents performed various MIGS and intraoperative gonioscopy. Results : In 2017 and 2020 respectively, 77% and 81% of residents reported that they were interested or very interested in MIGS. In 2017 32% of residents were satisfied by their MIGS training. In 2020, still only 25% of residents were satisfied by their current MIGS training. Conclusions : Despite widespread use of MIGS in the US and growing interest amongst graduating ophthalmologists, there continues to be a gap between resident interest in MIGS and satisfaction with training during residency. Over the four years, this gap has remained unchanged. A MIGS-based hands-on wet lab experience is one way to improve MIGS training for residents and close the gap between interest and satisfaction with current MIGS resident training.

Implementation of an Institutional Simulation Curriculum to Teach Team Leadership Skills, Management of Critically Ill Patients, and Emergent Procedures to Pediatric Residents

Background: Simulation in medical training is effective at increasing clinical knowledge, improving comfort with procedures, and teaching crisis resource management skills. Uniquely, simulation can also expose trainees to standardized cases independent of available clinical experience. This is especially important at a time when the COVID-19 pandemic has paradoxically led to decreased emergency department visits and hospitalizations, and, consequentially, decreased clinical opportunities for trainees. We developed and piloted a formal, longitudinal, high-fidelity simulation curriculum for pediatric residents, led by pediatric emergency medicine fellows in a unique, near-peer training program. The project goal was to assess the efficacy of this curriculum at increasing resident selfreported comfort in leading a team, managing critically ill patients, and performing essential emergent procedures. Methods: Six cases were designed by pediatric residents and emergency medicine fellows for the curriculum. Cases were reviewed by faculty members, focused on a critically ill pediatric patient, and included an associated emergent procedure. Three of the cases were used for the study, which was conducted over a four-month period in the 2021 academic year. Study participation was voluntary, and 27 pediatric residents participated, completing up to three cases each. Data was collected as self-reported Likert scales for questions regarding leadership, individual medical knowledge, and comfort with procedures. Surveys were completed prior to the curriculum implementation, following each case, and at study conclusion. To account for expected improvements during traditional residency training, data was also collected for two control cases not used in the study. Wilcoxon Signed-Rank test was used to compare pre- and post-intervention assessments. For significant results, the Dwass-Steel-Chritchlow-Fligner method was used to examine pair-wise comparisons by trainee post-graduate year. Results: Results are summarized in Table 1 and Table 2. There was a significant improvement in self-reported ability to function as team leader, identify and designate roles, effectively organize and minimize noise in the room, effectively use closed loop communication, and access additional resources. There was also an increase in self-reported comfort level with both medical knowledge and performing emergent procedures. There was no significant difference between responses based on trainee year. As expected, residents also reported an improvement in medical knowledge about control cases, although the improvement was less than with the implemented cases. When the size of this effect was compared between implemented and control cases, there was a trend towards significance favoring the simulated cases, suggesting that statistical significance may be achieved with a larger sample size. Conclusion: The implementation of a simulation curriculum can lead to improvements in pediatric resident's self-reported comfort with crisis resource management, team leadership, clinical knowledge, and emergent procedures. The effect on medical knowledge and comfort with procedures may be significantly different than the gains expected naturally over time in pediatric residency training.