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INTRODUCTION: With increased incorporation of simulation-based methodologies into quality improvement activities, standards for reporting on simulation-specific elements in healthcare improvement research are needed. METHODS: We followed established consensus process methodology to iteratively create simulation-based extensions for SQUIRE 2.0 reporting guidelines. Initial steps involved forming a steering committee, defining the scope, and conducting premeeting activities with an expert panel of simulation and quality improvement researchers. Recommendations from the expert panel were brought to a consensus meeting where existing guidelines were reviewed and recommendations made. Steering Committee members reviewed all recommendations, reconciled differences, and made final recommendations, which were piloted by experienced simulation and quality improvement researchers. RESULTS: Fifteen Steering Committee members, 59 experts in simulation and quality improvement research, and 86 consensus meeting attendees reviewed SQUIRE 2.0 reporting guidelines and ultimately recommended simulation-based reporting guidelines for 22 of the 41 (54%) SQUIRE 2.0 guidelines. Those items for which simulation-based extensions were identified were: Notes to Authors, 1 (Title), 2a (Abstract), 2b (Abstract), 4 (Introduction: Available knowledge), 5 (Introduction: Rationale), 7 and 8a & b (Methods: Context and intervention), 9a (Methods - Study of the intervention), 9b (Methods - Study of the intervention), 10a (Methods - Measures), 10b (Methods-Measures), 10c (Methods-Measures), 11b (Methods- Analysis), 12 (Methods - Ethical considerations), 13a (Results), 13e (Results), 14b (Discussion - Summary), 15a-e (Discussion - Interpretation), 16a (Discussion - Limitations), 16b (Discussion - Limitations), 17c (Discussion - Conclusions), and 17d (Discussion - Conclusions). CONCLUSIONS: We created simulation-based extensions to SQUIRE 2.0 reporting guidelines to improve the quality and standardization of reporting on simulation-specific elements of healthcare improvement research.

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INTRODUCTION: Simulation instructor training is a recognized key component of health care simulation implementation, including in low-resource settings. PediSTARS India (Pediatric Simulation Training and Research Society) has developed and delivered several instructor training courses and more recently a 3-level faculty development program. However, there is variability in adoption of simulation at workplaces. The goal of this study was to identify factors that influence translation of instructor training into workplace simulation. METHODS: At the conclusion of their faculty development program, participants of the 2018 PediSTARS simulation instructor workshop were invited to participate in a qualitative study with an online questionnaire followed by a semistructured interview. The 3 key questions explored the "enablers," "barriers," and "changes needed" at workplaces for simulation-based training. The responses were analyzed and classified into broad themes. RESULTS: Of the 76 participants of the workshop, 11 were interviewed. The enablers were classified under 3 themes; "management support," "trained team" and "smart sourcing." Barriers were "lack of infrastructure," "lack of time," and "lack of simulation culture." The proposed changes were to "raise awareness," "strengthen systems," and "curricular integration." CONCLUSIONS: This study demonstrates the importance of institutional leadership support for simulation-based training and also that new instructors should focus on training teams in the workplace and mapping simulation activities to existing curricula. These results have wide applicability to a variety of health care settings and instructor training programs. Collaboration between organizations for further research about the impact of simulation-based training on patient safety and outcomes is also required.

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SUMMARY STATEMENT: The PediSTARS Faculty Development Program is a novel approach for simulation faculty training with an aim to increase the pool of trained simulation faculty in India and neighboring countries that could then facilitate simulation-based training, both at their own workplaces and in the PediSTARS simulation-based workshops that provide training in pediatric and neonatal emergencies. This commentary describes the evolution of the faculty development program, the initial process, the feedback obtained, the changes undertaken, the progress made to date, and the challenges ahead. There is also an emphasis on the key generalizable principles that can be applicable to other low-resource settings.

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STATEMENT: The International Network for Simulation-based Pediatric Innovation, Research, and Education co-hosted a novel research accelerator meeting with the International Pediatric Simulation Society in May of 2019 in Toronto. The purpose of the meeting was to bring together healthcare simulation scientists with resuscitation stakeholders to brainstorm strategies for accelerating progress in the science of saving pediatric lives from cardiac arrest. This was achieved by working in teams to draft targeted requests for proposals calling the research community to action investigating this topic. During the 1-day meeting, groups were divided into 6 teams lead by experts representing specific domains of simulation research. Teams developed a pitch and presented a sample request for proposals to a panel of expert judges, making a case for why their domain was the most important to create a funding opportunity. The winner of the competition had their specific request for proposal turned into an actual funding opportunity, supported by philanthropy that was subsequently disseminated through International Network for Simulation-based Pediatric Innovation, Research, and Education as a competitive award. An inspired donor supported an award for the second-place proposal as well, evidence of early research acceleration catalyzed from this conference. This article is a summary of the meeting rationale, format, and a description of the requests for proposals that emerged from the meeting. Our goal is to inspire other stakeholders to use this document that leverages simulation and resuscitation science expertise, as the framework to create their own funding opportunities, further accelerating pediatric resuscitation research, ultimately saving the lives of more children worldwide.

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A previously healthy 3-year-old boy presented to the emergency department with abdominal pain, fever, and emesis. Laboratory and radiologic evaluation for causes of acute abdomen were negative; however, review of the abdominal x-ray demonstrated cardiomegaly with the subsequent diagnosis of pericardial cyst by echocardiogram and computed tomography. The patient underwent surgical decompression and attempted removal of the cystic structure revealing that the cyst originated from the epicardium. His abdominal pain and fever resolved postoperatively and he completed a 3-week course of ceftriaxone for treatment of Propionibacterium acnes infected congenital epicardial cyst. Emergency department physicians must maintain a broad differential in patients with symptoms of acute abdomen to prevent complications from serious cardiac or pulmonary diseases that present with symptoms of referred abdominal pain.

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BACKGROUND AND OBJECTIVES: Graduate 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. METHODS: A survey was developed by consensus methods and distributed to PEM program directors via an anonymous online survey. RESULTS: Sixty-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. CONCLUSIONS: PEM 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.

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