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Simulation Fellowship Programs: An International Survey of Program Directors

Natal, Brenda MD, MPH; Szyld, Demian MD, EdM; Pasichow, Scott MD, MPH; Bismilla, Zia MD, MEd; Pirie, Jonathan MD, MEd; Cheng, Adam MDfor the International Simulation Fellowship Training Investigators

doi: 10.1097/ACM.0000000000001668
Research Reports

Purpose To report on the evolution of simulation-based training (SBT) by identifying the composition and infrastructure of existing simulation fellowship programs, describing the current training practices, disclosing existing program barriers, and highlighting opportunities for standardization.

Method Investigators conducted a cross-sectional survey study among English-speaking simulation fellowship program directors (September 2014–September 2015). They identified fellowships through academic/institutional Web sites, peer-reviewed literature, Web-based search engines, and snowball sampling. They invited programs to participate in the Web-based questionnaire via e-mail and follow-up telephone calls.

Results Forty-nine programs met the inclusion criteria. Of these, 32 (65%) responded to the survey. Most programs were based in the United States, but others were from Canada, England, and Australia. Over half of the programs started in or after 2010. Across all 32 programs, 186 fellows had graduated since 1998. Fellows and directors were primarily departmentally funded; programs were primarily affiliated with hospitals and/or medical schools, many of which had sponsoring centers accredited by governing bodies. Fellows were typically medical trainees; directors were typically physicians. The majority of programs (over 90%) covered four core objectives, and all endorsed similar educational outcomes. Respondents identified no significant universal barriers to program success. Most directors (18/28 [64%]) advocated standardized fellowship guidelines on a national level.

Conclusions Paralleling the fast growth and integration of SBT, fellowship training opportunities have grown rapidly in the United States, Canada, and beyond. This study highlights potential areas for standardization and accreditation of simulation fellowships which would allow measurable competencies in graduates.

Supplemental Digital Content is available in the text.

B. Natal is an independent contractor in emergency medicine and health care simulation education and was, at the time of this research, assistant professor, Department of Emergency Medicine, and simulation director, Clinical Skills Center, Division of the Office of Education, Rutgers New Jersey Medical School, Newark, New Jersey.

D. Szyld is attending physician, Department of Emergency Medicine, Brigham and Women’s Hospital, and senior director, Institute for Medical Simulation, Center for Medical Simulation, Boston, Massachusetts.

S. Pasichow is postgraduate year 2 resident, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, and vice chair, Simulation Division, Emergency Medicine Residents Association, Providence, Rhode Island.

Z. Bismilla is assistant professor, University of Toronto, academic clinician, Hospital for Sick Children, and lead, Hospital for Sick Children Learning Institute Simulation Fellowship Program, Toronto, Ontario, Canada.

J. Pirie is associate professor, University of Toronto, pediatric emergency medicine (PEM) physician, and director of PEM simulation and the PEM Simulation Fellowship Program, Hospital for Sick Children, Toronto, Ontario, Canada.

A. Cheng is associate professor, Department of Pediatrics, University of Calgary, director, KidSIM-ASPIRE Simulation Research Program, and scientist, Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada.

Funding/Support: None reported.

Ethical approval: The Rutgers New Jersey Medical School Institutional Review Board approved this study.

Supplemental digitial content for this article is available at and

Correspondence should be addressed to Adam Cheng, Department of Pediatrics, Alberta Children’s Hospital, 2888 Shaganappi Trail, NW, Calgary, AB T3B 6A8, Canada; telephone: (403) 955-2633; e-mail:

© 2017 by the Association of American Medical Colleges