Table 1 Barriers to implementation of the pilot curriculum and revisions implemented

Space

• One simulation center for both the faculty of Medicine and Nursing at AUB opening on weekdays between 8 am and 4 pm

• We developed a close professional relationship with the Simulation Coordinator, with professionalism and following a regular schedule which allowed us regular access to the space

Equipment

• 1 adult and 1 pediatric manikin (could not accommodate mass casualty scenarios or multiple simultaneous activities)

• Adjusted scenarios to maximize use of the available manikins and other equipment

Personnel

• Only one simulation coordinator

• Only 1 local faculty member facilitating the simulation activities

• Two Emergency physicians (in addition to the coordinator) with previously protected education time took over the simulation activities

Time

• Variable clinical schedules of EM trainees: make scheduling individual and small group modules off-time difficult

• Limited faculty protected education time to implement curriculum

• Inclusion of simulation within the weekly resident conference

• Use of published simulation scenarios

• Using the same scenario and adapting its complexity to meet the different objectives according to trainees’ level of experience

Administration

• Limited stakeholder buy-in

• Scheduling residents during off-hour required a significant amount of faculty and/or chief resident administrative time

• Involvement of EM educational leadership: EM residency associate program director

• Inclusion of SBME in weekly conference minimized curriculum administration time for faculty and chief residents and ensured resident’s availability

• Department leadership buy-in: funded one faculty sim training course