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To describe residency graduates’ perceptions of their preparation for providing pediatric emergency medical care.The design was a cross-sectional survey set in a university-affiliated pediatric residency program. Twenty residency graduates from 1994 and 1995 who did not have an emergency department (ED) rotation (pre-ED group) and 24 graduates from 1998 and 1999 who had an ED rotation (post-ED group) participated in the study. The main outcome measures were residency graduates’ responses regarding their preparation for various types of emergency situations and ratings of various residency curriculum components for usefulness in pediatric emergency medicine education.Nearly all residency graduates (98%) believed that they were well prepared to manage pediatric emergencies, and this did not differ between the pre- and post-ED groups (P = 1.0). For both groups, urgent care and critical care rotations were generally the highest ranked residency curriculum components for learning about four specific areas of pediatric emergency medicine (minor trauma, toxic ingestions, and medical and surgical emergencies). For the post-ED group, the ED rotation was also rated highly for each of these areas, but it was not the highest ranked for any of the four curriculum components.Despite limited access to rotations in a pediatric ED, our graduates were confident in their ability to manage pediatric emergencies. A pediatric emergency medicine curriculum composed of didactic teaching and clinical rotations in a pediatric intensive care unit and urgent care served as an effective way to supplement limited ED experience.