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Currently, many pediatric hospitals are using simulation technology to teach trainees the skills required to effectively succeed in managing critically ill patients. Unfortunately, no curricula integrating the use of simulation have been described for pediatric emergency medicine (PEM) fellowship programs. Our objective was to outline our experience with the development, integration, and evaluation of a simulation-based, acute care curriculum into our current PEM fellowship training program.Using the American Board of Pediatrics and the Royal College of Physicians and Surgeons of Canada learning objectives for PEM as a guide, 12 modules composed of 43 scenarios were developed to address the skill sets required for PEM fellows. Six modules were identified as "core," allocated for completion in year 1 of fellowship, whereas the remaining modules were "subspecialty," designed for completion in year 2 of training. A 12-question survey (5-point Likert scale) was used to evaluate trainee satisfaction with regard to 4 domains: level of realism, utility of debriefing, quality of instruction, and overall satisfaction.A total of 66 surveys were collected between March and July 2007. Twenty-five surveys were completed by PEM fellows. Trainees responded favorably for all 4 domains, reporting that the new simulation curriculum provided realistic scenarios with high-quality debriefing, instruction, and an overall excellent learning experience.We have successfully integrated a simulation-based acute care curriculum into our PEM fellowship program. Satisfaction ratings were high for this program. Research to assess educational outcomes related to this curriculum is necessary.