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Simulation has been widely adopted as a training and assessment tool in medical education. Conventional teaching methods may be inadequate to properly train healthcare providers for rare but potentially lethal events in pediatrics such as trauma and respiratory arrest. Recent studies suggest pediatric acute care providers have limited exposure to critically ill patients and also lack the skills to manage them. Simulation has the potential to fill this educational void. This review will highlight the role of simulation as an educational and assessment tool, with a particular emphasis on retention of knowledge and skills.Simulation is currently used as an assessment tool to provide ongoing feedback during training (formative assessment) and is gaining popularity as an adjunctive method for demonstrating competency (summative assessment). Recent literature demonstrates increased retention of knowledge and skills after simulation-based training in the areas of resuscitation, trauma, airway management, procedural training, team training, and disaster management.Simulation is an effective training tool for pediatric acute care providers. Further research is necessary to develop validated performance assessment tools and demonstrate improvement in clinical outcomes after simulation training.