Boston Children's Hospital and Boston Medical Center have invested in state-of-the-art, high-fidelity simulator programs to optimize learning in the acute care setting. Children's Simulator Suite is a faithful reproduction of an intensive care unit bed space. The suite is outfitted with gas outlets, medical equipment, and both pediatric and infant patient simulators. Adjacent to the simulated patient room is a video control room linked to a conference room through closed circuit cameras for video-based debriefing sessions. An example of training in the suite is shown here. The PL-2 year ICU rotation features weekly mock codes led by the residents with video debriefings. In addition, there are frequent procedure sessions led by the ICU fellows to practice procedures such as intubation, central line placement, and chest tube placement.

At BMC, simulation sessions occur either in a similar simulation suite or in the PICU by using a portable SimBaby, which can simulate a range of conditions and enables a number of procedures from intubation to IV placement. The PICU senior and chief residents develop a weekly mock code for the ward team, which starts with interns learning to use basic equipment and progresses to the ward junior running a complex cardiac code. Recent cases have included severe myocarditis and status epilepticus.

Given the importance and complexity of running a code well, the practice of mock codes is not restricted to ICU rotations. They are scheduled throughout the intern, junior and senior years. The focus is on increasing skill level over time, knowing how and when to call for help and importantly, the basics of good communication in running a successful code.