For continued quality improvement of the curriculum, learners were surveyed on primary and secondary goals immediately prior to and upon completion of the curriculum (Additional file 1: Appendix S1). Confidence-based questions were measured on a 4-point Likert scale ranging from 0 (not at all confident) to 3 (very confident). Additionally, each debriefing was evaluated using the Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV)  Short Form to improve and ensure that debriefing was of the highest quality. The Wilcoxon rank sum and signed rank tests were used to compare these data and corresponding 95% confidence intervals for the difference in means were reported. SAS®, version 9.3 (SAS Institute, Inc., Cary, North Carolina) was used for all analyses, and a p value < .05 was considered significant. While the curriculum was mandatory for all interns caring for adult patients, all data were voluntarily collected as part of a curricular evaluation process, and retrospective review of the data was approved by the hospital Institutional Review Board under waiver of informed consent. Surveys were administered during the simulation sessions with a capture rate of nearly 100%.