Faculty Development for High‐Acuity Procedures: A Train‐the‐Trainer Simulation‐Based Innovation for Transvenous Pacemaker Placement

ABSTRACT Background Emergency medicine faculty are expected to perform and supervise high‐acuity, low‐occurrence (HALO) procedures despite limited clinical opportunities, placing them at risk for procedural skill decay. Transvenous pacemaker (TVP) placement is a life‐saving but infrequently performed intervention. While simulation is widely used for trainees, sustainable faculty development models for procedural maintenance remain limited. Methods We developed a train‐the‐trainer, peer‐led, simulation‐based faculty development program focused on TVP placement within a single academic emergency department. Volunteer faculty trainers received focused preparation in TVP placement, simulator use, and facilitation strategies, and subsequently led small‐group refresher sessions using a low‐cost, reusable TVP simulator. The intervention was embedded within existing departmental educational venues and incentivized through continuing medical education credit and value‐based compensation alignment. Over 1 year, 12 sessions (30–60 min each) were conducted, capped at four learners per session and facilitated by 10 faculty trainers. Faculty completed pre‐ and post‐session surveys assessing prior experience and self‐reported comfort with TVP placement. Paired pre‐ and post‐intervention comfort scores were compared. Results Fifty‐four of 56 eligible faculty participated and completed paired surveys. Baseline exposure to TVP placement was limited, with 37% reporting no prior simulation experience and 24% reporting no prior live placement. Faculty reporting comfort or high comfort with independently placing a TVP increased from 14.8% pre‐intervention to 83.3% post‐intervention. Mean comfort scores improved from 2.1 ± 0.6 to 3.2 ± 0.6 on a 4‐point Likert scale ( p < 0.001). The sessions were rated as highly useful (mean 4.9 ± 0.3 on a 5‐point Likert scale), and all participants would recommend the training to colleagues. Conclusion A train‐the‐trainer, peer‐led simulation model significantly improved faculty comfort with transvenous pacemaker placement while minimizing reliance on centralized simulation resources. Embedding brief, small‐group sessions within existing educational structures offers a feasible and scalable approach for maintaining faculty competency in HALO procedures.