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Medical students may graduate with limited experience in managing acutely decompensating patients independently. As interns they often assume that mantle of responsibility. This first call simulation-based training provided fourth-year medical students with a guided experience in creating differential diagnoses and initiating diagnostic plans while resuscitating patients.    Methods  This simulation session was designed as a 3-hour session as part of a larger internship preparatory course for fourth-year medical students. The session contained three high-fidelity simulation scenarios involving a decompensating patient with a focus on developing a broad differential diagnosis and initiating treatment. The medical student leader for each patient encounter rotated with the remaining medical students actively involved in the peri-scenario debriefing process. The simulation effectiveness tool (SET-M), a published instrument to measure a learner's perception of how effective the simulation met their learning needs, was completed at the end of the session.    Results  Twenty students participated in the session and completed the SET-M. Ninety-five percent of students strongly agreed they were better prepared to respond to changes in a patient's condition and felt empowered to make clinical decisions. Of students, 100% strongly agreed that the debriefing was valuable in helping to improve their clinical judgment and contributed to their learning.    Discussion  Simulation-based training with facilitated, peri-scenario debriefing may be an effective method to develop confidence and clinical reasoning skills. This may help fourth-year medical students prepare for the impending responsibility to evaluate and initiate care for acutely decompensating patients.

First Call Simulation: Preparing for Acute Patient Decompensation with Facilitated, Peri-Scenario Debriefing