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Pediatric residents' simulation-based training in patient safety during sedation. In Israeli emergency departments, pediatric residents are allowed to independently perform procedural sedation after training. Preparing the residents to practice unsupervised sedations requires participation in a simulation-based training in patient safety during sedation (STPSDS). The study objective was to evaluate participants' perception of knowledge and confidence from the STPSDS. We performed a retrospective analysis of participants' self-reported perception of knowledge acquisition. At the end of each course, participants were requested to rate, anonymously and independently, the training contribution to their knowledge and confidence using a four-point Likert scale. Between January 2010 and December 2017, 321 pediatric residents participated in 67 STPSDS courses; 315 completed the self-assessments. Participants' median responses of the training contribution were 4 (IQR 3-4) for overall knowledge, 4 (IQR 4-4) for understanding potential complications during sedation, 3 (IQR 3-4) for knowledge in managing adverse events, and 3 (IQR 2-4) for knowledge in practicing safe sedation. Median response for contribution to participants' confidence in performing sedation was 3 (IQR 3-4).Conclusion: We found that the STPSDS improved perception of knowledge and confidence among pediatric residents. Our findings suggest that this training has a valuable role in preparing pediatric residents to practice unsupervised sedations in the ED. What is Known: • In Israel, sedation-trained pediatric residents performed sedations in the Emergency Department • Successful completion of a simulation-based training in patient safety during sedation (STPSDS) is a mandatory requirement to perform unsupervised sedation. What is New: • The STPSDS improved perception of knowledge and confidence among pediatric residents. • This training may be valuable in preparing pediatric residents to practice unsupervised sedations.