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Thomas Jefferson University Hospital is a large urban Academic Medical Center with a level III Intensive Care Nursery (ICN). A new group of pediatric interns rotate through the ICN every year and receive limited education on mechanical ventilation. We developed a live, one hour training session performed by a Respiratory Therapist and a Respiratory Challenge Test to be completed by the physicians before and after each session. Clinical training was defined as routine training acquired during daily rotation in the ICN. We hypothesized that classroom and clinical training would be more effective than clinical training alone.