Critical care airway management (CCAM) is a key skill for critical care physicians. Simulation based training (SBT) may be an effective modality in training intensivists in CCAM.This study examines whether SBT of critical care fellows is an effective means of providing training in CCAM, with focus on urgent endotracheal intubation.and Methods: A total of thirteen first year pulmonary critical care medicine (PCCM) fellows at an academic training program underwent SBT with a computerized patient simulator (CPS) in their first month of fellowship training. At the end of the training period, the fellows underwent video-based scoring using a 46-item checklist (of which 40-points could be scored) while performing a complete CCAM sequence on the CPS. They were then tested using video-based scoring on their first real-life CCAM. Maintenance of skill at CCAM was assessed during the fellows' second and third year of training using the same scoring method.For the first-year fellows, the score on the CPS was 38.3 +/- 0.75 S.D. out of maximum score of 40. The score on their first real-life patient CCAM was 39.0 +/- 0.81 S.D. (p-value = 0.003 for equivalence, 95% CI for difference between real-life patient CCAM and CPS scores 0.011, 1.373). A total of sixteen second- and third-year fellows were tested at a real-life CCAM event later in their fellowship to examine for maintenance of skill. The mean maintenance of skill score of this group was 38.7 +/- 1.14 S.D.Skill acquired through SBT of critical care fellows for CCAM transfers effectively to the real-life patient care arena. Second- and third-year fellows who had initially received SBT maintained skill at CCAM.