The use of simulation in medical education has exponentially expanded over the past two decades (1). Medical simulation has a growing body of literature supporting its effectiveness in teaching skills to learners (1,2,3). This is especially important in critical care, where there are high risk procedures performed regularly. Residents are having an increasing diversity of experiences before beginning critical care fellowship and this leaves fellows with a wide range of skill sets. Our goal is to create a longitudinal simulation curriculum for critical care fellows that will provide both technical procedural skills including for high risk, rarely performed procedures in addition to crisis management and communication skills.