Critical care medicine is an environment that requires a wide skill set of medical knowledge and procedural skills. Trainees in critical care medicine along with future credentialing bodies have an expectation that proficiency in procedure skills are obtained during their training. Simulation training has been used in critical care training typically as task trainers or human patient simulators, which has been shown to be more effective in a recent meta-analysis1. This can easily be accomplished with the more common procedures such as central venous catheters, arterial line catheters, paracenteses, and intubations. Certain procedures are less common in many clinical environments but still require proficiency should the clinical situation arise. We are currently creating a curriculum that provides a simulation for the pulmonary and critical care trainees to review and practice the skills required for less common procedures such as placement of a Blakemore or Minnesota tube for management of hematemesis from gastric or variceal varices, and placement of transvenous pacers.