Simulation has consistently proven to be an effective teaching technique that has yet to be uniformly incorporated in Pulmonary and Critical Care programs. Simulating critically ill patients requires the development of high fidelity simulations (HFS), which may require the use of high cognitive load. This is in direct contrast to cognitive load learning theory in medical simulation, which suggests that simulation should aim to decrease cognitive load by limiting the number of learning objectives and distracting tasks (1). We hypothesize that a new approach to critical care simulation that allows for higher cognitive load can increase fidelity and will continue to improve knowledge and performance in managing rare clinical scenarios. This would provide evidence that HFS with high cognitive load should be included in Pulmonary and Critical Care curriculums nationwide. Radhika Shah, MD University of Maryland