The pre-eminent requirement for surgical education is that it is effective and efficient. We sought to determine if the addition of low-fidelity simulation to our standard method of teaching cricothyroidotomy improves Postgraduate Year 1 residents' self-efficacy, knowledge, and skill to perform cricothyroidotomy. The teaching methods were standard education using a lecture and video compared with standard education plus low-fidelity simulation instruction and practice on a mannequin. The methods were randomly assigned. After the assigned teaching in the morning and completion of pre- and posttests of self-efficacy and knowledge, the residents were evaluated on performance of cricothyroidotomy during the afternoon on euthanized swine. Time to complete the procedure and complications were recorded. Nineteen residents participated. Time to complete cricothyroidotomy was significantly less (P = 0.047) and performance scores were significantly higher (P = 0.01) in the simulation group. This group had four (36.4%) complications and the no simulation group had one (12.5%) complication (P = 0.34). Both groups improved on self-efficacy from pre- to posteducation (P < 0.05). Low-fidelity simulation can improve time and skill to perform cricothyroidotomy.