Simulation training has become the cornerstone of procedural training in neonatal intensive care (1). The use of animal models such as anesthetized kittens, rabbits, ferrets, and chickens has fallen out of favor for ethical and logistic concerns (2, 3, 4, 5). Increasingly sophisticated high-fidelity simulation models have been developed, but they are often expensive and unaffordable. Additionally, it is not clear that high-fidelity models offer major advantages in procedural training when compared to low-fidelity models (6).

In this chapter we describe how to make relatively inexpensive models for vital neonatal procedures, using materials that are easily available. These models have been used in training boot camps for Neonatal Perinatal Fellows and in Procedure Workshops at National Conferences. Other lowcost simulation models have been described in the literature for umbilical catheterization and for circumcision (7, 8). There are quality commercial models available for neonatal intubation and lumbar puncture, procedures for which lowcost simulation models are urgently required.

Simulation training is most effective in temporal proximity to the time when the skills are likely to be used and frequent refresher training should be considered to prevent skills decay (9, 10, 11). The use of check lists (see Appendix A) to monitor and document compliance with all steps of the procedures is encouraged for competency training. Repeated training improves technique and reduces number of overall attempts (11). Team-based training to improve team work and communication, particularly for emergency scenarios, is vital to improve performance in real-life situations (12, 13).