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INTRODUCTION. Fifteen years after the release of the Institute of Medicine landmark report [1], patient safety improved, but is still not enough. According to a recently published National Health Service -report, many medical systems are still not designed with patient safety in mind [2]. Most of these safety issues are not due to inadequate medical knowledge, but to problems in transforming that knowledge into meaningful clinical actions under real patient care conditions [3]. In complex systems like intensive care, medical decisions have to be made under uncertainty and time pressure. Working in multi-professional teams requires coordination and communication skills. Human factors are attributed with the majority of adverse events in the ICU. Creating a sound safety climate is therefore essential [1]. Studies have demonstrated that simulation and CRM training provide a valuable tool [4] to train the management of complex medical situations and may increase patient safety. Little is currently known about the optimal frequency of simulation and CRM training. OBJECTIVES. To investigate the effectiveness of simulation training to improve the CRM skills of ICU providers. A group of ICU-nurses and physiscians in training were observed over three subsequent years (2014, 2015, 2016). The providers were asked to rate her skills (1 = best, 6 = worst) with a self evaluation questionnaire before and after each training. Nonparametric tests including the Bonferroni correcture were performed. We hypothesized that a one day training once a year would be insufficient to improve CRM skills in complex ICU situations. RESULTS. 65 ICU-nurses and 10 physicians completed a total of 194 questionnaires. We observed a consistent improvement in CRM relevant items between pre and post training evaluation. In contrast to this finding, the providers rated their baseline skills equal during the whole observation period. CONCLUSIONS. Multidisciplinary simulation-based educational training significantly improves self-estimated competence and awareness of CRM in a medical complex ICU-setting within one session. However, the sustainability of these efforts is probably poor. We feel, that more than one training session per annum will be required to influence patient outcome and safety in daily routine. Further studies are needed to find the ideal dosage and frequency of a long lasting CRM training effect.