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To assess the impact of simulation training on complications associated with femoral arterial access obtained by first year cardiology fellows. Background: Prior studies demonstrate a higher incidence of arterial access related complications among patients undergoing invasive cardiac procedures.First year cardiology fellows at four teaching hospitals in Michigan tracked their femoral access experience and any associated complications between July 2011 and June 2013. Fellows starting their academic training in July 2012 were first trained on a specially developed simulator before starting their rotation in the catheterization laboratory. The primary outcome was access proficiency, defined as five successful femoral access attempts without any complication or need to seek help from a more experienced team member.A total of 1,278 femoral access attempts were made by 21 fellows in 2011–2012 compared with 869 femoral access attempts made by 21 fellows in 2012–2013. There was a lower rate of access related complications in patients undergoing access attempts by first year fellows in year 2 compared with year 1 (2.1% versus 4.5%,P= 0.003). The number of procedures to achieve procedural proficiency was significantly higher in year 1 compared with year 2 (median 20 versus 10,P= 0.007).Incorporation of simulation in the training of first year fellows was associated with an improvement in proficiency and a clinically meaningful reduction in vascular complications. © 2015 Wiley Periodicals, Inc.