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Health care professionals are expected to acquire decision-making skills during their training, but few methods are available to assess progress in acquiring these essential skills. The purpose of this study was to determine whether a simulation methodology could be used to assess whether decision-making skills improve during critical care training.Sixteen simulated scenarios were designed to assess a critical care provider's ability to make decisions in the care of a critical ill patient. Seventeen (17) critical care providers managed 8 of the scenarios early during their training and then managed a second set of 8 scenarios (T2) at the conclusion of their training.Provider's mean global scenario scores (0–9) increased significantly from T1 and T2 (5.64 ± 0.74) and (6.54 ± 0.64) with a large effect size (1.3). Acute care nurse practitioners and fellows achieved similar overall scores at the conclusion of their training (ACNP 6.43 ± 0.57; Fellows 6.64 ± 0.72).These findings provide evidence to support the validity of a simulation-based method to assess progress in decision-making skills. A simulation methodology could be used to establish a performance standard that determined a provider's ability to make independent decisions.An inventory of simulated scenarios was used to assess the critical care provider's decision-making skills.Participant's decision-making ability markedly improved during training as evidenced by the relatively large effect size differences in scenario scores observed from the initial to the follow-up simulation assessment.Simulation offered a method to measure progress in decision-making skills that occurs with experience and training in critical care management.The similar performance of fellows and critical care nurse practitioners at the conclusion of their training provides evidence to support the use of nurse practitioners as ‘front line providers’ in ICU settings.