 Appropriate airway management is the most critical point in pediatric resuscitation and pediatric critical care. It remains, however, a challenge for pediatric residents to learn and retain this critical skill. Recent report from our PICU showed pediatric residents participated only 28 of initial orotracheal intubation, and the rate of the first successful endotracheal tube placement was only 38 of all orotracheal intubation attempt. Repetitive poor-skilled intubation attempts may be associated with complication such as dental or laryngeal contusion, and prolonged intubation attempt may be associated with hypoxia and hemodynamic instability. In order to improve the operational performance in the efficacy first attempt success rate and safety minimizing the associated events which could potentially lead to adverse events, a better training method is warranted. 