The SIMULATOR study was a French trial performed in 42 university centers where fellows who were inexperienced in transesophageal echocardiogram (TEE) were randomized to simulation-based vs traditional teaching on TEE knowledge and skills.¹ Authors measured theoretical and practical scores 3 months after training, as well as TEE duration and fellows’ self-perceived preparedness to perform a TEE. Fellows in the simulation group were noted to have higher scores, shorter times to TEE completion, and more confidence in performing a TEE. The effectiveness of simulation training was noted to have the greatest impact on fellows who were less than 2 years into training. The study by Pezel et al¹ is a welcome addition to the simulation literature in the cardiology space, noteworthy for its randomized and multicenter design, feats rarely achieved in medical education scholarship. The authors should be congratulated both for executing a multisite study focused on optimizing medical education and for completely standardizing teaching of skills across sites. Notably, it is the largest TEE simulation study to date.