Introduction:Simulation training in airway management among nursing students was recommended to enhance skills, knowledge and confidence during their clinical attachment in the Emergency Department but the efficacy was not being explored adequately. The objective of this study was to determine the efficacy of simulation training in airway management among final year nursing student Kota Kinabalu Training Institute (KKTI). Methods: This was quasi-experimental research design, which the participant was divided into test and control group without random-ization. A sample of forty final year nursing students was selected for this study. This was a comparative study in-volving twenty KKTI final year nursing students (test group) with simulation versus twenty final year nursing students (control group) without simulation on airway before and after posted to Emergency and Trauma Department (ETD). Two instruments were used, i) Pretest/posttest survey design by Porter et al (2013), and; ii) The Simulation Efficacy Tool-Modified (SET-M). SPSS version 24 Independent T test was used to analyse the mean score between the groups. Results: Levene’s test for equality of variance shown significant (t= -.005, df = 38, p<.05), since the probability value (Sig.) obtained (.019) is less then predetermine alpha value (.05), thus null hypothesis was rejected. The test group were more confident compare to the control group before going for clinical posting in ETD. Conclusion: Simulation training in airway management increased confident level among the test group compare to control group who did not receive the simulation training.