Background: Tobacco smoke exposure has significant health impacts on youth and opportunities exist to improve smoking cessation treatment education in residency training. Objective: This study sought to improve resident self-perceived knowledge and skills with a structured simulation-enhanced educational intervention. Methods: Pediatric and anesthesia residents participated in the smoking cessation treatment education on their pediatric pulmonary rotation. Residents received a pre-questionnaire about self-perceived knowledge and skills of smoking cessation treatment on a 5-point Likert scale. The intervention consisted of a didactic session on the 5 A’s (Ask, Advise, Assess, Assist and Arrange), referral to the quitline and nicotine replacement therapy (NRT). This was followed by two simulations with standardized patients followed by debriefing. Residents received a post-questionnaire immediately afterwards and follow-up questionnaires at 3 and 6 months after the simulation. Fisher’s exact test was used to compare responses at baseline between groups and the signed rank test was used to evaluate change in mean scores. Results: Forty-seven (89%) of the 53 residents eligible participated and completed the pre and post-questionnaire between the study period of November 2014 and May 2016. Twenty-three (49%) and 13 (28%) of 47 questionnaires at 3 and 6 months, respectively, were completed. All question scores increased significantly (p < 0.001) on the post-intervention questionnaire in self-perceived knowledge and skills of smoking cessation treatment and remained significantly higher (p < 0.001) among the follow-up questionnaires completed. Conclusions: A structured simulation-enhanced educational intervention was successful in systematically exposing residents to smoking cessation treatment education and increased self-perceived knowledge and skills that persisted above baseline among those with follow-up although 6-month follow-up was sub-optimal.