Background: Simulation-based medical education (SBME) is an important tool for actively improving the skills and knowledge of healthcare professionals. Despite the growing popularity and proven effectiveness of simulation-based education, understanding the extent and scope of its use in European anaesthesiology residency training is necessary. This study aimed to evaluate the current status of simulation-based training for anaesthesiology trainees in Europe. Methods: We conducted a survey-based cross-sectional study to assess the current status of simulation-based education in anaesthesiology residency training in Europe. The online distributed survey included 56 items, aiming at trainees’ perspectives of availability in general and different types of SBME, implementation in national training programs, benefits and barriers. Regional, year of-training-dependent and workplace-associated distribution patterns of answers were analysed. Results: We collected responses from 268 anaesthesiology trainees from 37 different countries. Most trainees had participated in an anaesthesia-related simulation course, with the highest response rate in northern and western European countries. Anaesthesia-related simulation courses were included in the training programs of almost all respondents, regardless of the region, but perceptive availability varied significantly throughout Europe. The most taught topics using simulation included advanced/basic life support, airway management and management of polytrauma patients. The most frequently reported barriers to simulation were costs, followed by a need for more protected educational time. Conclusion: The study revealed discrepancies between the European countries as perceived by trainees. Further research is needed to explore the reasons behind these differences and promote greater access to simulation-based education across Europe.