As physician anesthesiologists, we seek to optimize patient safety throughout the perioperative experience. Those of us who train anesthesia residents and fellows, lead anesthesia departments or groups, or who are otherwise responsible for hiring and firing of anesthesia providers bear an added level of responsibility. How do we ensure that our graduates are competent to practice independently and that this level of competency is maintained throughout a career in anesthesia? In addition to the challenges introduced by new technology and evolution of clinical practice, outside events may test maintenance of skill and knowledge proficiency. These events range from prolonged leaves of absence due to personal or family illness, or temporary forays into alternate careers, to extended time in a limited scope of practice environment (e.g., an ambulatory endoscopy center), or simply the normal process of aging. While these situations...

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