“…Julie L. Huffmyer, MD,* Hallisey Estes, DO,* and Franklin Dexter, MD, PhD, FASA † T his issue of Anesthesia & Analgesia features a research article by de Oliveira Filho et al 1 regarding the accuracy of assessment of competence in anesthesiology residents, using the learning-curve cumulative sum method (LC-CUSUM) and its riskadjusted form. To frame the discussion of the evaluation of competence in anesthesiology training, a brief history of the Accreditation Council for Graduate Medical Education (ACGME)'s Next Accreditation System and Milestones may be of value.…”