The American Board of Medical Specialties requires the American Board of Anesthesiology (ABA) to include practice performance assessment and improvement in Part IV of the Maintenance of Certification (MOC). The ABA recognizes simulation training as an innovative approach to assess a physician’s clinical and teamwork skills in managing critical events and included it in the Part IV Maintenance of Certification in Anesthesiology (MOCA® ) requirements. Morning simulation activities focus on a range of anesthetic emergencies medical management and communication principles. Afternoon simulation activities focus on anesthesia crisis leadership principles.