A simulator-based educational program has been incorporated into many anesthesia residency training programs. The effectiveness of this method of teaching has been validated by several studies and is generally accepted as an effective method of resident education. Evaluation of performance and positive critical feedback through debriefing has been attributed to the effectiveness of simulator-based education. Perhaps, this process can be used to evaluate the competence of practicing physicians. We report our experience using multimodality simulator technology to assess physicians who may have allowed their competence to lapse. We discuss our simulator-based assessment process and the strengths and limitations of our program. We also discuss the legal ramifications of participating in such assessments. Because of confidentiality agreements signed by all parties involved with this process, cases are discussed in general terms to assure anonymity.