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Simulations have taken a central role in the education and assessment of medical students, residents, and practicing physicians. The introduction of simulation-based assessments in anesthesiology, especially those used to establish various competencies, has demanded fairly rigorous studies concerning the psychometric properties of the scores. Most important, major efforts have been directed at identifying, and addressing, potential threats to the validity of simulation-based assessment scores. As a result, organizations that wish to incorporate simulation-based assessments into their evaluation practices can access information regarding effective test development practices, the selection of appropriate metrics, the minimization of measurement errors, and test score validation processes. The purpose of this article is to provide a broad overview of the use of simulation for measuring physician skills and …