The study by Wahidi et al4 provides several important contributions in the area of bronchoscopy training and assessment. The first report of the efficacy of simulator use for bronchoscopy training was published in CHEST in 2001,6 and since that time, several other studies have been published, as recently reviewed by Davoudi and Colt.7 Collectively, prior studies demonstrate that bronchoscopy simulation leads to decreased procedure time, decreased wall contact, improved procedure efficiency, increased thoroughness, and increased accuracy of the airway examination. However, with the exception of a single, small study, all of these improved outcomes were shown in a simulated environment—in other words, prior work showed that simulation improved performance on a simulator. The study by Wahidi et al4 demonstrates that structured training including simulation results in measurable, statistically significant, sustained improvements in bronchoscopy technique for procedures subsequently performed on actual patients. Fellows who trained using simulation achieved higher BSTAT scores much earlier in training; scores at their 20th bronchoscopy were the same as scores for the 50th bronchoscopy in nonsimulation-trained fellows, evidence of a substantial shift in the learning curve by simulation. The simulation cohort also outperformed the nonsimulation cohort until the 100th bronchoscopy. The longitudinal, repeated evaluation of the learners as they moved to the real environment, the use of a structured, validated measurement tool, and the demonstration of sustained improvements in skills as a result of initial simulation training all make this study an important contribution to the field.