Procedural competency in bronchoscopy is currently judged by arbitrary thresholds of observed procedures and the subjective certification of the program director. Procedural competency is best determined by validated metrics evaluating both technical and cognitive components. In lieu of defined and validated metrics, recognized experts have provided important opinion-based guidelines1,2 delineating procedural training for basic and advanced bronchoscopy. This is inadequate. There is mounting evidence from the Interventional Chest Diagnostic Procedures Network Steering Committee-endorsed Multi-State Bronchoscopy Education Project that the current arbitrary numbers are an inadequate metric for technical competency (Gordon Downie, MD; personal communication, August 28, 2008).3 Furthermore, consistent with the current pedagogic approach, there is heterogeneity of core curriculums, if formal ones exist at all. Cognitive skills are therefore obtained by the self-study of textbooks or manuscripts, attending didactic sessions or “on-the-fly.” These are all valuable methods, but in the absence of objective assessments of core knowledge how do we ascertain competence? Early data4 have suggested that the current paradigm provides inadequate cognitive training. Cognitive expertise is paramount to reaching technical expertise, and the teaching of cognitive skills has been shown to improve technical performance.5 Cognitive competency in bronchoscopy is rarely evaluated by institutional testing and is inadequately evaluated on national board examinations.