I (C. B. S.) was flying home from a conference in a Boeing 787 when I first began to write this editorial and wondered about the analogous questions from other industries. Did I really want a trained pilot in the cockpit? Could not anyone train on simulators enough to achieve competence in handling any airplane? What if someone put in sufficient hours of simulator and supervised flight time, might they then be given the controls of my 787? And the answer was that with enough training anyone can become sufficiently competent to perform any procedure in medicine.