It is our vision to be leaders in education and create innovative practices in anesthesiology and perioperative medicine. Our department has been at the forefront of simulation education and research, culminating in our designation as an approved MOCA center by the ABA. We are continuing down this exciting path, immersing our residents and students in high-fidelity simulation to train them for high-acuity/low-frequency events. We have just acquired a simulator that will allow us to incorporate TEE images and pathology into our simulations. This is a powerful new tool that will aid in training our residents and faculty in basic TEE image acquisition and interpretation while adding to our ability to recreate complex cardiac simulations. We are also actively expanding resident involvement in pain management and perioperative medicine. It is truly the future of our specialty to be providing comprehensive high-quality care to complex patients from admission to discharge to improve their outcomes.