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The use of simulation to imitate real-life scenarios reaches back many centuries. In the last decade, the use of simulation in healthcare has gained acceptance as a valuable tool for teaching and learning technical and nontechnical skills in healthcare. The use of simulation technology has moved medical education from the standard of pen and paper examinations to the assessment of clinical competency before caring for patients. The old thinking of "see one, do one, teach one" is behind us as healthcare works to create a culture of safety that holds healthcare personnel accountable. A current use of testing clinical competence is the use of Objective Structured Clinical Examination (OSCE) by physician training programs. As a testing tool, the OSCE has great potential to assess the clinical competence of students before they enter the clinical setting. The nurse anesthesia program at the authors' university has moved toward creating a formal assessment to ensure clinical competence of their student registered nurse anesthetists. In this article, we describe the development and implementation of an OSCE to ensure clinical competence of first-year student registered nurse anesthetists before they begin their clinical training.