A minimum number of procedures is necessary, but this is not sufficient to prepare a trainee for a career in cardiac catheterization and intervention. Also important to a successful career, and perhaps more crucial, are technical facility and good clinical judgment. During advanced training the trainee must acquire sophisticated skills in complex catheter manipulations, wire and sheath exchanges, device implantation techniques, and retrievals. Furthermore, good clinical judgment regarding the indications for and against intervention require a thorough knowledge of the natural history of congenital cardiac defects (5- 6), and of the medical, catheter, and surgical options available for treatment. It is the responsibility of the training program director to assure that each advanced trainee graduates with the technical skills, clinical judgment, and cognitive knowledge to pursue an independent career in pediatric cardiac catheterization.