This presentation discusses using simulation for competency-based assessment of pediatric residents. More pediatric residency programs are developing simulation curricula to meet ACGME's Milestones Project for competency-based assessment. Simulation offers opportunities for structured assessment. The presentation proposes a study to identify gaps in existing assessment methods and opportunities for simulation-based assessment through a consensus-building exercise with pediatric simulation experts. It outlines plans to survey experts to prioritize Milestone subcompetencies for simulation-based assessment and review current assessment tools to define a research agenda.