Medical education is not static, but rather it is an evolutionary process. Continuous evolvement does not happen by accident, it takes foresight and flexibility. With unrelenting growth at its core, Fellowship training in the Department of Anesthesiology at Washington University provide depth and breadth in seven clinical practice areas and one in research. Each of these unique opportunities is designed to train future leaders in general clinical practice and in the subspecialties of anesthesiology. The goal is not only academic success- it is the development of a lifelong commitment to continued learning.