The Accreditation Council for Graduate Medical Education (ACGME) established six core competencies for percutaneous coronary intervention (PCI) operators to standardize goals for fellowship curricula [ ]. These include medical knowledge, patient care and procedures, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication [ ]. Beyond fellowship, interventional cardiologists face a challenge in maintaining and improving skills and quality of care. Often, operators rely on maintenance of certification (MOC), departmental-level and hospital-level quality improvement measures, peers, and case conferences; however, none of these provide structured individualized feedback on performance. The importance of operator feedback comes from the variability in institutional experience and in procedural volume. Fanaroff et al., noted differences in unadjusted in-hospital mortality operators with lower PCI volumes at 1.86 % (<50 PCIs/yr), intermediate PCI volumes at 1.73 % (50–100 PCIs/yr) and high PCI volumes at 1.53 % (>100 PCIs/yr) when analyzing data from the National Cardiovascular Data Registry (NCDR) CathPCI registry [ ]. Given differences in case mix across operators, procedural volume may be too crude a measure for PCI quality.