Determining the proficient level of performance for an individual skill and its decay over time is a challenge to readiness. Many procedural and cognitive skills relevant to healthcare professionals working in trauma and the operational environment do not have defined levels of performance nor are the sustainment of these skills well known. Leadership in the Defense Health Agency commissioned five leading universities to examine the skill proficiency in 20 select pre-hospital operationally relevant skills. Their charge was to develop skill proficiency levels in order to train future professionals to those levels. Once levels of proficiency are established, what are the next steps? Our panel of experts will describe the current state of determining skill proficiency and what methods we could employ to sustain those skills and mitigate decay. We will also introduce some exciting future technologies that will allow autonomous grading of skills and the creation of individual after action reports that can measure decay of skills over time. We will discuss how these concepts fit into the new Synthetic Training Environment (STE) currently being fielded by the US Armed Services.