The Medical College of Wisconsins (MCW) Advanced Practice Provider (APP) Critical Care Fellowship is an intensive one-year program designed to train novice APPs in all areas of critical care. The program utilizes some aspects of competency based medical education (CBME) to assess and guide trainee progress (e.g., core competencies and phase progression), however the ground level utilization was inconsistent, and trainee intra-rotation phase progression often stagnated. The purpose of this process improvement project was to determine the issues and barriers surrounding the poor utilization of the competency-based assessment tools developed by MCW's APP Critical Care Fellowship, as well as to begin the incremental changes necessary to operationalize these systems, such that they may be utilized to guide fellow development and phase progression within the core intensive care unit (ICU) rotations.