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OBJECTIVE The assessment of clinical skills was created that evaluates House Officer performance within 13 clinical domains during the Cardiac Anesthesiology rotation to provide an assessment and evaluation process for residents while performing a cardiac anesthetic. DESIGN A retrospective evaluation of performance assessments over a 33-month period. SETTING University hospital-based Accreditation Council for Graduate Medical Education accredited Residency Training program. PARTICIPANTS Anesthesiology house officers within the Department Residency Program. INTERVENTIONS This House Officer Clinical Assessment was created and implemented as residents rotated through the cardiac anesthesia service. Scores in 13 domain-specific components from this assessment were collected after the attending-resident debrief. MEASUREMENTS AND MAIN RESULTS Most scores were found to be sufficient to suggest competency, and the evaluation allowed for a more detailed approach to assessment and feedback. The most common aspects of the case in which the residents showed reduced performance and proficiency were the transition off cardiopulmonary bypass and the performance of the transesophageal echocardiogram. Overall, the resident survey showed a positive response to the assessment and the feedback provided during the post-examination debrief. CONCLUSION The House Officer Clinical Assessment in Cardiac Anesthesiology allows for a more objective assessment of performance for specific portions of the case and allows for improved feedback on performance. Aspects of the evaluation tool and where residents correlate with the Anesthesiology Milestones for residency are discussed, as well as the ability to determine sufficient proficiency with knowledge and skills over the use of subjective rank to determine competency.