Resident education is both, a science and an art. Quality and homogeneity of resident education has a considerable correlation with patient safety. This article appraises how formal training in anesthesiology was started in United States and how it has evolved over the years. A comprehensive literature search was performed to identify journal articles, periodicals and historic documents that detailed the development and progression of academic anesthesiology. Various Anesthesiology Departments were also consulted. In 1927 Dr. Waters established the first ever academic department of Anesthesiology at the University of Wisconsin, Madison. The graduates from that residency programs, the so called “Aqualumni” went on to establish residency programs throughout the country. In 1938 American Board of Anesthesiology was formed, elevating the level of anesthesiology to a distinct specialty. World War II and post war era was a period of rapid growth in anesthesiology in general and academic anesthesiology in particular. In late 1970’s and early 80’s American College of Graduate Medical Education (ACGME) closely regulated the anesthesiology residency programs by recommending minimum program requirements. Over the years the training model has transformed from a relatively heterogeneous one to a uniform outcome based model with focus on learning and teaching of 6 core competencies. This article explores how the anesthesiology education evolved throughout 20th century to its present form.