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This manual was designed with the physician trainee (medical students, residents, fellows, and others) in mind as they work to achieve their educational and technical competencies. As such, you will see that each chapter has specific areas of text that are subdivided into what a trainee at various levels of competency should be able to understand and perform. Green boxes represent beginner level competencies, yel-low boxes represent intermediate level competencies, and red boxes represent advanced level competencies that should be skillfully mastered as a physician enters independent practice.