cared for troops in France. From 1914 to 1915, three years prior to America entering the war, Dr. George Crile and nurse anesthetists Agatha Hodgins and Mabel Littleton served in the Lakeside Unit at the American Ambulance at Neuilly-sur-Seine in France. In addition, they helped train the French and British nurses and physicians in anesthesia care. In 1917, the American participation in the war resulted in the U.S. military training nurse anesthetists for service. The Army and Navy sent nurses anesthesia trainees to various hospitals, including the Mayo Clinic at Rochester and the Lakeside Hospital in Cleveland before overseas service. Among notable nurse anesthetists are Sophie Gran Winton. She served with the Red Cross at an army hospital in Château-Thierry, France, and earned the French Croix de Guerre in addition to other service awards. In addition, Anne Penland was the first nurse anesthetist to serve on the British Front and was decorated by the British government. American nurse anesthetists also served in World War II and Korea. Second Lieutenant Mildred Irene Clark provided anesthesia for casualties from the Japanese attack on Pearl Harbor. During the Vietnam War, nurse anesthetists served as both CRNAs and flight nurses, and also developed new field equipment. Nurse anesthetists have been casualties of war. Lieutenants Kenneth R. Shoemaker, Jr. and Jerome E. Olmsted, were killed in an air evac mission en route to Qui Nhon, Vietnam. At least one nurse anesthetist was a prisoner of war. Army Nurse anesthetist Annie Mealer endured a three-year imprisonment by the Japanese in the Philippines, and was released in 1945. During the Iraq War, nurse anesthetists provide care at forward positioned medical treatment facilities. In addition, they play a role in the continuing education and training of Department of Defense nurses and technicians in the care of wartime trauma patients. Certification Board certification and recertification process is governed by the National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA). The NBCRNA exists as an autonomous not-for-profit incorporated organization. CRNAs also have continuing education requirements and recertification check-ins every two years thereafter, plus any additional requirements of the state in which they practice. The new recertification pathway focuses on: maintenance of certification, lifelong learning, and continued competence. The Continued Professional Certification (CPC) Program consists of 8-year periods, and each period comprises two four-year cycles. Scope of practice The degree of independence or supervision by a licensed provider (physician, dentist,