With new staff orientation, implementation of a new process or procedure, and at regular intervals, usually annually, competencies are administered to review and measure employee compliance and maintenance of understanding. For annual review, topics such as safety, financial and privacy compliance, and core values are sometimes offered with a pre-test. A pre-test score of 100% accuracy allows the employee to skip the review.

Clinical and technical skills usually require a proficiency exam annually and at implementation of a change.