Otitis media with effusion (OME) is one of the most frequent pediatric diagnoses and is also one of the most common indications for medical or surgical intervention in this age group. Pneumatic otoscopy is the standard for physical diagnosis of a middle ear effusion. We report on our experience with a validation program for otolaryngology-head and neck surgery residents in the use of pneumatic otoscopy to diagnose OME. Four PGY 2 residents sequentially completed a 4 month clinical and didactic training program in pneumatic otoscopy. The trainee sequentially performs pneumatic otoscopy, otomicroscopy, and myringotomy on each patient scheduled for a myringotomy and tube placement the morning of surgery. After each task the trainee is required to state if an effusion is present or not, and the accuracy of the diagnosis is immediately reinforced at the time of myringotomy. The trainee's sensitivity and specificity in diagnosing OME is then calculated for the first and second half of the study period. The trainee is validated in pneumatic otoscopy if the sensitivity is > 80% and > 70% respectively, and the trainee is validated in otomicroscopy if the sensitivity and specificity is > 90% and > 80% respectively. Four residents completed the protocol, and a total of 275 ears were examined. Four residents were validated in pneumatic otoscopy, and three residents were validated in otomicroscopy. We conclude that this protocol allows for accurate documentation of the resident's skill progression and enhances resident education.