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Competency-Based Medical Education (CBME)

Medical education is changing to meet the demands of our evolving health care system. One of these changes is the development and implementation of competency-based medical education (CBME).

CBME is an outcomes-based approach to the design, implementation, and evaluation of education programs and to the assessment of learners across the continuum that uses competencies or observable abilities. The goal of CBME is to ensure that all learners achieve the desired patient-centered outcomes during their training.

The AAMC has been a leader in CBME for more than two decades and continues to support the development and implementation of new competencies. Below, you will find resources from the AAMC and other organizations toward the design and use of CBME.

Foundational Competencies for Undergraduate Medical Education

The AAMC (Association of American Medical Colleges), the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) are making great progress in their joint initiative to create a common set of foundational competencies and are on track to release a draft for community reaction later in 2023. A new website has been launched to provide updates and to collect additional input from the community. Learn more about this initiative and share your feedback.

An initial draft of undergraduate medical education competencies was developed by a diverse working group and circulated in January 2024. Following feedback received from the community on the initial draft, a revised second draft was developed. The second draft of the competencies was circulated in April 2024, and community input was collected through May 10, 2024. This feedback will inform our next steps.

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AAMC New and Emerging Areas in Medicine Competency Series

The AAMC New and Emerging Areas in Medicine competency series was developed by leaders from across the medical education and clinical practice communities. These competencies are intended to add depth to key emerging areas to guide curricular and professional development, formative performance assessment, cross-continuum collaborations, and, ultimately, improvements in health care services and outcomes.

Diversity, Equity, and Inclusion (DEI) Competencies 

Academic medicine has a responsibility to prepare physicians that are culturally responsive, provide care that is equitable, and confront factors that drive racism, hate, and bias in health care. The AAMC, with a diverse advisory group and broad iterative input, has developed the Diversity, Equity, and Inclusion Competencies Across the Learning Continuum, the third set in its series titled “New and Emerging Areas in Medicine” for use across the continuum of medical education. Please direct any questions or comments to DEIcompetencies@aamc.org.

For information about how medical schools are addressing diversity, equity, inclusion, and anti-racism in the curriculum, see the data snapshot of the New, Emerging and Evolving Demands (NEEDs) in Medical Education Survey (PDF).

Telehealth and Virtual Care

Telehealth, defined as the use of technology to deliver health care at a distance, has become an increasingly important and commonly used tool for delivering care to patients. The Telehealth Competencies Across the Learning Continuum report provides background, a glossary, and context (including curricular models) for integrating and improving telehealth curricula in medical education. Please direct any questions or comments to telehealth@aamc.org.

Updated Quality Improvement and Patient Safety (QIPS) Competencies

In September 2022, an iterative revisioning process began to update the QIPS competencies. A diverse, 12-member interprofessional, cross-continuum committee was convened to revise the 2019 competencies under the counsel of several of the original competency committee members. This 12-month iterative process included a thorough literature review, discussion of each QIPS competency, and a public feedback process. The final competencies are now available, and the full report will be released in summer 2024. Please direct any questions or comments to QIPS@aamc.org.

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Other Contemporary Consensus Competencies, Priorities, and Guidance Resources

Below are several examples of additional resources available to educators across the health professions to inform and guide curricular efforts. These resources are not specialty-specific and have been developed nationally through systematic and inclusive consensus building processes.

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Opportunities for Engagement and Professional Development

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Highlights From the Development of CBME

Highlights From the Development of CBME

1996 – CanMEDS is released. This framework aims to improve patient care by enhancing physician training through defining the necessary competencies for all areas of medical practice and providing a comprehensive foundation for medical education and practice in Canada. It is formally adopted by the Royal College of Physicians and Surgeons of Canada in 1996 and refreshed in 2005 and 2015.

1998 – The Medical School Objectives Project begins. This initiative is designed to reach a consensus within the medical education community on the skills, attitudes, and knowledge that graduating medical students should possess. From 1998 to 2008, the AAMC also convenes expert consultants and panels to address special topics in medicine and offer their findings on learning objectives and educational strategies for all medical students in a series of Contemporary Issues in Medicine reports.

1999 – The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties endorse a set of six core competencies that define the foundational skills every practicing physician should possess. The competencies are used to shape and evaluate the education of residents.

2009 – The Education in Pediatrics Across the Continuum project is established to build a model for true CBME, with progression through training based on the achievement of competencies rather than the passage of time. Four schools test the feasibility of using a time-variable, outcomes-based model in pediatrics training. In 2021, this project expands to focus on time-variable progression and educational programming at the graduate medical education level.

2011 – The Interprofessional Education Collaborative (IPEC), consisting of six founding organizations including the AAMC, releases its initial core competencies for interprofessional collaborative practice. Since its inception, IPEC has become more inclusive, and it updates its core competencies in 2016. IPEC is currently updating its core competencies again in preparation for a 2023 release.

2012 – The ACGME launches the Next Accreditation System, which incorporates milestones into the core competency framework. Milestones use stages of professional development and provide descriptive, longitudinal narratives for the six core competencies.

2013 – The Physician Competency Reference Set (PCRS) is released. The PCRS may be used by medical schools in their curriculum mapping systems and in the design of their program objectives and assessments. 

2014 – A set of 13 Core Entrustable Professional Activities (EPAs) for Entering Residency is developed by a drafting panel convened by the AAMC. The Core EPAs are made up of the activities that a resident could be expected to perform with indirect supervision on the first day of residency. Also in 2014, the AAMC begins a 10-school pilot to assess the feasibility of implementing the Core EPAs in undergraduate medical education. The pilot activities are completed in 2021.

2017 – The AAMC begins its AAMC New and Emerging Areas in Medicine competency series. This series includes competencies focused on QIPS (released in 2019), telehealth (released in 2020), and DEI (scheduled to be released in early 2022).

2018 – The ACGME Milestones 2.0 work begins. It includes expert development groups convened to develop cross-specialty “harmonized” milestones for Interpersonal and Communication Skills, Problem-Based Learning and Improvement, Professionalism, and Systems-Based Practice.

2020 – Action Plan 1 of the AAMC Strategic Plan is announced. This action plan focuses on strengthening the medical education continuum to transform the health care and learning environments. CBME is a key theme for the projects and activities supporting this action plan.

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