Table 1.

Core Components Framework for Competency-Based Medical Education (CBME)^a

Component	Description	Perceived Gap(s)	Goals and Approaches
An outcomes-based competency framework	Desired outcomes of training are identified based on societal needs. Outcomes are paramount, meaning a graduate's abilities to function as an effective health professional.	Outcomes are often unclear or unique to the local needs of the program. Outcomes meet the arbitrary needs of the institution or program rather than standardized specialty outcomes.	Medical curriculum must be developed to meet the needs of the health care system and the populations it serves. Medical curriculum must ensure that all graduates are prepared for unsupervised practice in all the essential competencies.
Progressive sequencing of competencies	In CBME, competencies and their developmental markers must be explicitly sequenced to support learner progression from novice to master clinician. Sequencing must consider that some competencies form building blocks for the development of further competence. Progression is not always a smooth, predictable developmental curve.	Competencies are not always explicitly identified and may not follow sequential development from foundational to more advanced elements. Current curricular structures are not well designed to support progressive sequencing of the core competencies.	Programs should map specialty Milestones with curricular objectives to ensure all critical outcomes are taught (and assessed) in a developmental progression that promotes mastery learning. Curricular design and assessment programs must account for different rates of progression among learners.
Learning experiences tailored to competencies in CBME	Time is a resource, not a driver. Learning experiences should be sequenced in a way that supports the progression of competence. There must be flexibility in order to accommodate variation in individual learner progression. Learning experiences should resemble the practice environment. Learning experiences should be carefully selected to enable acquisition of one or many abilities. Most learning experiences should be tied to an essential graduate ability.	Time is seen as limiting factor for progression. Learning experiences may not reflect real-world opportunities or practice. Learners are grouped to provide streamlining of teaching (ie, all residents of the same training year get the same material at the same time, regardless of assessment of competency).	Ensure that learning venues have clearly defined curricular outcomes that align and enrich the program's curriculum. Leaning experiences must prepare learners for unsupervised practice and allow for competency rather than time-based progression. Use individualized learning plans to help learners identify strengths and weaknesses and tailor learning on an ongoing basis.
Teaching tailored to competencies	Clinical teaching emphasizes learning through experience and application, not just knowledge acquisition. Teachers use coaching techniques to diagnose a learner in clinical situations and give actionable feedback. Teaching is responsive to individual learner needs. Learners are actively engaged in determining their learning needs. Teachers and learners work together to solve complex clinical problems.	Focus of teaching is on knowledge acquisition with application being limited both in scope and perspective. Teaching is unidirectional with the responsibility to improve solely that of the learner. Learners' goals are driven by teachers' competency and priority with little input from the learner and irrespective of societal need.	Develop faculty development programs addressing competencies in: Feedback techniques that actively engage the learner. Coaching techniques that promote self-regulated learning and development of individualized learning plans aimed at promoting the unique developmental needs of each learner. Assessment informed by “shared mental models” that are literature informed/evidence-based and criteria referenced.
Programmatic assessment	There are multiple points and methods for data collection. Methods for data collection match the quality of the competency being assessed. Emphasis is on workplace observation. Emphasis is on providing personalized, timely, meaningful feedback. Progression is based on documentation of achievement. There is a robust system for decision-making.	Data collection is infrequent and often summative in nature. Emphasis is on general impressions and subject to numerous educational “effects” (eg, Recency, “Horns or Halo,” etc). Progression is based on time spent in training rather than demonstration of competency. Frame of reference (eg, standards, criteria) for assessment is unclear.	Utilize multiple assessments longitudinally across all learning venues to generate frequent and robust data. Ensure that assessments are “fit for purpose,” ensuring data generation that guides the desired professional development of learners. Ensure assessments sample across Miller's Pyramid with emphasis on the “does.”

^aAdapted from Reference 6.