This past July was a busy month for American Board of Medical Specialties (ABMS) Member Boards whose specialties are making the transition to competency-based medical education (CBME).
The American Board of Surgery (ABS) moved to competency-based assessment of surgical trainees with the introduction of the ABS Entrustable Professional Activities (EPA) Project for general surgery residency programs. The resident class completing training in 2028 will be the first to be required to provide attestation of entrustment decisions across 18 EPAs[PDF] as part of their application for the ABS certification process. EPAs are being developed for the other ABS specialties: vascular surgery, pediatric surgery, complex general surgical oncology, and surgical critical care. The vascular surgery EPAs are expected to launch in 2024, with the others to follow in the coming years.
Similarly, the American Board of Pediatrics (ABP) plans to incorporate EPAs into certification decision-making by 2028 for pediatric residents. They include 17 EPAs for general pediatrics[PDF], 7 EPAs that are common to all pediatric subspecialties, and between three and six unique EPAs for each pediatrics subspecialty. ABP is part of a partnership with program directors, pediatric departments, and the larger pediatrics community, and the discussion has now shifted to focus on addressing unresolved issues and broader implementation of EPAs in graduate medical education and certification processes. These efforts are being led, in part, by the ABP’s volunteer-based CBME Committee.
Working with the Association of Family Medicine Residency Directors and many other affiliated partners, the American Board of Family Medicine (ABFM) developed and published its competency-based board eligibility policy for all residents as family residency programs transitioned to CBME. This policy will be implemented over the next three years. In spring, ABFM collaborated with the Accreditation Council for Graduate Medical Education (ACGME) Family Medicine Review Committee, program directors, faculty, and residents to develop a list of proposed core outcomes, which are similar to the EPAs used in other specialties. The Review Committee will be working with ACGME to shape the data residencies must submit to align with the new standards – this may include resident and faculty surveys. A major focus moving forward is launching a national strategy for faculty development, in which the ABFM Foundation has been instrumental.
Beginning July 2025, residents in orthopaedic residency programs will be required to participate in the American Board of Orthopaedic Surgery Knowledge, Skills & Behavior (ABOS KSB) Program launched in 2018 to support the shift to CBME. The ABOS KSB Program assesses resident knowledge through the American Academy of Orthopaedic Surgeons Orthopaedic In-Training Examination® taken each year; surgical skills via observation and real-time feedback from faculty using a surgical skills assessment tool; and professional behavior at the end of every rotation by each faculty member plus a 360° evaluation consisting of multiple professional behavior assessments completed once a year. ABOS has also collaborated with ACGME to integrate case log entry into the ABOS KSB web portal and app.
As the implementation of CBME spreads across the disciplines, other Member Boards are working with myriad stakeholders to explore the benefits and impact of this framework in their specialties. (See ABMS Member Boards Pave the Way for CBME.)