As Competency-Based Medical Education (CBME) – an outcomes-oriented approach to graduate medical education (GME) and assessment – extends across the medical specialties, American Board of Medical Specialties (ABMS) Member Boards are supporting its implementation by partnering with specialty organizations and other interested parties to ensure a smooth transition.
Two Member Boards are preparing for Entrustable Professional Activities (EPAs) to be incorporated into initial certification decisions for their residents and fellows by 2028, while two other boards have rolled out similarly aligned versions of EPAs to transition from time-based to outcomes-based training.
ABS’ CBME journey
In 2022, the American Board of Surgery (ABS) announced the move to competency-based assessment of surgical trainees with the introduction of the ABS Entrustable Professional Activities Project for general surgery residency programs. EPAs launched in 2023 for general surgery residency programs, and in 2025 for vascular surgery, pediatric surgery, complex general surgical oncology, and surgical critical care training programs.
The core EPAs break out as follows:
- 18 for general surgery
- 15 for vascular surgery
- 20 for pediatric surgery
- 12 for complex general surgical oncology
- 9 core EPAs and 4 optional ones for surgical critical care
To support trainee assessment, ABS worked with the Society for Improving Professional Learning (SIMPL) to develop the ABS EPA AppTM for general surgery and with Firefly to develop the ABS EPA App for surgical specialties. Both versions of the ABS EPA App, which ABS provides to surgical training programs at no cost, streamline the way trainees and faculty complete microassessments. The number of microassessments performed more than doubled in the first year following implementation as faculty and general surgery residents became more familiar with them. In addition, ABS has produced a full suite of resources for use during EPA implementation, including documents and guides, training videos, pre-recorded webinars, and presentations.
To help move the CBME framework forward in the surgical specialty, evidence is being collected to demonstrate that CBME helps identify gaps in residency training while a research consortium is being created to understand the impact of this approach on patient outcomes and the learning environment. The first resident cohort using the CBME model for general surgery will graduate in 2028, with subspecialties to follow.
ABP’s CBME champions
Like ABS, the American Board of Pediatrics (ABP) plans to incorporate EPAs into initial certification decision-making by 2028 as the specialty transitions to CBME. They include twelve General Pediatric EPAs, five EPAs that are common to all pediatric subspecialties, and between three and six unique EPAs for each pediatrics subspecialty.
In 2021, ABP announced the transition to an EPA-based certification process. Since that time, many training programs have begun using EPAs to guide their curricula and incorporate EPA-based assessment tools into their programs of assessment. ABP partnered with SIMPL to pilot a smartphone-based app to facilitate frontline assessment of EPAs in residency programs. Eighty general pediatric residency programs are participating in the pilot, and based on the success of this work, ABP is in the final stages of determining plans to support an app for frontline assessment at scale across the specialty.
From developing EPAs to piloting an assessment tool, ABP has partnered with the pediatric community at large. A key part of this partnership was establishing the CBME Champions program, a learning community of a diverse group of volunteers – primarily pediatric training program leaders – who meet remotely every month to discuss CBME implementation in their programs. Since the program’s start in 2024, the learning community’s focus has shifted from ABP-led discussions to Champions sharing their CBME experiences about enhancing frontline assessment, advancing equity in assessment, and implementing the core components of CBME, among other topics.
ABP offers several resources for training program leaders to assist in CBME implementation, including resources to convert EPA-based assessments to Accreditation Council for Graduate Medical Education (ACGME) Milestones and other materials to assist Clinical Competency Committees (CCCs), including a timeline of implementation expectations.
This spring, ABP began collecting program-level information – not trainee specific – about how training program directors (PDs) are using EPAs and CBME principles in their curricula and assessments of trainees’ readiness for practice.
ABFM’s Core Competencies for Board Eligibility
As family medicine residency programs began transitioning to CBME, the American Board of Family Medicine (ABFM) developed and published a Competency-Based Board Eligibility policy for all residents in 2023. This was based on a set of core outcomes – similar to EPAs adopted in other specialties – developed collaboratively with the ACGME Family Medicine Review Committee and other family medicine organizations. To meet ABFM board eligibility requirements, each resident must demonstrate competence in all 15 core outcomes. As part of the annual verification process, PDs, with input from their CCC, will attest that residents have met each core outcome.
In family medicine, the CBME requirement is part of a comprehensive residency redesign. ABFM Competency-Based Board Eligibility has been introduced gradually, expanding from five core outcomes in 2024, to nine in 2025, to fourteen in June 2026. Competency in the final 15th core outcome, focused on procedures, will be required for board eligibility beginning in 2027 with a Point-of-Care Ultrasound requirement coming later.
ABFM has continued to develop a comprehensive data system that includes the National Resident Survey reaching more than 99 percent of residents, a survey of PDs conducted during verification of board eligibility, and the National Graduate Survey (NGS) administered three years after graduation. The goal of the data system is to help shape the evolution of residency redesign with results being shared rapidly with PDs, academic organizations, and residents, as well as through publications.
The Society of Teachers of Family Medicine CBME Task Force has taken the lead in rolling out a national strategy for faculty development. The Task Force created free resources for all family medicine residency programs available through a CBME Toolkit. It includes a series of one-pagers about CBME implementation, an Outcome Assessment Starter Pack that links outcomes with program requirements and provides ideas for assessing those outcomes, an Individualized Learning Plan template, and a mobile app that maps direct observations to the ACGME Milestones. The Task Force worked with New Innovations and MedHub to create the mobile app. Last spring, the Task Force published a paper citing 13 recommendations for implementing CBME in family medicine. The Task Force has hosted webinars, conference presentations, and workshops at individual residency programs, all of which was funded by the ABFM Foundation.
The Association of Family Medicine Residency Directors has led webinars and an in-person workshop, and has also collaborated with ABFM on the Strengthening Outcomes and Assessment of Residency initiative, which includes an annual conference highlighting residencies identified with exemplary outcomes through the ABFM NGS, a web page for the learning community of PDs, and a fellowship program. In parallel, ABFM and its Foundation have also funded 31 residency learning networks focusing on clinical and/or educational transformation; more than 30 percent of all family medicine residencies are participating in these networks.
ABOS’ KSB Program
In 2018, the American Board of Orthopaedic Surgery (ABOS) launched its Knowledge, Skills & Behavior (ABOS KSB) Program to support the specialty’s shift to CBME. Following a pilot and soft launch, the ABOS KSB Program was onboarded to all orthopaedic surgery residents between 2023 and 2025.
The program consists of validated assessments in three areas:
- Knowledge: A yearly orthopaedic surgery in-training examination
- Surgical Skills: Case-by-case assessment of surgical skills
- Professional Behavior: End-of-rotation and yearly 360o assessments
Since July 2025, residents in orthopaedic programs have been required to participate in the ABOS KSB Program to be eligible to sit for the ABOS Part I Examination. It involves taking the American Academy of Orthopaedic Surgeons Orthopaedic In-Training Examination®, which is linked to the ABOS Part I Examination. Surgical Skills assessments are based on direct observation and real-time feedback from faculty using a surgical skills assessment tool that was developed by ABOS. Residents must also request end-of-rotation professional behavior assessments from faculty members. ABOS also provides residency programs with a 360o evaluation that is sent to faculty and residents and can also be sent to other healthcare professionals who interact with the residents. ABOS has partnered with ACGME to integrate case log entry into the ABOS KSB+ web portal and app, allowing residents to enter procedure logs and request ABOS KSB assessments all in the same place.
ABOS provides resources for PDs to produce ACGME Milestones reports with the ABOS KSB surgical skills and professional behavior assessments and incorporate ABOS KSB reports into the residents’ progress reviews. In the area of faculty development, the board offers an educational module on its website to assist faculty in providing high-quality formative feedback to residents. ABOS also offers resources for program coordinators, faculty, and residents.
As medical specialties embrace CBME, ABMS Member Boards are collaborating with specialty organizations and others rooted in GME and assessment to accelerate the transition from time-based to outcomes-based training.
© 2026 American Board of Medical Specialties
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