By Benjamin Kinnear, MD, PhD, MEd, Professor of Internal Medicine and Pediatrics, and Program Director of the Med-Peds Residency Program at Cincinnati Children’s Hospital Medical Center/University of Cincinnati Medical Center
For the past five years, the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties (ABMS) have held bi-annual symposia aimed at promoting and supporting Competency-Based Medical Education (CBME) initiatives at the level of accrediting and certifying organizations. The symposia – known as the ACGME-ABMS CBME Learning Community – are attended by multiple ABMS Member Boards, ACGME, and several other organizations such as the American Medical Association and National Board of Medical Examiners. It serves as a community of practice that shares CBME experiences, innovations, and ideas within and across medical and surgical specialties. Why are these symposia needed and what has been the outcome?
Since the Flexner Report in 1910, medical education had been focused on standardization of curricula and training processes, with less focus on outcomes per se. CBME is an outcomes-focused philosophy of training that entered medicine’s zeitgeist in the 1970s as a way to improve accountability to the public. CBME advocates for starting with the needs of patients and society, and using those needs to define necessary training outcomes to develop health professionals who can deliver on those needs. It requires the use of multimodal assessment systems to ascertain (as best as possible) when trainees have met those training outcomes. At a high level, this sounds straightforward. But implementation can be challenging.
CBME is often conceptualized as having five consensus-derived core components: defined outcomes of training, sequenced progression of competence, programmatic assessment, competency-focused instruction, and tailored learning experiences. These components can be operationalized in flexible, context-specific manners, meaning CBME may be implemented variably depending on local needs. This can be a blessing and a curse. While flexibility can allow for innovation and context-sensitive adaptations, it also makes broad implementation and cross-specialty knowledge sharing challenging. The ACGME-ABMS symposia have served as a crucible to mitigate such challenges.
These symposia have used inter-board mentorship, technology sharing, and reports from the field to catalyze CBME efforts across specialties. Early symposia focused on the why of CBME and creating a vision for integrating competency-based approaches into accreditation and certification. Many Member Boards have since progressed toward the how of implementation and program evaluation. Trainees from multiple specialties have also attended these symposia and led discussions on how CBME impacts learners. Discussions have ranged across the core CBME components – from how to define training outcomes for a specialty to the boundary-pushing concept of time-variable training (not a core component, but a potential corollary of full CBME implementation).
Every year the symposium’s discourse advances, and relationships across organizations strengthen. A few lessons stand out. First, CBME implementation must be context sensitive. CBME in surgery may look different than it does in pediatrics, but the aforementioned core components can serve as guiding principles that can be flexibly implemented across specialties. Second, progress is sometimes slow and requires many iterations. Several symposium attendees have used tools from quality improvement or implementation science to iteratively explore the best strategies within specialties. Grit, persistence, and curiosity pay off in the long term. Third, the learner’s voice should play a central role in implementation. Co-creation with trainees is critical to ensure CBME is serving them well and having the intended impact. When it does not serve learners well, refinement or reimagination is necessary. Fourth, some discussions have centered around non-core components such as time-variable training. Time variability may be a corollary of outcomes-based training, but it is not specifically a core component. Organizations or programs that are still nascent in their CBME journey might benefit from focusing on other core components (e.g., defining outcomes, programmatic assessment) and not focus on time variability early on. As CBME programs mature, time variability may emerge as an option, but it does not need to be the goal. Finally, many hands make the load light. Collaboration across specialties and organizations, with knowledge and technology sharing, can accelerate implementation efforts.
Certifying and accrediting bodies have a key role in helping training programs pursue CBME. The ACGME-ABMS symposia have helped shape the future of health professions education through community building and knowledge sharing.
“These symposia have used inter-board mentorship, technology sharing, and reports from the field to catalyze CBME efforts across specialties.”
© 2026 American Board of Medical Specialties
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