While some medical specialties will be incorporating Entrustable Professional Activities (EPAs) into initial certification decisions for their residents and fellows in the next couple of years, others are exploring how Competency-Based Medical Education (CBME) might be addressed in their specialty.
American Board of Medical Specialties (ABMS) Member Boards are collaborating with others in their respective specialties by supporting CBME pilot projects developing EPAs; or convening the specialty-specific educational community, specialty societies, and other interested parties to determine how best to move the outcomes-oriented approach forward. The following are examples of how different boards are accelerating and exploring the adoption of CBME.
Supporting EPA Pilots
The American Board of Plastic Surgery (ABPS) is supporting a CBME pilot at four plastic surgery residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). The pilots were led by a consortium composed of the original three residency programs: the University of Pittsburgh, Texas A&M College of Medicine – Scott & White, and the University of Michigan, which were later joined by Johns Hopkins University. The University of Pittsburgh’s first resident graduated in 2024 followed by Johns Hopkins University’s first residents who graduated in 2025; Texas A&M College of Medicine – Scott & White will graduate its first residents in 2028. The University of Michigan withdrew from the pilot in 2021. The consortium developed a curriculum with assessments approved under ACGME’s Advancing Innovation in Residency Education pilot. Components of the pilot include 360o evaluations, in-training examination metrics, plastic surgery operative logs, modular exams based on the ACGME Plastic Surgery Milestones, professional development coaching for the residents, and a surgical skills evaluation tool. The Clinical Competency Committee (CCC) uses modular exams, a mobile application powered by the Society for Improving Professional Learning (SIMPL), and end-of-rotation evaluations to determine competency.
The consortium, along with ABPS, is evaluating the pilot results. Based on preliminary results at one institution, two classes with three residents per year have graduated. Three residents were “on target,” deemed clinically competent at five years, one year earlier than traditional training in plastic surgery. One resident did a research year, one did a fellowship, and one deferred graduation and eventually did a fellowship. Two residents were “in range,” but chose to defer graduation. Only one resident was “not on target” and finished the full six years of training and went on to practice. ABPS has incorporated the CBME model into its current acceptable requisite training requirements. The board is tracking the participating residents’ performance on its Written and Oral Examinations and eventually on its Continuous Certification Self-Assessments. ABPS is also collaborating on an EPA Task Force to launch a national pilot among approximately 20 residency programs planned for spring 2027.
The American Board of Pathology (ABPath) is supportive of two ongoing CBME EPA pilot programs. One pilot is being conducted by the EPA Working Group, a collaboration between the Association of Pathology Chairs and the College of American Pathologists’ Graduate Medical Education Committee, of which ABPath is a member. The pilot set out to validate four EPAs in six pathology residency programs in 2021. (Nineteen EPAs for anatomic and clinical pathology that align with the ACGME Milestones were developed in 2017 and published in 2018.) Residents reported receiving more frequent assessments and valuable feedback from faculty than in the past. Program Directors (PDs) indicated an increased understanding of resident strengths, abilities, and weaknesses. In 2025, the pilot was expanded to 10 EPAs. This year, the assessment tool was upgraded to a more robust app-based reporting tool than the one previously used. Current projects involve faculty training.
The Promotion in Place pilot for pathology at Massachusetts General Hospital began in 2021. During the four years, 24 of the 30 residents qualified to graduate early and became credentialed, board-eligible junior attendings in a period of “sheltered independence,” which offers less supervision than in training while the residents remained at the hospital. Seventeen of the 24 residents did that. Eleven of the 17 residents spent nine weeks, on average, in sheltered independence as junior attendings in various anatomic and clinical pathology roles. All residents passed their board exams on the initial attempt. These residents demonstrated competence for independent practice before the time-based completion of their residency training. Although the pilot has ended, the pathology department is committed to using the CBME model to determine whether it is sustainable.
Additionally, ABPath is piloting and exploring other competency-based assessments (CBAs), including simulation, that will complement EPAs. The board has also approved pilot initiatives to re-evaluate the length, format, and content of primary and subspecialty certification exams; pilot in-training CBAs to provide formative and summative feedback to trainees and PDs prior to the primary certification exam; and assess the relationship between CBA and certification.
The American Board of Allergy and Immunology (ABAI) and the ACGME Review Committee (RC) for Allergy and Immunology formed a CBME Working Group in 2022, convening key leaders for strategic implementation of CBME in the specialty. An action plan was developed outlining multi-year phases beginning with exploration and discovery. The plan calls for educating all interested parties in the specialty, discovering lessons learned from CBME implementation, and including CBME core components into the ACGME allergy-immunology program requirement revision that was already in progress. ACGME and ABAI are also planning to harmonize requirements, reporting, documentation, attestations, and goals for both fellowship program certification and new ABAI physician certification.
As part of an ABMS Scholar’s research project (See ABMS Scholars Set Out to Reframe Medical Education), seven EPAs were developed and mapped to the ACGME Milestones and are being piloted at the University of Virginia. Next steps include expanding the pilot to additional institutions and adapting it to a scalable automation platform.
While the Working Group published an update to the community in the May 2026 issue of Annals of Allergy, Asthma & Immunology, ABAI leaders are engaging specialty society leaders to discuss partnership opportunities for implementation.
Working in collaboration with the Thoracic Surgery Directors Association (TSDA), ACGME RC for Thoracic Surgery, and Thoracic Surgery Residents Association, the American Board of Thoracic Surgery (ABTS) has initiated a pilot program of seven EPAs at 15 cardiothoracic surgery residency programs. Official roll-out of the initiative to the remaining thoracic surgery training programs will be staggered and is scheduled to begin late summer. While ABTS is underwriting the cost of the pilot for the next three years, TSDA is taking the lead on faculty development.
In 2021, the American Board of Emergency Medicine (ABEM) began exploring CBME as part of its Becoming Certified Initiative. The board conducted surveys of board certified emergency medicine (EM) physicians, PDs, and the public, as well as ran focus groups with physicians, PDs, emergency physician employers, EM societies, and its Stakeholder Advisory Group. ABEM’s primary interest in the CBME space centers on defining terminal outcome competencies that establish a resident’s sufficiency for board eligibility. The board is focused on aligning GME outcomes with board certification standards. In 2023, ABEM convened a summit to develop a specialty-wide strategy for CBME and subsequently formed a CBME Steering Committee to further this work.
Additionally, in 2021, the American Medical Association’s (AMA) Reimagining Residency initiative began piloting 22 EM-focused EPAs. The pilot began in eight EM residency programs and has grown to include 15, with more onboarding. Developed for the pilot, the EPAs were drafted using a rigorous expert consensus process with broad input and mapped to the ACGME Milestones. However, they have not been formally adopted by national EM organizations. An app-based assessment tool powered by SIMPL is used in the CCC decision-making processes and to provide feedback to residents via individualized learning plans. To date, the pilot has significantly increased the number of assessments for residents. Residents and faculty alike rate both the process and the increased availability of performance feedback favorably. The pilot is scheduled to end this year.
Developing EPAs
In addition to those Member Boards piloting EPAs, others are currently focusing their efforts on EPA development.
In 2023, the American Board of Medical Genetics and Genomics (ABMGG) convened a CBME Task Force composed of representatives from the Association of Professors of Human and Medical Genetics (APHMG), American College of Medical Genetics and Genomics, and ACGME RC for MGG, as well as residency and lab fellowship PDs. Developing EPAs was a key agenda item. Task force co-chairs attended an EPA Facilitators Retreat hosted by the American Board of Surgery to learn about developing EPAs.
Three writing groups for EPAs were established: one for the medical specialties/subspecialties (MGG and Medical Biochemical Genetics) and one each for the two laboratory specialties (Clinical Biochemical Genetics, and Laboratory Genetics and Genomics). Each writing group has drafted one to two EPAs, which will be mapped to the ACGME Milestones and core competencies. Once the EPAs have been reviewed and approved, they will be pilot tested by programs not involved in their development. The review and pilot phases will include trainees from each specialty. In May, this process was presented at the APHMG annual meeting attended by PDs from each specialty/subspecialty and was well received.
In 2023, the American Board of Urology (ABU) began discussions with the Chair of the ACGME RC for Urology about a pilot study of five EPAs – one for each year of urologic training. ABU has contacted urologic colleagues in Canada to obtain their EPAs to help with the EPA selection process. While ABU, the ACGME RC, and the Society of Academic Urologists (SAU) are working closely to support the exploration of EPAs, ABU and SAU are taking the lead. Using a Delphi analysis, they have identified five to ten content domains suitable for EPA development. SAU has created an internal workgroup and is now narrowing its focus to two or three areas that will become the basis for the urologic EPAs. Once the EPAs are developed and approved, a pilot program will be implemented.
Since 2021, the American Board of Obstetrics and Gynecology (ABOG) has been collaborating with ACGME, the American College of Obstetricians and Gynecologists, the Council on Resident Education in Obstetrics and Gynecology, and their osteopathic counterparts to determine how CBME can serve as a guiding philosophy for residency training and initial certification. In 2025, the GME Summit, which is annually convened by ABOG, was designed to share plans for moving forward with CBME with a broad group of relevant leaders and to gather their perspectives on potential pathways, processes, and change management strategies. This year, ABOG began convening the CBME Steering Committee, a multi-organizational leadership group, to help drive CBME-focused initiatives in OB-GYN. The Steering Committee held its first in-person meeting in March. This summer, it began work to delineate a set of EPAs for OB-GYN.
Convening interested parties
Other Member Boards are not focusing on EPAs, but rather on convening interested parties to determine the benefits and implications of CBME on their specialties.
The American Board of Physical Medicine and Rehabilitation conducted a survey of PDs to determine the frequency of graduating residents for whom there were concerns about readiness for independent practice. After sharing the results with its specialty society partners, the board is convening a specialty-specific team with society representatives to discuss further development of CBME for the specialty.
In 2025, the American Board of Psychiatry and Neurology held a Crucial Issues Forum on Improving Outcomes Assessments in GME. Informed by that Forum and ongoing discussions with major professional societies and other colleagues, the board is considering funding external investigators to advance the evidence base regarding the usefulness and feasibility of EPAs in the board’s primary specialties.
The American Board of Anesthesiology (ABA) stands ready to collaborate on defining outcomes and aligning them with certification expectations as CBME advances in the specialty. Consistent with its role as a certifying board, ABA’s focus is on supporting training programs with optional assessment tools and resources such as the In-Training Examination, content outlines, and sample scenarios rather than creating a separate national EPA requirement. While anesthesiology GME already incorporates entrustment decisions through graduated autonomy and case assignments, ABA has several elements of CBME embedded into its current assessment/certification paradigm. These include bi-annual Clinical Competence Evaluations and a staged examination process, which allow for longitudinal assessments during training. After graduation, the APPLIED Exam, which is the final step for initial certification, includes performance-based assessments through the Standardized Oral Examination and Objective Structured Clinical Examination.
Whether in the implementation phase or a state of exploration, ABMS Member Boards are committed to working with the broader, specialty-specific educational community and specialty societies to move CBME forward as the outcomes-oriented approach continues to gain momentum across the specialties.
© 2026 American Board of Medical Specialties
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