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Competency-based medical education

An outcomes-based approach to the design, implementation, assessment and evaluation of a medical education program using an organizing framework of competencies.


An observable ability of a health professional related to a specific activity that integrates knowledge, skills, values, and attitudes. Since they are observable, competencies can be measured and assessed. They can be assembled like building blocks to facilitate progressive development.


Possessing the knowledge, skills and attitudes across multiple domains or aspects of performance in a certain context. Statements about competence require descriptive qualifiers to define the relevant abilities, context, and stage of training. Competence is multi-dimensional and dynamic, changing with time, experience and setting.

Entrustable Professional Activities (EPAs)

EPAs, as defined by ten Cate, are “those professional activities that together constitute the mass of critical elements that operationally define a profession”. It is the core of the profession that a patient or another provider could identify as what constitutes that physician’s professional tasks and role. EPAs require specific knowledge, attitudes and skills that are acquired through training. Each EPA is an observable, recognizable output that can be measured. They also reflect the competencies expected for the profession.


A milestone is a significant point in development. Milestones should enable the trainee, program and the certification board to know an individual’s trajectory of competency acquisition. The milestones define the floor of competence but do not eliminate the need for aspirational goals.

As part of the ACGME Next Accreditation System (NAS), the American Board of Internal Medicine (ABIM) and leaders of the Internal Medicine subspecialty societies developed 23 Subspecialty Reporting Milestones that will be used by program directors to assess their learners throughout their training. They are called the Reporting Milestones Order Online because they will be reported to the ACGME in aggregated fashion as part of the ACGME NAS.


Standardized descriptions that will be used to identify and describe residents as they move toward competence in a category. Program directors will NOT be asked to write individual narratives about each fellow.