Author: Elizabeth M. Chawla, MD, Director of Clinical Faculty Affairs for MedStar Health
As we begin our third year of the MEM column this month, we turn our attention to a new topic this year: Best Practices for Feedback and Assessment in Medical Education. Before we dive too deeply into the various types of feedback and assessment, it is important to start with a shared understanding of the Competency-Based Medical Education (CBME) framework. All of our future discussions about assessment this year will be grounded in this framework, which puts patient care at the center of individual trainees’ learning needs.
What is Competency-Based Medical Education (CBME)?
You may have heard the term Competency-Based Medical Education (CBME) before, but what does that mean? CBME is an outcomes-based approach to medical education and assessment that starts with the end in mind: patient care. The goal of CBME is to ensure that all trainees achieve patient-centered outcomes during their training. Starting with the desired end result of excellent patient care, each specialty breaks down learning into components that are needed to achieve competence in providing quality care for that specialty. These components may be described as observable behaviors such as Milestones, or as a more global picture of what it means to provide competent care such as Entrustable Professional Activities (EPAs). [More on these to come!]. Instead of focusing on what content to teach, CBME focuses on what should be achieved – i.e. what does competence look like, and what knowledge and skills does each trainee need to reach that level of competence.
CBME also acknowledges that trainees learn and develop at different rates and uses continuous assessment to shape that learning. A trainee may excel in one area, such as procedural skills, but still has potential for growth in another, such as communication skills. A different trainee in the same program may excel in different areas and need growth in others. In this way, CBME is rooted in a growth mindset, understanding that all trainees are on their own path to competence and may need different educational opportunities to move along that path at their own pace. This framework can give faculty language to deliver individualized and productive feedback and can help trainees understand their own individualized learning plan.
The Value of CBME
The CBME approach better prepares trainees for the activities they will need in practice because:
It is comprehensive and thorough, focusing on the ability of a trainee to meet patient needs, which requires more than just medical knowledge and/or surgical technique
CBME assessment occurs in the workplace where trainees are working directly with patients
Future learning for trainees can be individualized and flexible, based on their unique needs
CBME can help programs define and address curricular gaps in helping trainees achieve competence
Check out these resources to learn more:
Competency-Based Health Professions Education as a QI Journey – ICE (International Clinician Educators) blog, published online Sept 3, 2026