The Transformational Path Ahead: Competency-Based Medical Education in Family Medicine

Competency-based medical education (CBME) is an outcomes-based approach that has taken root in residency training nationally and internationally. CBME explicitly places the patient, family, and community at the center of training with the primary goals of concomitantly improving both educational and clinical outcomes. Family medicine, as the foundational primary care discipline, has always embraced the importance of linking training with health system needs and performance since its inception. While CBME is no longer a new concept, full implementation of this outcomes-based approach has been daunting and challenging. Gaps in the effectiveness, safety, equity, efficiency, timeliness, and patient/family centeredness of health and health care in the United States continue to be persistent and pernicious. These gaps summon family medicine and the entire graduate medical education system to take stock of its current state and to examine how more fully embracing an outcomes-based educational approach can help to close these gaps. This article provides a brief history of the CBME movement, and more importantly, its key underlying educational principles and science. I will explore the key inflection points of progress, including identifying core CBME components, introduction of competency Milestones, experimental pilots of time variable training, advancements in mastery-based learning, and advances in work-based assessment, within the context of family medicine. I will conclude with suggestions for accelerating the adoption and implementation of CBME within family medicine residency training.