CBME is Here – The Time is Now

Competency Based Medical Education (CBME) is here. The new Accreditation Council for Graduate Medical Education (ACGME) requirements started July 1, 2023, with explicit inclusion of competency-based medical education (CBME).¹

These new requirements call on programs to think differently about how we assess and educate our residents. Gone are the days of counting to equate competence. Instead, programs will need to lean into adapting their curriculum to develop assessment strategies that focus on competence, faculty development, and individualized learning plans (ILPs) among many other things, while also focusing on program structure and training that meets the needs of their community. These upcoming changes have brought the “family” of Family Medicine together to move toward successful implementation for residency programs, faculty, and residents.

We know CBME is not new. In 1999, the ACGME and the American Board of Medical Specialties (ABMS) endorsed the 6 known core competencies, and since then we have gradually been leaning into CBME.² There have been numerous articles outlining the importance of CBME, including Van Melle’s framework, with suggestions on implementation.³ Now the ABMS and ACGME are collaborating further to bring CBME to graduate medical education, and family medicine is one of the specialties leading the way.⁴

To think about how to implement CBME, we need to build successful residency curriculums in this new era and “start with the end in mind,” as stated by the American Board of Family Medicine (ABFM). Newton, et al recently published that end for Program Directors in the form of 12 “core outcomes.”⁵ Working together, the ABFM and the ACGME Family Medicine Review Committee established these outcomes.

We know that ACGME Milestones and core outcomes are different. Milestones describe performance levels residents are expected to demonstrate in the 6 Core Competencies in ACGME.⁶ The intent of the ABFM core outcomes is to combine ACGME competencies with the transition to independent practice.⁴ Both Milestones and core outcomes will need to be tracked to determine readiness, proficiency for autonomous practice, and for ABFM Board Eligibility.

The ABFM is explicitly shifting focus to competency-based Board Eligibility as GME shifts focus to CBME. Previously, program directors only had to attest residents completed residency, but starting June 2024 program directors will also have to attest that residents are competent in these newly established core outcomes.⁴ This can seem a daunting task for our residency community; however, the ABFM has outlined a timeline with suggested assessment strategies. Clinical competency committees (CCCs) and program directors are being asked to assess these core outcomes, rolling out 5 core outcomes over the next 3 years (Table 1).⁴

As Barr and Stutzman stated, “what none of us can do alone, we can definitely do together.”⁷ We will need to work together as a community to build assessments that address ACGME milestones and the core outcomes. Thankfully, there is much work already in progress and the community is ready to do the work. ABFM laid out examples of assessments for the first 5 core outcomes we need to assess over this year to attest by June 2024 for our graduates (Table 2).⁴ Additionally, look for resources from the Association of Family Medicine Residency Directors (AFMRD), including the program director toolbox, the member discussion forum, and upcoming webinars. For example, AFMRD-ABFM will have cohosted and recorded a CBME webinar in August that will be available to members. Other resources available outside the AFMRD, such as the ACGME Learn portal and the Society of Teachers of Family Medicine (STFM) Task Force on Assessment are looking to map ACGME competences to core outcomes, including other specialties, such as pediatrics. This work will require more evaluations and assessments of our residents, more direct observation, and more buy-in from residents themselves to help direct their own education in this transition to a more learner-centric model. We encourage each program to start planning early how they will meet these new expectations now. It can seem overwhelming when thinking of a complete overhaul of a program’s curricula in order to support CMBE, but we encourage programs to take smaller steps to start, which can include additional assessments, engaging faculty members in any of the above resources, planning with residents to have effective individual learning plans, and engaging the entire educational team in the new process. By supporting each other we WILL do this. The time is now.

• © 2023 Annals of Family Medicine, Inc.