Somewhere on your campus there is a PDF named something like "competencies 2024" and a clerkship gradebook that still ranks students against each other. The PDF was updated for a committee. The gradebook runs the year. The question on a dean's desk is not whether competency-based medical education is a good idea. It is which competency set you are running, and what has to change in the map, in assessment, and in what you can report this term.
This guide is the operating protocol for MD-program deans: name the set, change the three records (curriculum, assessment, reporting), name the people who own them, and catch the failure points after kickoff. It is not a collection of school success stories, and it is not a product tour. For the LCME document set, owners, and backward timeline, use the companion Evidence article Managing LCME Accreditation.
Verified September 1, 2026 against AAMC CBME, Core EPAs, Curriculum Resources, and LCME. Sources at the end.
What does CBME change, if it is not a new poster?
It changes three operating records: where named competencies are taught, how they are assessed over time, and what a dean can report from those records this term. A list of competencies that is not attached to sessions, observations, and decisions is a poster.
The AAMC defines competency-based medical education as an outcomes-based approach to the design, implementation, and evaluation of education programs and to the assessment of learners across the continuum that uses competencies or observable abilities. The stated goal is that all learners achieve the desired patient-centered outcomes during their training. That sentence is useful only if you can point at the outcomes you named, the assessments that measure them, and the experiences that are supposed to produce them. If you cannot, you do not have CBME yet. You have a document.
A 30-second check. Open the competencies PDF your curriculum committee last approved. Open last year's clerkship grade spreadsheet. If you cannot walk from one competency on the PDF to the assessments that actually graded students against it, that is the first row of work, and it is due this term, not in visit year.
Which competency set are we actually running?
Name one, in writing, with an owner. Running both Foundational Competencies and Core EPAs without saying which assessments attach to produces two maps and no decisions.
| Object | Whose document | Dated facts | What it is not |
|---|---|---|---|
| Foundational Competencies for Undergraduate Medical Education | AAMC, AACOM, and ACGME | Released in December 2024. Expected outcomes for all medical students, regardless of degree type and future specialty. | LCME element text |
| Core Entrustable Professional Activities for Entering Residency | AAMC | Published in May 2014 as 13 Core EPAs. A 10-school UME pilot ended in 2021. Summary released in September 2022. Use is currently being evaluated in light of the 2024 competencies. | A current LCME checkbox |
The 2024 domains, from the AAMC CBME page:
| Six broad areas |
|---|
| Professionalism |
| Patient care and procedural skills |
| Medical knowledge |
| Practice-based learning and improvement |
| Interpersonal and communication skills |
| Systems-based practice |
The AAMC, the American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education released Foundational Competencies for Undergraduate Medical Education in December 2024. The AAMC published 13 Core Entrustable Professional Activities for Entering Residency in May 2014. A 10-school pilot on implementing them in undergraduate medical education ended in 2021; the AAMC released a summary in September 2022. On the AAMC's own CBME page, use of the Core EPAs is currently being evaluated in light of the release of the Foundational Competencies in 2024.
Pick the set your committees will actually use this academic year. If you keep Core EPAs as local workplace activities under the 2024 domains, write that relationship down. If you have not adopted Core EPAs, do not buy a module that assumes you did.
Are Core EPAs an LCME requirement?
No. They are an AAMC member-organization framework. LCME accreditation is judged against Functions and Structure of a Medical School.
| Member-organization frameworks | LCME | |
|---|---|---|
| Job | Name outcomes a school can teach and assess | Judge the MD program against Functions and Structure |
| Official source | AAMC pages named in Sources | The LCME Secretariat and the publications on lcme.org are the only official sources on policies, procedures, and the intent of elements |
| Professional competencies | Foundational Competencies and, if you adopt them, Core EPAs | Programs must demonstrate graduates exhibit general professional competencies that are appropriate for entry to the next stage of training and serve as the foundation for lifelong learning and proficient medical care |
| Treating one as the other | Imports a 2014 AAMC pilot into the accreditor's document set | Will not survive a survey team reading this year's Functions and Structure |
Confirm with your LCME survey contact which edition governs your visit. Put a standing annual task on the accreditation lead to diff the Change Log against your tracker. Publication dates and the 2028-29 draft sit in Sources. Do not invent current element numbers.
What this is not
Treating Core EPAs as a current LCME checkbox is a category error. The LCME professional-competency sentence above is not the same thing as adopting the 13 Core EPAs.
What actually changes in the curriculum?
Every required course, session, and clerkship has to name which competencies it teaches and which it assesses, in a map people can search this term. If the map exists only as a visit-year export, it is not a curriculum. It is a reconstruction.
The work is backward:
| Step | What you name |
|---|---|
| 1 | The graduate outcomes you actually adopted |
| 2 | The assessments that would count as evidence |
| 3 | The experiences that are supposed to produce that evidence |
Gaps that show up here (a domain with teaching and no assessment, or assessment with no teaching) are curriculum problems you can fix in the next block. Gaps that show up in visit year are findings.
The AAMC Curriculum Resources page states that the AAMC is no longer collecting curriculum mapping data via the Curriculum Inventory Portal, and that the curriculum inventory standards and vocabulary lists remain available for school and vendor use. Keep a shared vocabulary for instructional and assessment methods because your curriculum committee still needs it. Do not keep a dead portal workflow. Faculty will not email IT to find out whether a concept is already taught. If course directors cannot open the current map without a specialist, the map is already stale.
This guide recommends a simple test: pick one Foundational Competency domain. Can a stranger find where it is taught this term, where it is assessed, and who owns the gap if either is missing? If the answer is a folder of last year's PDFs, you are not mapping. You are archiving.
What actually changes in assessment?
Isolated exams and a single clerkship grade are not enough. You need multiple observations, over time, from more than one setting, that a committee can read as evidence for a decision.
That is the operational meaning of programmatic assessment: frequent, lower-stakes data feeding a later high-stakes judgment, not one structured clinical exam standing in for a competency.
Van Melle and colleagues, writing in Academic Medicine in 2019, named five core components of a CBME curriculum after an international Delphi. Use that list as a fidelity check on your own design, not as accreditation text.
| Van Melle 2019 component | If this is missing |
|---|---|
| Outcome competencies | You have a poster, not named outcomes |
| Sequenced progression | Checkpoints are missing or only exist at graduation |
| Tailored learning experiences | Every student gets the same path regardless of evidence |
| Competency-focused instruction | Teaching is still organized only by discipline hours |
| Programmatic assessment | One structured exam stands in for a competency |
If you have rewritten the outcomes poster and left the gradebook, clerkship comments, and promotion rules untouched, you have not implemented CBME. You have implemented one component.
| Decision | What changes |
|---|---|
| What is assessed | Observable abilities you named, in the settings where they actually occur, not only knowledge tests that happen to be easy to score |
| How often | Enough times, and early enough, that a student who is behind is visible while there is still a term left to work. A competency that is only scored at the end of fourth year is a surprise, not a program |
| By whom | More than one observer, and not only the faculty member who also assigns the clerkship grade. Direct observation, structured clinical exams, and multi-source feedback are methods. They are not a system until someone can see the set |
| Who decides | A named committee that reads the longitudinal record and makes a progression decision, with a written rule for what "enough evidence" means. Day-to-day supervision is not the same as a summative entrustment or promotion decision. Write down which one you are making |
Faculty development is not a single workshop. Observers have to share a scale, write comments a committee can use, and have time on the clock to observe. If observation is unpaid extra labor, you will get missing forms and late surprises. Assign domain champions who can train colleagues and escalate when a clerkship is not producing the data the committee needs.
What actually changes in reporting?
A dean should be able to answer, from current records, two questions: is this student progressing against the competencies we named, and where is the program thin. If either answer requires a data project, you do not have CBME reporting. You have a binder.
Reporting is the unglamorous third record, and it is where CBME usually dies. Curriculum maps live in one office. Evaluations live in another. The promotion committee reads a third packet assembled by hand. The LCME package, when it comes, is a fourth reconstruction. None of those systems will agree, because nobody was asked to make them agree.
| Level | What a working report looks like this term |
|---|---|
| Student | An advisor or competency committee can open one student's observations, exam results, and narrative comments against the competencies you named, without a custom export |
| Cohort | Curriculum leads can see which domains are under-assessed, which clerkships produce thin comments, and which sites are missing observations, in time to change the next block |
| Accreditation | The same evaluations and outcomes that feed student decisions are the evidence behind the professional-competency story in your LCME package. Narratives that contradict tables are a records problem, not a writing problem |
Do not wait for visit year to discover that clerkship comments cannot be joined to the competency list. Run the join now, on a masked sample, and write down what broke.
Do we have to make promotion time-variable?
Not as an LCME or AAMC mandate. Most MD programs will keep a four-year calendar and put competency checkpoints inside it. Pretending the calendar disappeared is how CBME dies in the registrar's office.
The AAMC's Education in Pediatrics Across the Continuum project tested the feasibility of a training model based on learners' demonstration of defined outcomes rather than on time, from early in medical school through the completion of residency. This past AAMC project ran from 2014-2023 with 5 medical schools and their affiliated pediatrics residency programs. That is a feasibility pilot, not a national requirement, and not a reason to tell faculty that "time no longer matters" while financial aid, the academic calendar, and residency Match still run on dates.
This guide's own rule: name the checkpoints that sit inside your existing years. Say what evidence the committee needs at each one. Say what happens when the evidence is thin (remediation with an owner and a date, not a surprise in April of fourth year). Time-variable advancement across the UME-GME boundary is a separate, rare design. Do not import it as rhetoric.
| Checkpoint inside the calendar you run | What the committee needs |
|---|---|
| End of pre-clerkship | Evidence against the domains you named, with owners for gaps |
| Mid-clerkship | Repeated observations from more than one setting, not one exam |
| Acting internship | Workplace evidence a later reader can find |
| Graduation | A written rule for "enough evidence," and a remediation path that already ran |
Who owns this after the kickoff?
The recurring pattern in programs that stall is not ignorance of CBME. It is that the work lives in one person's head, or in a committee that meets twice. The structure below is boring on purpose.
| Role | What they own |
|---|---|
| A named CBME lead with real authority | Usually an associate dean for curriculum or assessment, not a faculty volunteer. This person owns the framework decision, the map, the assessment calendar, and the escalation path to the dean. |
| Domain owners, in writing | Every domain in the competency set you named gets a person who can produce the teaching map and the assessment evidence, not the most senior person nearby. The owner list is a living document. Update it when people leave. |
| A standing assessment committee that actually reads data | Modeled on the idea of a clinical competency committee, even if you do not use that name. The committee's job is to make progression decisions from the longitudinal record, and to tell curriculum when a domain is under-assessed. A committee that only meets to confirm grades you already have is a grade review, not a competency committee. |
| A data steward for the join | Someone accountable for curriculum tags, evaluation forms, and outcomes staying internally consistent. Most painful CBME moments are not philosophical. They are a dashboard that cannot be traced to a form, or a narrative that cites a competency the form never scored. |
| The dean's visible sponsorship | Domain owners hit walls only the dean can remove: faculty time to observe, honest answers when a clerkship is not producing data, and a stop on running two grading philosophies at once. A kickoff where the dean personally charges the work is worth more than any tracking tool. |
Where it goes wrong after the kickoff
The failure points below are the ones that surface late, cost the most, and are cheapest to prevent early.
| Failure | Fix |
|---|---|
| The poster without the gradebook. Outcomes get rewritten. Clerkships still rank students against each other and file a final grade. Students learn which system actually counts. | Every high-stakes decision names the competency evidence it used, in the same term it was made. |
| Core EPAs as an LCME checkbox. A vendor or a committee treats the 2014 AAMC list as accreditation coverage. | Keep member-organization frameworks and LCME elements in separate columns. Confirm current element language in this year's Functions and Structure. Do not invent numbers from memory. |
| Two frameworks, no join. Foundational Competencies on the website, Core EPAs on clerkship cards, local objectives in the syllabus. | One crosswalk, owned, dated, and used by the people who write forms. |
| Assessment as a new exam. A structured clinical exam is added and declared "the competency assessment." | One structured exam is a method. It is not programmatic assessment. |
| Observation without time. Faculty are asked to observe and comment without clinical time being protected. You will get missing forms. | Observation is scheduled work, with a completion list a coordinator can act on in the term the clerkship ran. |
| Time-variable rhetoric, four-year operations. Speeches say students progress when ready. The registrar, financial aid, and the Match still need dates. | Write the checkpoints inside the calendar you actually run. |
| Reporting as a visit-year project. Maps, evaluations, and the LCME package are reconciled when a survey is scheduled. | The join is a standing monthly task for the data steward, on a masked sample, with gaps written down. |
| Single-person knowledge. The crosswalk, the form library, and the committee rules live in a personal drive. | Shared, access-controlled records. The day that person leaves, CBME should not return to being a PDF. |
The working list
Download the CBME dean working list (CSV) and import it into Excel or Google Sheets. Every task above is a row, grouped by framework, curriculum, assessment, reporting, and governance, with columns for the suggested owner, what "good" looks like, status, and notes. Put real names in the owner column at your next leadership meeting.
The list is a handoff into the standing process, not the system of record. If the join only exists in this spreadsheet, you still do not have CBME reporting.
Where this lives in Medtrics
Named owners and a standing process come first. The working list is a handoff into that process, not the system of record. In Medtrics, start at curriculum mapping.
Sources and status
This guide was verified on September 1, 2026 against the following sources. After publication, the current editions on lcme.org and aamc.org remain the only authoritative statements of any requirement or member-organization recommendation. The current Functions and Structure of a Medical School and Data Collection Instrument files were not retrievable this run. Pull this year's editions from lcme.org before you treat any summary, including this one, as a requirement.
- AAMC CBME: outcomes-based definition; Foundational Competencies released December 2024 across six broad areas; Core EPAs as a past 2014 initiative piloted at 10 schools from 2014-2021 and now being evaluated against the 2024 competencies; EPAC as a past 2014-2023 feasibility pilot. AAMC CBME
- AAMC Core EPAs: 13 Core EPAs published May 2014; 10-school pilot ended 2021; summary September 2022. AAMC Core EPAs
- AAMC Curriculum Resources: Curriculum Inventory Portal collection has ended; standards and vocabulary remain available; Curriculum SCOPE Survey from 2023. AAMC Curriculum Resources
- LCME About: Secretariat and lcme.org publications are the only official sources; programs must meet Functions and Structure; graduates must exhibit general professional competencies appropriate for entry to the next stage of training. lcme.org/about
- LCME Publications: as of March 9, 2026, publications are not on one page; standards are under the Resources tab. lcme.org/publications
- LCME homepage: public comment on the draft 2028-29 Functions and Structure. lcme.org
- LCME Substantive Changes to Publications, updated April 15, 2026. lcme.org/substantive-changes-to-publications
- Van Melle, Frank, Holmboe, Dagnone, Stockley, and Sherbino, Academic Medicine 2019: five core components of CBME implementation (outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, programmatic assessment). Implementation framework, not requirement text.
LCME, AAMC, AACOM, ACGME, and AMA are named descriptively. This article is an independent operational guide from Medtrics, not LCME or AAMC guidance, and nothing here promises any accreditation outcome. The work does that, or nothing does.