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FIVE CORE Components of CBME

Research into the competency-based medical education (CBME) model has identified five core components of proper CBME systems: framework, progression, tailored experiences, competency-focused instruction, and programmatic assessment, described in further detail below by Van Melle (2016).


An Outcomes Competency Framework

  • Desired outcomes of training are identified based on societal needs
  • Outcomes are “king”, meaning: graduate abilities to function as an effective health professional

Progressive Sequencing of Competencies

  • In CBME, competencies and their developmental markers must be explicitly sequenced to support learner progression from novice to master clinician
  • Sequencing must take into account that some competencies form building blocks for the development of further competence
  • Progression is not always a smooth, predictable curve

Learning Experiences Tailored to Competencies In CBME

  • Time is a resource, not a driver
  • Learning experiences should be sequenced in a way that supports the progression of competence There must be flexibility in order to accommodate variation in individual learner progression
  • Learning experiences should resemble the practice environment
  • Learning experiences should be carefully selected to enable acquisition of one or many abilities
  • Most learning experiences should be tied to an essential graduate ability

Teaching Tailored o Competencies

  • Clinical teaching emphasizes learning through experience and application, not just knowledge acquisition
  • Teachers use coaching techniques to diagnose a learner in clinical situations and give actionable feedbak
  • Teaching is responsive to individual learner needs
  • Learners are actively engaged in determining their learning needs Teachers and learners work together to solve complex clinical problems


  • There are multiple points and methods for data collection
  • Methods for data collection match the quality of the competency being assessed
  • Emphasis is on workplace observation
  • Emphasis is on providing personalized, timely, meaningful feedback
  • Progression is based on entrustment
  • There is a robust system for decision-making
 Five core componets: 1. An Outcomes Competency Framework. 2. Progressive Sequencing of Competencies. 3. Learning Experiences Tailored to Competencies. 4. Teaching Tailored to Competencies. 5. Programmatic Assessment.


The more specific we can be about our end and interim goals for training...

  • The more specific we can be in knowing when someone is not moving forward in ways that we
  • The more effective we can be in facilitating a smooth transition into practice
  • The more effective we will be in knowing if the training has achieved what it is intended to achieve

Recognizing that CBME is not a prescriptive construct, but rather an overarching theory, CBME has been implemented in different iterations internationally. Application of the five core components of CBME listed above largely depends on the context of implementation across programs, though many ingredients to these models of medical education are similar.