CBME As a Philosophy of Training: Balancing Fidelity and Flexibility in Emergency Medicine.

Abstract

The 2025 SAEM Consensus Conference: "Competency-Based Training and Certification: The Future of Emergency Medicine Education" provided the opportunity to further the development of competency-based medical education (CBME) in Emergency Medicine. This perspective argues that CBME is a flexible philosophy of training rather than a fixed checklist or recipe, and as such can and should manifest variably across contexts and specialties. The authors reason that by viewing CBME as a philosophy, multiple beneficial corollaries follow: (1) CBME training will demand a balance of fidelity of philosophical implementation with necessary context-specific flexibility. (2) Philosophies are dynamic, and as such CBME has already evolved over time and will continue to do so. (3) Medical education has agency to direct such evolution and to choose different philosophies of training if CBME is not delivering what it purports to do. Emergency Medicine is encouraged to approach their work through the philosophy of CBME by embracing CBME principles with training and reframing assessment.