Ensuring that the performance of physicians meets the needs of patients is central to safe care. However, assessment of physician performance across the continuum of training and practice is inadequate. Often isolated as only an education problem, this assessment gap is also a clinical care problem.¹

The goal of competency-based education, the purported focus of Graduate Medical Education training during the past 2 decades, is to design and implement educational programs that achieve outcomes necessary to optimize patient and population outcomes.² Unfortunately, performance of residency graduates suggests this goal is often not achieved.^3,4 Indeed, the Medicare Payment Advisory Committee and Institute of Medicine have focused on shortcomings in care delivery, calling for changes in reimbursements and transformation funding, respectively, to address them.^3,4