The Accreditation Council for Graduate Medical Education (ACGME) introduced the six domains of clinical competency to the profession, and in 2009 it began a multiyear process of restructuring its accreditation system to be based on educational outcomes in these competencies. Accreditation standards through national organizations are more rigorous and based on attainment of competency therefore, outcome-based education has developed as a key factor. Many of the truths we knew as educators are no longer accurate and we are faced with educating our learners in this new environment. The playing field that most of us know and recognize has been evolving over the past decade. Medical education is faced with a growing number of challenges.
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