BACKGROUND
Emergency medicine (EM) residency training in Korea has evolved steadily since its introduction in the 1990s, despite its relatively short history and the challenges inherent to the training environment. However, the traditional time-based training model has several important limitations. Training outcomes have not been explicitly defined, resulting in uncertainty regarding the expected level of performance at the completion of residency. Assessment has relied primarily on end-of-rotation evaluations conducted by program leadership and written in-training examinations, rather than on systematic workplace-based assessment (WBA). In addition, trainee progression has largely been determined by time spent in training rather than by demonstrated competence, and certification has depended predominantly on a single high-stakes board examination.
Competency-based medical education (CBME) has emerged as an alternative framework to address these limitations [
1]. CBME is an outcomes-oriented approach that organizes curriculum design, assessment, and program evaluation around a defined competency framework. Since early calls by the World Health Organization for competency-based curriculum development [
2], CBME has been widely adopted internationally and is now regarded as a prevailing model in graduate medical education [
3–
5]. However, early competency frameworks were sometimes criticized for overemphasizing detailed lists of competencies, which risk fragmenting clinical practice and becoming disconnected from real-world clinical work and local context. Entrustable professional activities (EPAs) were subsequently proposed to address this limitation by linking assessment to authentic clinical tasks [
6,
7]. EPAs represent units of professional practice—discrete, observable tasks, or responsibilities—that trainees can be entrusted to perform with a specified level of supervision once they have demonstrated sufficient competence. In line with these international developments, CBME models operationalized through EPAs have begun to emerge across multiple specialty societies [
8–
11], and EM training globally has shifted toward EPA-based curricula within CBME frameworks [
12,
13].
Over the past 5 years, the Korean Society of Emergency Medicine (KSEM) has developed an EM competency framework, a set of EPAs mapped to those competencies, and an aligned programmatic assessment framework supported by practical assessment tools. This commentary describes KSEM’s 4-year process of developing this new residency training model and preparing for its implementation.
THE DEVELOPMENT PROCESS
In January 2021, KSEM launched a task force to reform its residency training model. This initiative was prompted by residents’ calls for substantial improvements in training following the nationwide doctors’ strike in 2020, which was triggered by government-proposed health policy reforms, including an increase in medical school admission quotas and plans to establish a publicly funded medical school (
Fig. 1).
The task force consisted of 35 members, including representatives from the KSEM Residency Training Committee, Education Committee, and Board Examination Committee, as well as clinician educators with expertise in medical education. The task force secured research funding through a project commissioned by the Korean Ministry of Health and Welfare and the Korean Hospital Association, focused on the development and systematization of residency training curricula [
14]. With this support, KSEM established six EM competency domains (
Table 1,
Fig. 2). KSEM subsequently adopted EPAs as a practical mechanism to operationalize CBME and conducted a modified Delphi study to develop EM-specific EPAs (
Table 2). The selected EPAs were then piloted using established WBA methods (e.g., mini-clinical evaluation exercise and multisource feedback) to evaluate supervisors’ and residents’ perceptions and to identify implementation needs related to EPA-aligned assessment [
15].
To maintain coherence and operational focus, KSEM established the Quality Improvement in Residency Training Committee in 2023. Through a series of iterative workshops, the committee developed an assessment matrix aligning EPAs with appropriate assessment methods, created five EPA assessment forms to cover the 10 EPAs (
Suppl. 1), recommended a programmatic assessment framework (
Suppl. 2), and developed a comprehensive resident assessment form (
Fig. 3). A detailed description of each development stage is provided in the following sections.
A residency curriculum should be intentionally designed to enable trainees to acquire the competencies required for independent EM practice. To establish a defensible framework, KSEM reviewed prior work on generic resident competencies, including the RESPECT 100 framework proposed in a 2010 report by the Research Institute for Healthcare Policy of Korean Medical Association [
16], subsequent nationally funded reports [
17–
19], and the patient-centered doctor’s competency framework in Korea developed through a project led by the National Evidence-based Healthcare Collaborating Agency [
20]. Using the most comprehensive and stakeholder-informed framework as a foundation, KSEM defined six EM competency domains (expert, communicator, collaborator, emergency care leader, professional, and scholar), encompassing 16 core competencies and 47 subcompetencies (
Table 1,
Fig. 2).
To develop EPAs appropriate for Korean EM practice, the working group initially drafted 22 candidate EPAs based on a review of the literature and expert consultation. A modified Delphi process was subsequently conducted. In the first round, 30 task force members rated each candidate EPA on relevance, observability, and measurability using a 5-point Likert scale and provided anonymous input regarding the anticipated stage of attainment. Following synthesis and group discussion, the second round focused on items with lower levels of agreement and asked participants to consider anticipated system-level changes. This process resulted in a final set of 10 EPAs (
Table 2). Each EPA was then described in accordance with guidance from the Association for Medical Education in Europe [
21], and an EM competency–EPA mapping matrix was developed. After final review and refinement, the KSEM Board of Directors formally approved the EPA set and its associated mapping.
KSEM proposed minimum assessment requirements for each stage of training, informed by required training experience (RTE), while encouraging program directors to tailor assessment plans to local resources and program strengths. The working group initially developed 18 draft EPA assessment tools that relied heavily on checklists. However, after reviewing international experience and considering concerns that checklist-dominant WBA may devolve into a “tick-box” exercise and diminish the quality of observation and feedback [
22–
24], the committee streamlined and revised the toolset to emphasize concise narrative feedback and coaching. Ultimately, five assessment forms were developed to assess the 10 EPAs (
Suppl. 1), accompanied by detailed guides to support feasible and consistent implementation in clinical settings.
EPAs 1–4 relate directly to acute care and depend on adequate exposure to core clinical presentations and procedures, whereas EPAs 5–10 focus primarily on nontechnical skills developed through routine clinical work. Because Korean EM residency programs vary substantially in clinical environments and rotation structures, the working group conducted two additional modified Delphi studies to establish consensus on the RTEs and essential procedures needed to support competency-based training and assessment. The methods and results of these studies are described in a separate commentary [
25].
Programmatic assessment is a core element of CBME because it integrates assessment for learning with assessment for decision-making [
26,
27]. Multiple low-stakes assessments collected over time generate information and feedback that can guide training while also supporting high-stakes decisions, such as progression to the next stage of training and eligibility for certification [
28]. Entrustment decisions may be classified as ad hoc determinations made by individual supervisors during day-to-day clinical work or as summative entrustment decisions derived from review of aggregated evidence; the latter requires systematic processes and documentation [
29]. Because summative entrustment implies increasing responsibility, it should be grounded in group decision-making informed by multiple sources of evidence (e.g., knowledge tests, skills assessments, and multisource feedback) [
30].
Consistent with these principles, KSEM recommends that residents and supervising faculty identify feasible EPAs and appropriate assessment tools during each rotation, complete low-stakes WBA, and compile assessment evidence in an e-portfolio. In addition, the new training model supports the establishment of competence committees to review aggregated assessment evidence, determine progression decisions and entrustment levels for each EPA, and identify remediation needs using a comprehensive resident assessment form (
Fig. 3). The competence committee’s recommendations are then submitted to the Residency Program Committee, which makes final decisions regarding progression and remediation, communicates these decisions to residents, and provides an appeals process. In October 2025, KSEM hosted a workshop for program directors on curricular mapping and assessment program development to support implementation across training sites.
NEXT STEPS
The KSEM EM competencies, EPAs, aligned assessment tools, and programmatic assessment framework provide a foundation for implementing CBME-oriented EM residency training in Korea. The integration of these components marks a fundamental shift toward greater social accountability and excellence in Korean EM residency training. The next steps include the development of an e-portfolio platform with personalized dashboards, as well as the establishment of a holistic entrustment decision-making process through competence committees and structured feedback. Through pilot implementation and rapid-cycle evaluation, KSEM remains committed to refining this CBME model to ensure that future emergency physicians are prepared to meet the evolving needs of the healthcare system.
NOTES
-
Author contributions
Conceptualization: YMK; Investigation: all authors; Methodology: YMK; Supervision: CWK; Writing–original draft: YMK; Writing–review & editing: all authors. All authors read and approved the final manuscript.
-
Conflicts of interest
The authors have no conflicts of interest to declare.
-
Funding
The authors received no financial support for this study.
-
Acknowledgments
The authors acknowledge Chul Han (Department of Emergency Medicine, Ewha Womans University College of Medicine), Yu Jin Lee (Department of Emergency Medicine, Inha University College of Medicine), Ju Ok Park (Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital), Song Yi Park (Department of Emergency Medicine, University of Ulsan College of Medicine), Hyun Soo Park (Department of Emergency Medicine, Korea University College of Medicine), and Young Soon Cho (Department of Emergency Medicine, Soonchunhyang University College of Medicine) for their contributions to the study.
-
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.
Supplementary materials
Fig. 1.The Korean Society of Emergency Medicine (KSEM) competency-based medical education (CBME) project process. TF, task force; EPA, entrustable professional activity; WBA, workplace-based assessment; EM, emergency medicine; PD, program director.
Fig. 2.The six emergency medicine competency domains established by the Korean Society of Emergency Medicine.
Fig. 3.The Korean Society of Emergency Medicine (KSEM) comprehensive resident assessment form. PGY, postgraduate year; EPA, entrustable professional activity; EBP, evidence-based practice; QI, quality improvement; EM, emergency medicine.
Table 1.KSEM emergency medicine competency framework
Table 1.
|
Competency domain |
Core competency |
Subcompetency |
|
Expert |
Competent practice |
• Provides clinical care based on up-to-date medical knowledge and evidence |
|
• Continuously monitors and maintains procedural competence |
|
• Defines a scope of practice appropriate to one’s competence and provides care within that scope |
|
• Accurately completes medical records and medical documents (e.g., medical certificates) |
|
Scientific reasoning and patient-centered decision-making |
• Performs history taking and physical examination in a patient-centered manner |
|
• Makes clinical judgments based on scientific, evidence-based reasoning |
|
• Makes patient-centered decisions that respect each patient’s values, preferences, and goals |
|
Promoting patient safety and quality of life |
• Incorporates patients’ needs regarding quality of life into clinical care |
|
• Actively manages patients’ pain and distress |
|
• Respects patients’ dignity and supports dignified end-of-life care |
|
• Strives to create a clinical environment that promotes patient safety |
|
• Responds appropriately to situations that threaten patient safety |
|
Communicator |
Therapeutic and collaborative doctor-patient relationship |
• Establishes a professional therapeutic relationship with patients and their families based on trust |
|
• Involves patients and their families in developing treatment plans |
|
• Respects the values, preferences, and needs of patients and their families |
|
• Provides care without discrimination based on patients’ socioeconomic status, race, religion, age, gender, or other characteristics |
|
Empathic communication |
• Listens without bias to the emotions, thoughts, and expressions of patients and their families from their perspective |
|
• Demonstrates empathy for the distress of patients and their families through appropriate verbal and nonverbal communication |
|
Obtaining informed consent |
• Before seeking consent, explains the diagnosis, clinical course, and risks so that patients and caregivers can make informed decisions |
|
• Provides patients and caregivers with sufficient time to ask questions and responds appropriately to questions and concerns |
|
• Explains plans for discontinuation of care, limitations of coverage, referral, or transfer to patients and caregivers in advance, and confirms their understanding and agreement |
|
Collaborator |
Effective consultation and referral |
• Requests consultation or referral to other physicians when necessary to provide optimal care |
|
• Ensures safe consultation and referral by respecting other healthcare professionals and sharing sufficient information |
|
Teamwork and continuous quality improvement |
• Fulfills one’s roles and responsibilities as the leader of the clinical care team |
|
• Respects the professional roles of team members and collaborates in carrying out assigned roles |
|
• Recognizes interpersonal conflicts and conflicts of interest within the team and works to resolve them |
|
• Engages continuously in team evaluation and improvement activities to enhance the quality of care |
|
Emergency care leader |
Improving emergency care delivery system |
• Utilizes diverse community resources and services to improve the quality of emergency care |
|
• Participates in emergency medical support activities required in disasters or national public health crises that threaten community health |
|
• Contributes emergency medicine expertise to the development of policies, laws, and systems that promote and protect patient health |
|
Fulfilling social accountability |
• Identifies andworks to address the health needs of vulnerable populations in emergency care |
|
• Contributes to reducing disparities in emergency care through fair use of healthcare resources |
|
• Prepares to respond to future changes in healthcare |
|
Professional |
Adherence to professional ethics |
• Recognizes ethical issues in clinical care and responds appropriately when they arise |
|
• Is familiar with the code of medical ethics and ethical guidelines and provides care based on them |
|
• Recognizes potential conflicts of interest in clinical practice and manages them appropriately |
|
• Handles electronic medical information in accordance with data protection requirements and the public interest |
|
• Understands and adheres to the principles of patient confidentiality |
|
Participation in professional self-regulation |
• Understands the principles of professional self-regulation for responsible medical practice and participates in related organizational activities |
|
• Reflects on and adjusts one’s practice in response to objective and reasonable societal criticism |
|
• Responds to unprofessional or unethical behavior of colleagues in accordance with ethical guidelines |
|
Self-care and protection of colleagues |
• Maintains optimal physical and mental health for clinical practice |
|
• Strives to create a safe clinical practice environment for oneself and colleagues |
|
Scholar |
Continuous professional development |
• Learns and applies new knowledge and skills |
|
Facilitation of learning for health professionals |
• Facilitates the learning of colleagues and junior doctors through effective teaching, assessment, and constructive feedback |
|
Contributing to the advancement of medicine |
• Generates scholarly questions from practice and attempts to address them through scientific approaches |
|
• Adheres to the ethical principles and guidelines in research activities |
Table 2.EPAs for Korean emergency physicians
Table 2.
|
Title |
|
EPA 1 |
Triage emergency patients according to their clinical situation and severity |
|
EPA 2 |
Take a history, perform a physical examination, and formulate a differential diagnosis and care plan |
|
EPA 3 |
Provide resuscitation and critical care for critically ill patients |
|
EPA 4 |
Perform emergency procedures for diagnosis and treatment |
|
EPA 5 |
Communicate emergency care process and results with patients, guardians, and healthcare teams |
|
EPA 6 |
Share information and cooperate with other healthcare providers for continuity of care |
|
EPA 7 |
Provide clinical education related to emergency care |
|
EPA 8 |
Perform evidence-based practice with the latest scientific evidence |
|
EPA 9 |
Manage legal and ethical situations frequently encountered in emergency care |
|
EPA 10 |
Participate in patient safety and quality improvement activities in emergency care |
REFERENCES
- 1. Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach 2010;32:638-45.
- 2. McGaghie WC, Miller GE, Sajid AW, Telder TV. Competency-based curriculum development on medical education: an introduction. World Health Organization; 1978.
- 3. Ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med 2007;82:542-7.
- 4. Iobst WF, Sherbino J, Cate OT, et al. Competency-based medical education in postgraduate medical education. Med Teach 2010;32:651-6.
- 5. Ten Cate O. Competency-based postgraduate medical education: past, present and future. GMS J Med Educ 2017;34:Doc69.
- 6. Ten Cate O. Entrustability of professional activities and competency-based training. Med Educ 2005;39:1176-7.
- 7. Pangaro L, ten Cate O. Frameworks for learner assessment in medicine: AMEE Guide No. 78. Med Teach 2013;35:e1197-210.
- 8. Kyeon YG, Kim J, Shim S, Sohn I, Seo J, Lee K. Competency-based psychiatry residency training program development in South Korea. Korean Med Educ Rev 2018;20:51-9.
- 9. Kim YM, Choi MH, Lee JH, et al. Development of entrustable professional activity, core competencies, and guidelines in 2021 Radiology Competency Education Project. J Korean Soc Radiol 2022;83:284-92.
- 10. Kim KW, Choe WJ, Kim JH. Application of competency-based education in the Korean anesthesiology residency program and survey analysis. Korean J Anesthesiol 2023;76:135-42.
- 11. Park YC, Lee D, Park SG, Kim Y. Competency-based residency training and development of competencies and entrustable professional activities for family medicine in South Korea. Korean J Fam Pract 2025;15:77-83.
- 12. Sherbino J, Bandiera G, Doyle K, et al. The competency-based medical education evolution of Canadian emergency medicine specialist training. CJEM 2020;22:95-102.
- 13. Passoni Lopes LC, Ferrazini RV, Costa K, et al. Entrustable professional activities, emergency medicine and medical education: a systematic review. Int J Emerg Med 2024;17:112.
- 14. Song KJ, Chung SP, Yoon JC, et al. [Research on the development and systematization of the training curriculum for residency]. Korean Society of Emergency Medicine (KSEM); 2023.
- 15. Park KH, Oh YT, Park JO. Entrustable professional activity-aligned workplace-based assessments in the emergency department: perceptions of emergency medicine residents and assessors. Clin Exp Emerg Med 2025;12:391-9.
- 16. Lee MS, Ahn DS, Kim MK, Kim YR, Bae JY. Development of generic curriculum for graduate medical education. Research Report No. 2010-12. Research Institute for Healthcare Policy, Korea Medical Association; 2010.
- 17. Kim JJ, Whang KC, Kang WK, et al. A study on the reorganization of the training curriculum for efficient training of the residents. Ministry of Health and Welfare (KR); 2013.
- 18. Lee SW, Kim WS, Park SB, et al. Development of general competencies and EPA based on roles of doctors in South Korea. Research Report No. 2018-08. Research Institute for Healthcare Policy, Korea Medical Association; 2018.
- 19. Lee SW, Kim YM, Kim HW, et al. [Preliminary research for the development of a new resident training program in Korea]. Research Report No. 2022-05. Research Institute for Healthcare Policy, Korea Medical Association; 2022.
- 20. Jeon WT, Jung H, Kim Y, et al. The patient-centered doctor’s competency framework in Korea. Korean Med Educ Rev 2024;26(Suppl 1):S48-63.
- 21. Ten Cate O, Taylor DR. The recommended description of an entrustable professional activity: AMEE Guide No. 140. Med Teach 2021;43:1106-14.
- 22. Branfield Day L, Miles A, Ginsburg S, Melvin L. Resident perceptions of assessment and feedback in competency-based medical education: a focus group study of one internal medicine residency program. Acad Med 2020;95:1712-7.
- 23. Ahn E, LaDonna KA, Landreville JM, Mcheimech R, Cheung WJ. Only as strong as the weakest link: resident perspectives on entrustable professional activities and their impact on learning. J Grad Med Educ 2023;15:676-84.
- 24. Cheung WJ, Bhanji F, Gofton W, et al. Design and implementation of a national program of assessment model: integrating entrustable professional activity assessments in Canadian specialist postgraduate medical education. Perspect Med Educ 2024;13:44-55.
- 25. Park KH, Kim YM. Required training experience and essential procedures for competency-based emergency medicine residency program: two modified Delphi consensus studies. Clin Exp Emerg Med 2026;13:221-6.
- 26. van der Vleuten CP, Schuwirth LW. Assessing professional competence: from methods to programmes. Med Educ 2005;39:309-17.
- 27. van der Vleuten CP, Schuwirth LW, Driessen EW, et al. A model for programmatic assessment fit for purpose. Med Teach 2012;34:205-14.
- 28. Perry M, Linn A, Munzer BW, et al. Programmatic assessment in emergency medicine: implementation of best practices. J Grad Med Educ 2018;10:84-90.
- 29. Ten Cate O, Hart D, Ankel F, et al. Entrustment decision making in clinical training. Acad Med 2016;91:191-8.
- 30. Oswald A, Dubois D, Snell L, et al. Implementing competence committees on a national scale: design and lessons learned. Perspect Med Educ 2024;13:56-67.
Citations
Citations to this article as recorded by
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