Describing the Journey and Lessons Learned Implementing a Competency-Based, Time-Variable Undergraduate Medical Education Curriculum.

Oregon Health & Science University School of Medicine launched a completely new undergraduate medical education curriculum in 2014. This initiative dramatically transformed the MD degree program, changing the instructional content taught, the pedagogical methods used by the faculty, and the methods of assessment, and it added new elements such as academic coaching and programmatic entrustment to the program. One of the most exciting and impactful aspects to date of this curricular transformation has been the deliberate implementation of a competency-based framework that incorporates frequent assessment, tracking of student progression using an electronic portfolio, and academic coaching to optimize learning and customize curricular elements for each student. The next major step in this process-the implementation of time-variable progression-is currently ongoing as a planning group at the school works through the conceptual, logistical, legal, and regulatory issues related to implementing such a system. When implementation is complete, MD students will graduate only once they have earned entrustment for all 13 Core Entrustable Professional Activities for Entering Residency. This article describes the school's progress to date in its curricular transformation and articulates lessons learned thus far in driving substantive and dramatic institutional changes that profoundly impact students, faculty, and administrators in one academic health center.