The central step in shifting from a traditional to a competency-based educational framework is to define the learner competencies. These competencies reflect specific goals of education, but also express institutional, disciplinary, or national priorities. Competency definitions are intended, among other things, to communicate these priorities in memorable and meaningful ways.
Schools, licensing agencies, and professional societies may each define the competencies differently or use different terminology for similar domains or even have different conceptions of what constitutes a ‘competent’ professional. For example, each of five published competency frameworks includes ‘communication skills’. However, only two contain competencies related to ‘managing information’ or ‘lifelong learning’. Other competencies, such as ‘clinical skills’ are represented in each set but under somewhat different labeling.
Competency descriptions typically operate at multiple levels of detail. ‘Communication skills’, as a description of a target competency, does not provide clear guidance for educators or learners. To make competencies relevant to education, they must be translated into much more specific statements that include the context, content, and criteria for the competency to be attained. This results in a hierarchy of competency specificity within any single domain.
For example, the University of New South Wales  identifies ‘effective communication’ as one of its eight competencies, but then goes on to refine this to include three more detailed competencies: ‘communicates effectively with patients and their families’, ‘communicates effectively with peers and tutors’, and ‘communicates with communities’. There is then further specificity with more operational competencies such as ‘counsels patients appropriately on a range of health risks including poor nutrition, smoking cessation, drug and alcohol management, and refers to community programs and services if appropriate’. It is easier to develop educational activities and assessment tools for the more specific, detailed competency statements than for the more broad domains.
This example illustrates a major challenge in CBE, which is the rapid expansion of the number of competencies as they become more focused on teachable and observable skills or performance. This creates an information burden for learners and the institution. It may also lead towards ‘checkbox education’ and a focus on individual pieces of performance with the loss of the more holistic, comprehensive competencies we desire in professionals. Checkbox education is not, however, an inherent limitation of CBE. For example, proficiency in patient care, medical knowledge and communication all might readily be assessed through the observation of a learner performing a normal delivery of a newborn. This reflects the proposal of ten Cate and colleagues that we use a more integrative framework for assessing competencies that centers around ‘entrustable professional activities’, those that reflect day-to-day professional activities appropriate to the level of learner .