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Dr. Eric Holmboe, Senior Vice President at the Accreditation Council for Graduate Medical Education (ACGME) in Pennsylvania, discusses the fundamental principles of competency based education. He proposes that we need to think of education as a co-production model that brings together the importance of clinical and education outcomes centered on the patient. Dr. Holmboe also suggests that context and culture play an important role in evaluating new training programs, for example when assessing a competency like professionalism.