Mastery Learning, Milestones, and Entrustable Professional Activities

  • Eric S. HolmboeEmail author
  • David H. Salzman
  • Joshua L. Goldstein
  • William C. McGaghie
Part of the Comprehensive Healthcare Simulation book series (CHS)


Competency-based medical education (CBME) has developed strong roots in many professional education systems worldwide. The CBME movement is driven by concern and evidence of significant challenges in the quality and safety of healthcare. Medical education can be viewed as a translational science intervention because the competencies acquired by learners must transfer directly to the care of patients and families. Mastery learning specifically incorporates this critical outcomes-based philosophy into its design and application. Milestones and entrustable professional activities (EPAs) have emerged as developmental educational strategies and approaches to advance the implementation of CBME. However, implementation of competencies through milestones and EPAs has been challenging and is still in its infancy.

The logical, and necessary, next step is to integrate mastery learning into all developmental models. Health professions education is a highly experiential process involving vulnerable patients, families, and communities. A mastery mindset can help accelerate the evolution, if not transformation, now occurring in medical education. This chapter explores how mastery-based methods can substantially advance CBME and enhance the utility of milestones and EPAs. Mastery learning provides the roadmap to achieve the ultimate aims of medical education to improve the healthcare of patients and families.


Mastery learning Competency-based medical education Competencies Milestones Entrustable professional activities Shared mental models Shared mental representations Quality Patient safety Outcomes 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Eric S. Holmboe
    • 1
    • 2
    Email author
  • David H. Salzman
    • 3
  • Joshua L. Goldstein
    • 4
  • William C. McGaghie
    • 5
  1. 1.Accreditation Council for Graduate Medical Education, Chief Research, Milestone Development, and Evaluation Officer, Department of MilestonesChicagoUSA
  2. 2.Northwestern University Feinberg School of Medicine, Adjunct Professor of Medical EducationChicagoUSA
  3. 3.Northwestern University Feinberg School of Medicine, Departments of Emergency Medicine and Medical EducationChicagoUSA
  4. 4.Northwestern University Feinberg School of Medicine, Departments of Pediatrics, Medical Education, and NeurologyChicagoUSA
  5. 5.Northwestern University Feinberg School of Medicine, Departments of Medical Education and Preventive MedicineChicagoUSA

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