Competency-based medical education is a journey that FM residencies have traveled for more than two decades, largely without using that specific term. We are on the precipice of a daunting new phase of CBME: the implementation of the ABFM Core Outcomes, which define specific targets for all FM residency graduates. In this chapter, we detail the history of CBME and explain the key terminology that can obscure this topic. We describe the foundational principles of education that underlie the value of CMBE. We detail the key pieces of residency program design that facilitate the development of a system of assessment to track residents’ progress on the journey to competency. We provide examples of processes that can be a part of such a system of assessment. Finally, we explore the future of CBME in FM, considering several crucial factors that will influence the development of our discipline in the next decade.