A competency-based approach to health professions education creates accountability around necessary outcomes while promoting equity and accommodating individual variability in learning. While developmental trajectories and milestones have been established for traditional clinical skills, equity, diversity, and inclusion (EDI) competencies have only recently been defined, based on increasing recognition of the importance of EDI to patient care and health equity. Operationalizing these competencies into curricula entails developing and validating assessment modalities to determine learner performance levels. EDI competencies, in particular, like many clinical skills, are highly behavioral in nature. Simulation offers the ability to not only teach but also assess behavior, as well as learner knowledge and attitudes in complex and realistic scenarios that are more likely to reflect real-life responses than standard written assessments. Simulation-based assessment cases and tasks associated with or based on a simulation scenario must be purposefully constructed to elicit the behaviors to be assessed in a standardized manner despite the diversity of the learner population. Learner performance (e.g., on a standard checklist or rubric-guided essay prompts) must be mapped to developmental milestones to enable interpretation within the competency framework.