Each year the American Centers for Medicare and Medicaid (CMS) pays Graduate medical over 10 billion dollars for graduate medical education in the USA.(1) Up until now education; there has been lack of evidence based research on the effectiveness of how Amer Learner centered ican osteopathic trainees learn and are taught. An outcomes based delivery system education; has proven to be an important tool for measuring the status of graduate medical Competency based education (GME) in America. Competency based medical education (CBME) has medical education; shown to be an important part of the international medical education system. Since Teaching the ACGME (American Council on graduate medical education) started measuring the six core competencies over a decade ago, questions have arisen regarding traditional residency training methods and their benefits. Since the Single Accreditation System of the ACGME and AOA (American Osteopathic Association) was put in effect in July 2015, now is the best time for the osteopathic community, both nationally and internationally, to take a look at how we are teaching residents. Within this article, faculty training of residents, reflective practices, and the assessment of professionalism is specifically focused on. It is of utmost importance to research and reevaluate our medical education curriculum so that we will be able to help meet the needs of future generations, while also graduating competent, globally engaged, professional physicians. This article seeks to show the need for innovation in osteopathic GME and the role that competency based medical education (CBME) can play in the osteopathic profession to meet this need. (C) 2016 Elsevier Ltd. All rights reserved.