In Reply to Ibrahim and Abdel-Razig.

We are grateful for the international perspective on implementing competency-based medical education highlighted by Ibrahim and Abdel-Razig in their comments on our article. Although we agree with the sentiment that local context is critical to consider, we contend that this is a “both/and” rather than “either/or” phenomenon. 1 In an increasingly globalized community, we must consider both our local context and how those needs interface with the larger, global systems of education and clinical practice. The authors share the important point that COVID-19 has unmasked disparities and inequities between countries. At a macro level, we agree with this point; broadly speaking, lower-income countries encountered many more systemic challenges in providing education compared with higher-income counterparts. However, it is also true that there are substantial disparities between programs and institutions within the same country, even in those with greater economic advantage. This point is illustrated eloquently by Muller and colleagues. 2 In their discussion of the social determinants of education framework, the authors describe the marked disparities in access to health care, personal/family illness, food insecurities, experience with racism and bias, etc., in educational programs within the United States. 2 Thus, we suggest that disparities exist at both national levels (i.e., between countries) and local levels (i.e., within countries, institutions, and among individuals). Ibrahim and Abdel-Razig also share that “rather than developing a global standard of competence, we should focus on best practices in competency development, implementation, and assessment.” We agree that the education community should place emphasis on evidence-based practice of education. However, we contend that this is not mutually exclusive of developing global standards. The development and dissemination of the World Health Organization’s Patient Safety Toolkit provides an example of this point. 3 This resource provides health care professionals with systematic approaches to implement patient safety improvement programs that may be adopted across diverse health care settings. 3 Competency-based frameworks, such as the 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs), provide a similar example. The development of these EPAs was designated “core” intentionally; they were deemed foundational activities required of all MD-program graduates regardless of specialty, but were not sufficient to describe the individual needs of each residency training program. 4 As the examples of patient safety and Core EPAs illustrate, a global standard is foundational for all programs. But, this does not subvert the need to identify additional local needs nor should it hinder advancement of best practices in education.