This chapter focuses on strategies for approaching competency-based medical education (CBME) in the undergraduate medical curriculum (UME). CBME uses national professional standards, typically set by accrediting bodies or professional organizations, to shape curricular design and assessment of learner outcomes as well as to provide clarity to the learner about the knowledge, skills, and attitudes needed for successful practice. Wiggins and McTighe's (2015) Backward Design instructional design model provides a practical structure for approaching CBME since it proposes beginning with the national standards, defining outcomes and assessment methods, and then developing curricular content. The chapter will describe the backward design model, the history of CBME in the United States, current issues with CBME, and use of an integrated curriculum to successfully implement CBME. It will culminate with a discussion of creating action plans for individual programs to align assessment and outcome measures more directly to curriculum.