Both the Accreditation Council for Graduate Medical Education (ACGME) in the United States and the Royal College of physicians in Canada are in the process of moving from a traditional time-based approach to medical education to a competency based approach (CBME). This will involve a number of changes to how we train the next generation of cardiac surgeons and cardiologists on both sides of the border. Programs will need to adapt to this new paradigm and completely rethink how they structure their training and how they evaluate their trainees. The goal of this workshop will be to describe the opportunities and challenges offered by this new approach for cardiovascular training in Canada and the United States. Presenters will include three members of the American College of Cardiology, who will discuss the ACGME's milestones, the ACC's core cardiovascular training statement (COCATS4) and tools to better deliver feedback to trainees. Four presenters from the Canadian Cardiovascular Society will discuss how CBME will be implemented in their respective speciality, namely adult cardiology, paediatric cardiology and cardiac surgery and the role of simulation to better train and assess trainees.