What’s the Difference Between Competency-Based and Outcome-Based Education?
Competency-based education (or CBE) is front and center in nursing education: a fact highlighted by its prominence at the 2025 NLN Education Summit. How you evaluate competency; the technologies that support CBE; and proposals for new competencies are making up a huge part of the conversation.
This focus on competency-based education is a reminder that the terminology we use in nursing education plays a real role in the ways teaching is structured and innovated. CBE can’t be dismissed as just another acronym: it’s the bedrock of today’s standards.
But at the same time, it can be difficult to separate the terms that matter from jargon, buzzwords, or potentially confusing overlaps. That’s especially a pitfall when it comes to outcomes-based education (or OBE). This is a concept that's often mentioned in the same breath as CBE, and one that can easily cause educators and administrators to question whether this is another principle that needs to be absorbed into curricular frameworks.
In this blog post, we’ll talk you through the ways each term has been defined, and discuss:
- How outcomes-based learning in nursing can look
- Which terms really matter in the context of nursing education standards
- How outcomes-based principles are helping graduates with both knowledge and practice
Competency-Based Education vs Outcomes-Based Education: The Blurred Lines of CBE and OBE
It’s tempting to assume that working out the difference between competency-based and outcome-based education, in nursing or other settings, is as simple as settling on a definition for each.
The trouble is that when you put official definitions side by side, the waters can feel a little muddier.
Let’s Define Outcome-Based Education
Outcome-based education has been around, conceptually, for decades. The term was coined by William Spady, who defined outcome-based education in 1994:
Outcome-based education means clearly focusing and organizing everything in an educational system around what is essential for all students to be able to do successfully at the end of their learning experiences.
And this is an idea that’s since been translated into official policy by the likes of UNESCO which, in 2017, described learning outcomes (the things students need to be able to 'do') as:
[The] totality of information, knowledge, understanding, attitudes, values, skills, competencies or behaviours an individual is expected to master upon successful completion of an educational programme.
These are clear, workable definitions. But notice the language at play here: knowledge, attitudes, and skills are clearly central to outcomes-based education. Useful guiding characteristics, certainly, but when you're looking to get a clear sense of OBE's parameters and boundaries, they can contribute to confusion.
In fact, nursing educators more familiar with competency-based education might feel the wording here has a familiar ring to it, and they’d be right to think so.
How Competency-Based Education Compares to Outcomes-Based Learning
That feeling of familiarity surfaces when you compare those OBE definitions with UNESCO’s own take on competency-based education:
This model is based on demonstrating mastery of the knowledge, skills, attitudes and values which comprise a specific competence. Time is variable and the learning outcome is the focus.
Straightaway, it’s easy to see where the confusion sets in. UNESCO’s definitions of each term both lean on the same core concepts: knowledge, skills, and attitudes.
In fact, to underscore how blurred those definitional lines can get, it's not just a question of shared characteristics. Observant readers will notice UNESCO's take on CBE refers to outcomes as the focus, suggesting the two are either synonymous or at the same level. But its definition of outcomes (as we saw above) describes competencies as a contributing factor to outcomes.
At a glance, this may cause some understandable confusion. Are outcomes and competencies different ways of describing the same phenomenon, or are competencies one factor among many, sitting alongside the knowledge, skills, and attitudes found in both definitions?
In short: the harder you look at the two terms, you’re left with a string of definitions so closely related that they’re difficult to disentangle. So, how do we break this stalemate?
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Which Matters More: CBE or OBE?
The lesson to be learned from this set of overlaps is that worrying over semantics isn’t the most efficient use of educator or administrator time. The goal, here, is to recognize where these concepts hold practical weight, and that means turning to the language used by the standards bodies that guide nursing education.
And in that light, the term to watch is competency-based education. CBE is at the heart of the American Association of Colleges of Nursing’s (AACN’s) Essentials: the standards introduced in 2021 which nursing schools are required to align with. The Essentials document includes a clear definition of competence which aligns exactly with the language we’ve seen above: ‘knowledge, skills, and attitudes,’ which in this case correspond to the 10 learning domains described in the Essentials.
That doesn’t mean OBE is out of the picture. The AACN Essentials clarify those points of overlap as follows:
Outcomes [...] describe the desired outcomes of the graduate at the completion of the program. The student learning outcomes will reflect attainment of all competencies.
So, for the AACN, competencies and outcomes don’t overlap. Instead, competencies are the building blocks; outcomes are the result.
And, since the AACN defines competencies so clearly, we're left with a hierarchy that resolves the murkiness of UNESCO's definitions. Knowledge, skills, and attitudes represent competency, and competencies form the basis of outcomes.
This isn’t just semantics. The AACN Essentials are the benchmark that the Commission on Collegiate Nursing Education uses to evaluate programs, highlighting that outcomes must be linked to the competencies those Essentials encompass. Confusing the terms could risk misalignment in curriculum design, accreditation documentation, or even in demonstrating graduate readiness.
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What's OBE’s Enduring Influence on the AACN Essentials?
While the AACN authoritatively clarifies outcomes as the sum of all competencies students gain, that doesn’t mean the other elements of OBE aren’t represented in the Essentials.
Looking back at Spady’s definition of OBE, perhaps the key phrase is: ‘what is essential for all students to be able to do’. For Spady, a focus on outcomes means going beyond knowledge to encompass action as well.
That emphasis is alive and well in the AACN Essentials, where (as we’ve seen) outcomes are explicitly linked to the attainment of competencies. This is reflected in AACN’s justification for adopting a CBE model:
Employers desire assurance that graduates have expected competencies—the ability 'to know' and also 'to do.'
In other words, this key principle of OBE has simply been absorbed into the competency-first framework that now defines nursing education. The task for institutions is to ensure both the building blocks (competencies) and the results (outcomes) are supported and demonstrated in practice.
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Frequently Asked Questions on Competency- and Outcome-Based Education
Outcome-based education (OBE) is an approach that organizes teaching and assessment around the results students are expected to achieve. Outcomes typically include knowledge, skills, and professional attitudes.
Both OBE and CBE emphasize what students should achieve. Definitions of both concepts overlap, with competencies and outcomes often boiling down to knowledge, skills, and attitudes. In nursing, competency-based education has become the dominant framework through the AACN Essentials, while learning outcomes are described as the total attainment of all relevant competencies.
The AACN describes student learning outcomes as the attainment of competencies that can be linked back to its Essentials: 10 domains including areas like Knowledge for Nursing Practice and Person-Centered Care.
In nursing education, outcome-based approaches ensure that students leave programs with the skills and knowledge necessary for safe, effective practice. This means ensuring students can both 'know' and 'do', reflecting the dual importance of both theory and practice for nursing graduates.
When people talk about OBE in education, they’re referring to structuring lessons, assessments, and resources so that they directly support defined outcomes, ensuring students can demonstrate mastery by the end of a module or program.
Support Student Outcomes and Competencies With Immersify
Whether you prefer the term ‘competencies’ or ‘outcomes’, the AACN is absolutely right that nursing graduates need to leave school with the ability to know and to do. With Immersify, you can support both.
Help students 'know’ with quizzes, flashcards, and video lessons that cultivate core competencies, helping them on their journey through the AACN’s key domains.
Give students opportunities to ‘do’ with digital simulations that put theoretical knowledge into practice, all from the comfort of their smartphones.
Reach out to our team today to discuss how Immersify’s standards-aligned, competency-first resources can be integrated effortlessly into your curriculum.
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