To the Editor,

I appreciate and agree with the comments made by Drs Shorten and Levine.1 The introduction of competence by design appears to require a significant increase in data collection relevant to trainee performance and assessment. Increasing the efficiency of collecting these data will likely require innovative approaches. Capturing the data with video cameras is certainly one option. Confidentiality and privacy of information for both the patients and the trainees are factors that will require attention for all data that are collected, regardless of the collection tool. Mapping out learning curves (and forgetting curves) for required areas of competence will certainly require large data sets. Collection and analysis of these large data sets without a significant increase in workload for the instructors and administrators of a curriculum is an important goal. The results could hopefully lead to more efficient, more effective learning strategies. As calls for increased assessment data appear to be inevitable, a sustainable solution for collecting and analyzing the data is paramount.