Green et al. (1), using the Dreyfus model of skills acquisition, proposed developmental milestones for internal medicine residents and timelines for when a resident could be expected to achieve them. Referring to patient care-related milestones, five are proposed as attainable within 6 months by a trainee (Table 1). The use of entrustable professional activities (EPAs) might serve as a bridge from these competency-based milestones to meaningful, context-based activities (2). EPAs represent the essential professional work—the daily activities—that define a profession, and each one generally cuts across several competencies, allowing the interplay between them to be demonstrated in one clinical activity. An example of an EPA specific to psychiatry would be the provision of electroconvulsive therapy (ECT). If a resident has successfully demonstrated that he/she is competent to perform ECT independently, he/she would have developed knowledge, skills, and attitudes in all six of the competencies. Accordingly, demonstrating the ability to perform ECT capably can result in a “statement of awarded responsibility (STAR),” (2) which marks a threshold that allows a resident to then carry out ECT independently.