The University of Cincinnati College of Medicine curriculum emphasizes vertical and horizontal integration across all years by bringing patient care and clinical experience into the pre-clerkship years. We revisit important aspects of the foundational sciences in the formal clinical training of the clerkship and fourth years. This curricular structure provides our students with an educational experience that will prepare them to succeed in a variety of career choices—physician, educator, researcher or agent of change in their communities of practice. The desired traits can be categorized into eight core competencies that align with the standards set by the Accreditation Council for Graduate Medical Education (ACGME). We have further aligned our program competencies with the AAMC Entrustable Professional Activities (EPAs) and the associated Physician Competency Reference Set (PCRS). We designed a competency-based assessment strategy that provides students formative feedback on their progress toward mastering the graduation competencies and Entrustment.