Competency-based learning and assessment are increasingly being applied within health professions education at all levels across the continuum. An important component of competency-based learning is performance level, an expected level of performance related to a competency. In the US, the Accreditation Council for Graduate Medical Education (ACGME) has developed Milestones for each of the 26 specialties in its purview. In undergraduate medical education, several medical schools, including the University of California, San Francisco, are implementing milestones related to the developmental achievement of competence. In Nursing and other health professions, levels of performance are associated with the assessment and development of competence. Standards are essential to make performance data portable and easily understood across the continuum of a learner’s career. The Performance Framework is one step towards making that possible. It is designed to work in concert with other competency-related specifications, including the Competency Framework.