The University of Miami Miller School of Medicine (UMMSM) has developed and implemented a competency-based undergraduate medical education (UME) curriculum that targets 61 learning objectives for three geriattic syndromes: dementia, falls, and delirium. This curriculum redesign changed the educational focus from what is taught to what is learned. Students complete 13 different competency assessments throughout their four years of training and are required to meet specific performance standards. Documentation of competency is now provided for 600 students annually. This paper describes the design, development, implementation, and evaluation of this curriculum, reviews our data-driven curriculum quality improvement efforts, and discusses the challenges to translating student competency into routine practice. (Contains 2 tables.)