Context: To understand and appropriately implement competency-based education (CBE) to its fullest potential in professional programs, an investigation of its evolution is required. Objective: To reveal the development of the CBE approach now dominating many professional programs in higher education, including Athletic Training Education Programs (ATEPs). While behavioral science research at the turn of the 20th century laid the groundwork for the CBE approach, the process used to establish its construct in education stemmed from scientific management methodology used in industry. A history of various educational paradigms, including social efficiency, essentialism, and vocationalism, contributed to the birth and eventual use of the CBE approach in professional programs. Data Sources: Literature reviewed for this article included published articles and books pertaining to CBE and the sciences, philosophies, theories, and educational paradigms that constitute the underpinnings of the CBE approach used in higher education professional programs. Data Synthesis: A contradiction of learning theories has led to inconsistent employment of the CBE framework, making its use inconsistent in professional programs. The emphasis in health care education programs, such as athletic training, has been on using specific behavioral objectives that provide distinct quantifiable data as competencies assessed within specific time frames, as opposed to incorporating integrated objectives as competencies with completion determined by level of skill achievement. Conclusions: Authenticity and immeasurable skills are examples of limitations with the CBE approach in athletic training programs. These limitations will be discussed and suggestions for future direction provided.