ArticleJournal of graduate medical education2022
"The Most Crushing Thing": Understanding Resident Assessment Burden in a Competency-Based Curriculum.
Article in Journal of graduate medical education, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers.
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Who cites it
49 citing papers in PubMed.
- 'Just a checkbox': Growth mindset and feedback in resident experiences with EPA assessments.Medical education · 2026Article
- Reflection With Risk: Does It Belong in the Postgraduate Portfolio?The clinical teacher · 2026Article
- Life in the slow lane: reflective practice in postgraduate Emergency Medicine training in South Africa.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026Review
- Re-centering education on the learner: insights from a Pediatric Residency Coaching Program.Paediatrics & child health · 2026Article
- Assessment burden by design: exploring the variability in competence by design assessment forms.Canadian medical education journal · 2026Article
- Competency based medical education: assessment of procedural and cognitive skills in gastroenterology residency training.BMC medical education · 2026Article
- Outcomes of the SAEM Competency-Based Medical Education Consensus Conference: Challenges and Opportunities in Implementing CBME.AEM education and training · 2026Review
- CBME As a Philosophy of Training: Balancing Fidelity and Flexibility in Emergency Medicine.AEM education and training · 2026Review
- Cracks and lights of assessment implementation in competency-based medical education.Medical education · 2026Article
- Centered on learning, but is it learner centered?: Paediatric resident perspectives on competency-based medical education.Medical education · 2026Article
- Postgraduate learner perspectives on transforming learner handover to promote self-regulated learning.BMC medical education · 2026Article
- Competency-Based Health Professions Education in Evolution: Challenges and Adaptations After Implementation.Perspectives on medical education · 2026Article
- Approaches to the Evaluation of Competency-Based Health Professions Education Implementation from Around the Globe.Perspectives on medical education · 2026Article
- Reframing Validity: How Values Shape Assessment in Postgraduate Medical Education.Perspectives on medical education · 2026Article
- Feedback gap and strategies for handling criticism in early surgical career.Surgery open science · 2025Article
- Motivations to conduct research and burnout in medical education: a mixed methods study of students and residents.Canadian medical education journal · 2025Article
- Objective skill assessment for cataract surgery from surgical microscope video.International journal of computer assisted radiology and surgery · 2025Article
- AI's Accuracy in Extracting Learning Experiences From Clinical Practice Logs: Observational Study.JMIR medical education · 2025Observational
- A competency-based curriculum for palliative medicine in Canada.Canadian medical education journal · 2025Article
- Surgical Trainees' Lived Experience of Entrustable Professional Activities: Assessment in the Australasian Context.ANZ journal of surgery · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Competency-based medical education (CBME) was expected to increase the workload of assessment for graduate training programs to support the development of competence. Learning conditions were anticipated to improve through the provision of tailored learning experiences and more frequent, low-stakes assessments. Canada has adopted an approach to CBME called Competence by Design (CBD). However, in the process of implementation, learner anxiety and assessment burden have increased unexpectedly. To mitigate this unintended consequence, we need a stronger understanding of how resident assessment burdens emerge and function. Objective: This study investigates contextual factors leading to assessment burden on residents within the framework of CBD. Methods: Residents were interviewed about their experiences of assessment using constructivist grounded theory. Participants (n=21) were a purposive sample from operative and perioperative training programs, recruited from 6 Canadian medical schools between 2019 and 2020. Self-determination theory was used as a sensitizing concept to categorize findings on types of assessment burden. Results: Nine assessment burdens were identified and organized by threats to psychological needs for autonomy, relatedness, and competence. Burdens included: missed opportunities for self-regulated learning, lack of situational control, comparative assessment, lack of trust, constraints on time and resources, disconnects between teachers and learners, lack of clarity, unrealistic expectations, and limitations of assessment forms for providing meaningful feedback. Conclusions: This study contributes a contextual understanding of how assessment burdens emerged as unmet psychological needs for autonomy, relatedness, and competence, with unintended consequences for learner well-being and intrinsic motivation.
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