"The Most Crushing Thing": Understanding Resident Assessment Burden in a Competency-Based Curriculum

Area of Science:

• Medical Education
• Competency-Based Medical Education
• Resident Training

Background:

• Competency-based medical education (CBME) was intended to enhance learning through tailored experiences and frequent assessments.
• Canada's Competence by Design (CBD) implementation has paradoxically increased learner anxiety and assessment burden.
• A deeper understanding of resident assessment burdens is needed to address unintended consequences.

Purpose of the Study:

• Investigate contextual factors contributing to assessment burden in residents under the CBD framework.
• Identify specific assessment burdens experienced by residents in graduate medical training.

Main Methods:

• Qualitative study employing constructivist grounded theory.
• Interviews conducted with 21 residents from operative and perioperative programs across 6 Canadian medical schools (2019-2020).
• Self-determination theory used to categorize assessment burden types.

Main Results:

• Nine distinct assessment burdens were identified, linked to threats to psychological needs.
• Burdens included: compromised self-regulated learning, lack of control, comparative assessment, trust issues, time/resource constraints, poor teacher-learner connection, lack of clarity, unrealistic expectations, and inadequate feedback.

Conclusions:

• Assessment burdens in CBD stem from unmet psychological needs for autonomy, relatedness, and competence.
• These burdens have unintended negative consequences on resident well-being and intrinsic motivation.
• Addressing these unmet needs is crucial for successful CBME implementation.