From compliance to commitment: supporting autonomous growth in competency-based medical education

Area of Science:

• Medical Education
• Psychology

Background:

• Competency-based medical education (CBME) aims to enhance postgraduate training.
• Current CBME practices are often perceived as procedural and lacking meaningful resident growth.

Purpose of the Study:

• To analyze how CBME impacts resident needs for autonomy, competence, and relatedness using self-determination theory.
• To identify strategies for revitalizing CBME through agentic engagement and need-supportive practices.

Main Methods:

• Analysis of current CBME practices through the lens of self-determination theory.
• Examination of resident agentic engagement in shaping their learning experiences.
• Review of literature on need-supportive strategies in educational settings.

Main Results:

• Current CBME can undermine resident autonomy, competence, and relatedness, leading to superficial compliance.
• Agentic engagement, where residents actively seek support and shape feedback, is crucial for CBME effectiveness.
• Field notes and entrustable professional activities can be effective coaching tools when integrated into supportive dialogue and feedback.

Conclusions:

• Aligning CBME with resident motivation, identity formation, and well-being is essential for its success.
• Implementing evidence-based, need-supportive strategies can transform CBME from a procedural exercise to a substantive developmental process.
• Failure to address motivational alignment risks CBME remaining superficial and ineffective.