Resident perceptions of assessment and feedback in competency-based medical education: a focus group study of one internal medicine residency program
Abstract
Purpose As key participants in the assessment dyad, residents must be engaged with the process. However, residents' experiences with competency-based medical education (CBME), and specifically with entrustable professional activity (EPA)-based assessments, have not been well studied. The authors explored junior residents' perceptions regarding the implementation of EPA assessment and feedback initiatives in an internal medicine program. Method From May to November 2018, 5 focus groups were conducted with 28 first-year internal medicine residents from the University of Toronto, exploring their experiences with facilitators and barriers to EPA-based assessments in the first years of the CBME initiative. Residents were exposed to EPA-based feedback tools from early in residency. Themes were identified using constructivist grounded theory to develop a framework to understand the resident perception of EPA assessment and feedback initiatives. Results Residents' discussions reflected a growth mindset orientation, as they valued the idea of meaningful feedback through multiple low-stakes assessments. However, in practice, feedback seeking was onerous. While the quantity of feedback had increased, the quality had not; some residents felt it had worsened, by reducing it to a form-filling exercise. The assessments were felt to have increased daily workload with consequent disrupted workflow and to have blurred the lines between formative and summative assessment. Conclusions Residents…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Supervising physicians in clinical settings often have multiple tasks, which strains the time they have to support learning through feedback.
“However, supervising physicians in the clinical setting often have multiple tasks, which puts a strain on the time they have to support learning through feedback [9].”
From AI-Generated Versus Human Supervisor Feedback on Medical Students’ Clinical Clerkship Logs: Cross-Sectional Convergent Mixed Methods Study (2026) · cites this paper as [9]
Cites
Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?
Hennink, M. M., Kaiser, B. N., & Marconi, V. C. (2017) · Qualitative Health Research · doi:10.1177/1049732316665344 · Cited by 4,597 · see citing works
The Significance of Saturation
Morse, J. M. (1995) · Qualitative Health Research · doi:10.1177/104973239500500201 · Cited by 2,663 · see citing works
Qualitative Interviewing and Grounded Theory Analysis
Charmaz, K. C., & Belgrave, L. L. (2012) · Sage eBooks · doi:10.4135/9781452218403.n25 · Cited by 2,079 · see citing works
Entrustability of professional activities and competency‐based training
ten Cate, O. (2005) · Medical Education · doi:10.1111/j.1365-2929.2005.02341.x · Cited by 1,238 · see citing works
The role of assessment in competency-based medical education
Holmboe, E. S., Sherbino, J., Long, D. M., Swing, S. R., Frank, J. R., & Collaborators, F. T. I. C. (2010) · Medical Teacher · doi:10.3109/0142159x.2010.500704 · Cited by 956 · see citing works
Grounded theory in medical education research: AMEE Guide No. 70
Watling, C., & Lingard, L. (2012) · Medical Teacher · doi:10.3109/0142159x.2012.704439 · Cited by 573 · see citing works
Assessment, feedback and the alchemy of learning
Watling, C., & Ginsburg, S. (2018) · Medical Education · doi:10.1111/medu.13645 · Cited by 434 · see citing works
Self-citationProgrammatic assessment of competency-based workplace learning: when theory meets practice
Bok, H. G., Teunissen, P. W., Favier, R. P., Rietbroek, N. J., Theyse, L. F., Brommer, H., Haarhuis, J. C., van Beukelen, P., van der Vleuten, C. P., & Jaarsma, D. A. (2013) · BMC Medical Education · doi:10.1186/1472-6920-13-123 · Cited by 303 · see citing works
Toward a shared language for competency-based medical education
Englander, R., Frank, J. R., Carraccio, C. L., Sherbino, J., Ross, S., Snell, L. S., & Collaborators, O. B. O. T. I. (2017) · Medical Teacher · doi:10.1080/0142159x.2017.1315066 · Cited by 209 · see citing works
Beyond individualism: professional culture and its influence on feedback
Watling, C., Driessen, E., van der Vleuten, C. P. M., Vanstone, M., & Lingard, L. (2013) · Medical Education · doi:10.1111/medu.12150 · Cited by 174 · see citing works
Feedback falling on deaf ears: residents' receptivity to feedback tempered by sender credibility
Bing-You, R. G., Paterson, J., & Levine, M. A. (1997) · Medical Teacher · doi:10.3109/01421599709019346 · Cited by 161 · see citing works
Evolving concepts of assessment in a competency-based world
Harris, P., Bhanji, F., Topps, M. H., Ross, S., Lieberman, S. A., Frank, J. R., Snell, L. S., Sherbino, J., & Collaborators, O. B. O. T. I. (2017) · Medical Teacher · doi:10.1080/0142159x.2017.1315071 · Cited by 155 · see citing works
Trainee doctors’ views on workplace-based assessments: Are they just a tick box exercise?
Bindal, T., Wall, D., & Goodyear, H. M. (2011) · Medical Teacher · doi:10.3109/0142159x.2011.558140 · Cited by 144 · see citing works
Schut, S., Driessen, E. W., van Tartwijk, J., van der Vleuten, C. P. M., & Heeneman, S. (2018) · Medical Education · doi:10.1111/medu.13532 · Cited by 141 · see citing works
Barriers to the uptake and use of feedback in the context of summative assessment
Harrison, C., Könings, K. D., Schuwirth, L., Wass, V., & van der Vleuten, C. P. M. (2014) · Advances in Health Sciences Education · doi:10.1007/s10459-014-9524-6 · Cited by 138 · see citing works
Ramani, S., Post, S. E., Könings, K., Mann, K., Katz, J. T., & van der Vleuten, C. (2017) · Teaching and Learning in Medicine · doi:10.1080/10401334.2016.1244014 · Cited by 138 · see citing works
Ramani, S., Könings, K. D., Mann, K. V., Pisarski, E. E., & van der Vleuten, C. P. M. (2018) · Academic Medicine · doi:10.1097/acm.0000000000002193 · Cited by 128 · see citing works
Qualitative and quantitative feedback in the context of competency-based education
Tekian, A. S., Watling, C., Roberts, T. E., Steinert, Y., & Norcini, J. J. (2017) · Medical Teacher · doi:10.1080/0142159x.2017.1372564 · Cited by 93 · see citing works
Rules of Engagement: Residents’ Perceptions of the In-Training Evaluation Process
Watling, C. J., Kenyon, C. F., Zibrowski, E. M., Schulz, V., Goldszmidt, M. A., Singh, I., Maddocks, H. L., & Lingard, L. (2008) · Academic Medicine · doi:10.1097/acm.0b013e318183e78c · Cited by 86 · see citing works
Duijn, C. C. M. A., Welink, L. S., Mándoki, M., Kremer, W. D. J., ten Cate, O., & Bok, H. G. J. (2017) · Perspectives on Medical Education · doi:10.1007/s40037-017-0361-1 · Cited by 86 · see citing works
‘Playing the game’: How do surgical trainees seek feedback using workplace‐based assessment?
Gaunt, A., Patel, A., Rusius, V., Royle, T. J., Markham, D. H., & Pawlikowska, T. R. B. (2017) · Medical Education · doi:10.1111/medu.13380 · Cited by 73 · see citing works
Aagaard, E., Kane, G. C., Conforti, L. N., Hood, S., Caverzagie, K. J., Smith, C. D., Chick, D. A., Holmboe, E. S., & Iobst, W. F. (2013) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-13-00001.1 · Cited by 54 · see citing works
Tomiak, A. T., Braund, H., Egan, R. G., Dalgarno, N., Emack, J., Reid, M.-A., & Hammad, N. (2019) · Journal of Cancer Education · doi:10.1007/s13187-018-1456-z · Cited by 53 · see citing works
Which Factors, Personal or External, Most Influence Studentsʼ Generation of Learning Goals?
Eva, K. W., Munoz, J., Hanson, M. D., et al. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181ed42f2 · Cited by 51 · see citing works
Workplace-Based Assessment and Assessment for Learning: Threats to Validity
Govaerts, M. (2015) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-15-00101.1 · Cited by 48 · see citing works
Hatala, R. A., Ginsburg, S., Hauer, K. E., & Gingerich, A. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-04878-y · Cited by 44 · see citing works
Self-citationThe uneasy alliance of assessment and feedback
Watling, C. (2016) · Perspectives on Medical Education · doi:10.1007/s40037-016-0300-6 · Cited by 40 · see citing works
Internal Medicine Residents' Perspectives on Receiving Feedback in Milestone Format
Angus, S. V., Moriarty, J. P., Nardino, R. J., et al. (2015) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-14-00446.1 · Cited by 22 · see citing works
Raaum, S. E., Lappé, K., Colbert‐Getz, J. M., & Milne, C. K. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-04946-3 · Cited by 22 · see citing works
Lessons learnt from a pilot of assessment for learning
Cho, S. P., Parry, D., & Wade, W. B. (2014) · Clinical Medicine · doi:10.7861/clinmedicine.14-6-577 · Cited by 18 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Predictors of faculty narrative evaluation quality in medical school clerkships
Mooney, C. J., Pascoe, J. M., Blatt, A. E., Lang, V. J., Kelly, M. S., Braun, M. K., Burch, J. E., & Stone, R. T. (2022) · Medical Education · doi:10.1111/medu.14911 · Cited by 10 · see citing works
Kondo, T., Donkers, J., Nishigori, H., Rovers, S., & Heeneman, S. (2026) · JMIR Medical Education · doi:10.2196/90064 · Cited by 1 · see citing works
“Furthermore, prior comparative studies often allowed humans ample preparation time for crafting feedback [13,18,19], whereas in real clinical settings, supervisors are time-pressured and may produce brief or nonspecific comments [9,10].”
- Authors
- Branfield Day, L., Miles, A., Ginsburg, S., & Melvin, L.
- Affiliations
- L. Branfield Dayis a fourth-year chief medical resident, internal medicine training program, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- University of Toronto (CA)
- Mount Sinai Hospital (CA)
- University Health Network (CA)
- Corresponding author
- Melvin, Lindsay
- Venue
- Academic Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-03-17
- Volume
- 95
- Issue
- 11
- Pages
- 1712-1717
- ISSN
- 1040-2446 (ISSN-L)
- OpenAlex
- W3011773386
- Cited by
- 120
- References
- 30
- Citations by year
- 2026: 25 · 2025: 13 · 2024: 28 · 2023: 22 · 2022: 14 · 2021: 14 · 2020: 3
- FWCI
- 9.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Education › Student Assessment and Feedback
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- competency-based medical education, entrustable professional activities, resident perceptions, feedback, assessment, internal medicine residency, formative assessment, summative assessment, growth mindset, workload, low-stakes assessment, feedback seeking
- MeSH terms
- Formative Feedback, Attitude of Health Personnel, Clinical Competence, Competency-Based Education, Education, Medical, Graduate, Educational Measurement, Humans, Internal Medicine, Internship and Residency, Workload, Focus Groups, Qualitative Research, Workflow, Grounded Theory
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
