Abstract Competency-based medical education (CBME) aims to modernize postgraduate training through developmental, learner-centered assessment. However, many residents still experience the process as procedural and detached from meaningful growth. Using self-determination theory, the authors examine how current CBME practices often undermine residents’ needs for autonomy, competence, and relatedness, producing superficial compliance rather than internalization and authentic commitment. Beyond structural critique, they highlight agentic engagement—residents’ proactive efforts to “pull” autonomy support and shape feedback—as an underused but essential lever for revitalizing CBME. Field notes and entrustable professional activities can serve as coaching tools rather than bureaucratic artifacts but only if situated within autonomy-supportive dialogue, trusting relationships, and competence-oriented feedback. Drawing from self-determination theory research, the authors outline evidence-based, need-supportive strategies for embedding CBME practices into routine workflows. Collectively, the recommendations offer educators a pragmatic guide for aligning assessment culture with resident motivation, professional identity formation, and well-being. Without motivational alignment, CBME risks remaining an exercise in form over substance.
Neufeld et al. (Sat,) studied this question.
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