Residents' Experiences with Personalized Learning in Postgraduate Training; Going Beyond Competency Based Medical Education.

INTRODUCTION

Personalization is increasingly emphasized in postgraduate medical education. While competency-based medical education (CBME) is theoretically positioned to support personalization, practical challenges such as fixed learning outcomes, workplace constraints, time-fixed rotations, and assessment requirements, often limit its realization. This case study aimed to explore how residents experience and make use of individualized development trajectories within a program that combined fixed outcomes with flexible program components.

METHOD: We conducted a case study using semi-structured interviews and template analysis. The study was situated in the Dutch national Obstetrics and Gynecology residency program, which includes formally embedded individualized development trajectories with open-ended learning goals and no pre-determined assessment. We interviewed 12 residents and discussed their portfolios.

RESULTS

All participants engaged in individualized development trajectories. The level of engagement varied and motivation sprang from: personal interest, moral values and dilemma's, clinical exposure, role models, and workplace possibilities. Three interacting factors enabled this: 1) formal program structure legitimized and fostered engagement; 2) time and workplace exposure allowed participants to recognize personally meaningful goals; 3) program directors' support facilitated engagement. Program directors varied in their guidance: some coached, endorsed, or role-modeled; others merely monitored activity; and a few did neither. Participants engaged with the individualized development trajectories, despite the absence of assessment.

CONCLUSION

Structured autonomy, workplace exposure and personal motivation can support personalized learning in CBME. Personalization requires intentional design, supportive structures, trust towards residents, and coaching attuned to the individual learner.