Reframing Assessment in Medical Education: Toward Emotionally Sustainable Assessment in the Era of Competency-based Medical Education

Assessment is a central driver of learning in medical education, shaping students’ engagement, faculty priorities, and institutional culture. The introduction of competency-based medical education (CBME) by the National Medical Commission in India has transformed assessment from a predominantly summative exercise to a longitudinal, formative, and competency-aligned process. While this shift emphasizes workplace-based assessment, structured feedback, and reflective practice, the emotional and relational dimensions of assessment remain underexplored in both policy and practice. This conceptual review synthesizes contemporary literature on CBME-aligned assessment with particular attention to the Indian context. It examines evolving assessment strategies, feedback practices, and learner experiences under CBME, highlighting persistent challenges such as assessment anxiety, feedback resistance, and faculty discomfort with formative evaluation. Building on these insights, the article proposes the framework of emotionally sustainable assessment (ESA) – an approach that integrates transparency, psychological safety, reflective practice, and longitudinal feedback within existing CBME structures. ESA is presented not as an alternative to CBME but as a necessary extension that humanizes assessment while preserving rigor and accountability. By acknowledging assessment as both a cognitive and emotional process, ESA aims to enhance learner motivation, resilience, and professional identity formation. The article concludes by advocating for emotionally intelligent assessment ecosystems that align with the goals of CBME and support the holistic development of the Indian Medical Graduate.