Table 1. Resident perceptions of progress testing.

Subtheme	Specifics	Exemplar Quotes*
Provision of formal evaluation (grades)	Specific number on a given test is perceived as not useful
	Numbers used to trend professional progression	I like having numbers, I like having numbers over and over again so I can see my trend. – PGY1
	Barometer to compare performance to peer group	I think in context it [block exam] is a good barometer for how you are doing – PGY3
Engages learning	Discovers learning gaps	I think the exams are motivating…because you need to be shown what you don't know – PGY4
	Validates learned knowledge and skills	…[I]t allows you to know what find out what you know and don't know and helps with that piece of sort of your meta-cognitive strategy - Unknown
	Pushes learners beyond comfort zone
Provides motivation	Encourages review of recently learned content	I find that I did try to make a concerted effort with some of the block exams to be kind of like, okay this is a good time to stop and study – PGY2
	Professional management (motivated to manage their performance as a physician resident)	I'm motivated to know what is going on when I come to half day because you never know when you are going to get asked a question. So that is a big one for me and I don't want to look like an idiot – PGY2
	Performance conformity (avoid being an outlier)	I think that the publishing kind of averages for each year and you don't want to be the one who is significantly lower. So it is a good motivator to keep on studying regularly – PGY4
	Source of externally precipitated internal motivation	So while it is meant to be formative and a way of assessing what you know, instead it has turned into a really good motivator to make us study as residents. – PGY4/5
Identifying resident progress at the systems level	Helps program identify outliers	I think they [block exams] are more looking for the outliers – PGY2
	Helps program to begin remediation and assistance of residents-at-risk	…[T]hose people that are two variations below the mean and need a little bit of a boost up in terms of understanding study strategy – PGY2
*Exemplar quotes are provided when coherent quote is available.

Specific	Quotes
Source of Stress	I know it sucks because we have to study and it's stressful but it is actually very helpful. – PGY2
Variable use by program director
Variable motivation (clinical or non-clinical)
*Exemplar quotes are provided when coherent quote is available.