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Abstract

Abstract Competency-based assessment assumes shared standards for expected performance, yet residents and preceptors may interpret competence, evidence, and progression differently. We examined how evaluative judgments were constructed and negotiated during structured feedback encounters in family and community medicine residency programs. In a qualitative study informed by constructivist grounded theory, 14 resident–preceptor dyads in Paraíba, Brazil, independently rated 34 professional competencies and then justified their judgments in recorded feedback sessions. The 476 paired ratings were descriptively compared, and 456 transcript units were analyzed through initial and focused coding, constant comparison, and analytic memoing. Ratings differed in 56.5% of comparisons, with preceptors generally assigning higher scores than residents assigned themselves. However, score agreement did not necessarily reflect shared reasoning. Residents primarily based judgments on performed activities, practice opportunities, and perceived autonomy, whereas preceptors also drew on theoretical knowledge, overall impressions, expected progression, and anticipated potential, sometimes without direct observation. These findings generated evaluative (mis)alignment as a relational construct describing whether participants’ ratings and underlying frames of reference converge or diverge. Feedback became more educationally productive when participants clarified criteria, compared evidence, identified contextual barriers, and translated discussion into actionable plans. The analysis informed S-SKILLS-F, an eight-step framework integrating contextualization, self-assessment, criterion clarification, developmental staging, barrier analysis, perspective integration, planning, and longitudinal follow-up. Evaluative misalignment should therefore be addressed as a negotiated feature of competency assessment rather than as individual inaccuracy. S-SKILLS-F offers an empirically derived approach to aligning assessment, feedback, supervision, and professional development, although its transferability requires evaluation in other contexts.