| Sumario: | This article focuses on the implementation challenges of programmatic assessment (PA) in medical education, using Indonesia as a case study. It highlights how sociocultural factors, such as hierarchical structures and exam traditions, influence PA adoption and emphasizes the need for alignment between local systems and PA processes. Key issues include educators’ difficulties managing increased assessment data, ethical tensions between mentoring and monitoring roles, and the importance of building trust within educational relationships. The article also notes that successful PA implementation requires both bottom-up engagement and supportive broader systemic conditions, such as stable leadership and coherent policies.
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