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.