<p>Competency-Based Medical Education (CBME) requires assessment systems that capture learners’ development over time and across contexts. Programmatic Assessment for Learning (PAL) provides such a framework, emphasizing longitudinal data collection, triangulation, proportionality, and learner agency. Yet, clerkships, the bridge between preclinical and clinical training, differ structurally between Block Clerkships (BCs) and Longitudinal Integrated Clerkships (LICs), each offering distinct affordances and challenges for implementing PAL. Drawing on Vygotsky’s Zone of Proximal Development, Cognitive Load Theory, and Landscapes of Practice, this conceptual paper also incorporates learning principles such as distributed learning and interleaving to explain how repeated, varied, and contextualized assessment supports durable competence development. LICs, with continuity of supervision and patient care, naturally facilitate longitudinal assessment, feedback, and coaching but risk confirmation bias and cognitive overload. BCs, though episodic, can achieve longitudinality through structured handovers, portfolios, and cross-disciplinary coaching. Across both models, successful PAL implementation depends on deliberate educational design, faculty assessment literacy, and alignment of infrastructure, culture, and governance. Ultimately, the implementation of PAL depends less on the clerkship structure than on the intentional integration of feedback, longitudinal data, and learning principles that support validity, fairness, and educational impact.</p>