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The move towards a competency-based education (CBE) model requires the development of authentic tools for providing meaningful formative feedback. Developing such tools however requires a deep understanding of the underlying facets of the competencies being assessed. Gaining this understanding remains challenging in contexts where performance is not readily visible to supervisors such as the senior medical resident (SMR) on-call role in internal medicine. In this paper, we describe our approach to studying this role and our key finding of the little things and their importance in shaping effective and less effective practice. We then describe their significance in relation to the development of future CBE tools for assessing and offering feedback to residents taking on the SMR role.