Patient involvement in resident assessment within the Competence by Design context: a mixed-methods study

Area of Science:

• Medical Education
• Healthcare Administration
• Patient-Centered Care

Background:

• Competence by Design (CBD) is a framework for resident assessment in medical education.
• Patient involvement in resident assessment is a potential but underexplored aspect of CBD.
• This study investigates patient participation in resident assessment within Canadian specialty programs transitioning to CBD.

Purpose of the Study:

• To explore the extent and nature of patient involvement in resident assessment in CBD programs.
• To identify factors that facilitate or hinder patient involvement in this context.

Main Methods:

• A two-phase sequential explanatory mixed-methods design was employed.
• Phase 1 involved surveying program directors (PDs) across Canadian specialty programs.
• Phase 2 included in-depth interviews with PDs from Phase 1.

Main Results:

• In the CBD preparation stage, a significant portion of PDs were unsure about patient involvement (62.4%).
• Among programs in field-testing or implementation stages, most PDs reported no patient involvement (72.7%).
• Key facilitators and hindrances identified include patient factors, program guidelines, assessment types (Entrustable Professional Activities), and organizational support.

Conclusions:

• Patient involvement in resident assessment within CBD programs is currently limited.
• Discussions are necessary to develop strategies for supporting and integrating patient involvement in CBD resident assessment.
• Further research is needed to understand and optimize the role of patients in medical resident evaluations.