Anti-oppression pedagogy in health professions: a scoping review.

Health professional learners are increasingly called to learn about health inequity to reduce inequities and improve patient care and health outcomes. Anti-oppression pedagogy (AOP) addresses the need for health professional learners to understand multiple health inequities and the structures and systems that produce inequities. However, the inclusion of AOP in health professions education varies and there is a lack of clarity in its conceptualization and integration. A scoping review was conducted to address this gap and to understand how AOP is conceptualized and integrated in health professions education. Thirty-six articles met the inclusion criteria. The articles demonstrated that AOP is not commonly utilized terminology within health professions education. When AOP is integrated, it is not consistently conceptualized but is generally viewed as a broad concept that focuses on antiracism; decoloniality; intersectionality; and supporting learners to understand, critically reflect on, and act against structural and systemic forms of oppressions. In addition, there is variation in the integration of AOP in health professions education with the most common methods consisting of discussions, cases, reflection, learning through lived experiences, and the incorporation of humanities within a longitudinal curriculum. The results of this scoping review highlight the need for health professions education to develop one clear concept that educators use when teaching about anti-oppression, which may reduce working in silos and allow educators to better collaborate with each other in advancing this work. In addition, this review suggests that health professional programs should consider incorporating AOP in curricula with a broad and longitudinal approach utilizing the common methods of delivery. To better support programs in including AOP in curricula, further research is required to emphasize the benefits, provide clarity on its conceptualization, and determine the most effective methods of integration.

Extending social accountability mandates to biomedical research in Canadian faculties of medicine.

Background: Social accountability (SA), as defined by Boelen and Heck, is the obligation of medical schools to address the needs of communities through education, research and service activities. While SA is embedded within health profession education frameworks in medicine, they are rarely taught within graduate-level (MSc/PhD) education. Methods: As these programs train future medical researchers, we invited first-year graduate students enrolled in a mandatory professionalism class at our institution (n = 111) to complete a survey on their perceptions of the importance of SA in their research, training, and future careers. Results: Over 80% (n = 87) of respondents agreed that SA is relevant and felt committed to integrating it into their future research activities, only a limited number of students felt confident and/or supported in their abilities to integrate SA into their research. Conclusions: Specific SA training in graduate education is necessary for students to effectively incorporate elements of SA into their research, and as such support the SA mandates of their training institutions. We posit that awareness of SA principles formalizes the professional standards for biomedical researchers and is thus foundational for developing a professionalism curriculum in graduate education programs in medicine. We propose an expansion of the World Health Organization (WHO) partnership pentagon to include partners within the research ecosystem (funding partners, certification bodies) that collaborate with biomedical researchers to make research socially accountable.

Contexte: La responsabilité sociale (RS), telle que définie par Boelen et Heck, est l'obligation pour les facultés de médecine de répondre aux besoins des communautés par l'entremise de l'éducation, de la recherche et des activités de service. Bien que la responsabilité sociale soit intégrée dans les cadres de formation des professionnels de santé en médecine, elle est rarement enseignée au niveau des études supérieures (MSc/PhD). Méthodes: Étant donné que ces programmes forment les futurs chercheurs médicaux, nous avons invité les étudiants de première année inscrits à un cours obligatoire sur le professionnalisme dans notre établissement (n = 111) à participer à une enquête sur leurs perceptions de l'importance de la RS dans leur recherche, leur formation et leur future carrière. Résultats: Plus de 80 % (n = 87) des répondants ont reconnu la pertinence de la RS et se sont engagés à l'intégrer dans leurs futures activités de recherche, mais seul un nombre limité d'étudiants se sont sentis confiants et/ou soutenus dans leurs capacités à intégrer la RS dans leur recherche. Conclusions: Une formation propre à la RS dans le cadre des études supérieures est nécessaire pour que les étudiants puissent intégrer efficacement des éléments de la RS dans leur recherche, et ainsi promouvoir les mandats de RS de leurs établissements de formation. Nous estimons que la sensibilisation aux principes de la RS formalise les normes professionnelles des chercheurs biomédicaux et qu'elle est donc fondamentale pour l'élaboration d'un programme de professionnalisme dans les programmes d'études supérieures en médecine. Nous proposons d'élargir le pentagone du partenariat de l'Organisation mondiale de la santé (OMS) pour y inclure les partenaires de l'écosystème de la recherche (partenaires financiers, organismes de certification) qui collaborent avec les chercheurs biomédicaux pour rendre la recherche socialement responsable.

A Medical Education Research Library: key research topics and associated experts.

When clinician-educators and medical education researchers use and discuss medical education research, they can advance innovation in medical education as well as improve its quality. To facilitate the use and discussions of medical education research, we created a prefatory visual representation of key medical education research topics and associated experts. We conducted one-on-one virtual interviews with medical education journal editorial board members to identify what they perceived as key medical education research topics as well as who they associated, as experts, with each of the identified topics. We used content analysis to create categories representing key topics and noted occurrences of named experts. Twenty-one editorial board members, representing nine of the top medical education journals, participated. From the data we created a figure entitled, Medical Education Research Library. The library includes 13 research topics, with assessment as the most prevalent. It also notes recognized experts, including van der Vleuten, ten Cate, and Norman. The key medical education research topics identified and included in the library align with what others have identified as trends in the literature. Selected topics, including workplace-based learning, equity, diversity, and inclusion, physician wellbeing and burnout, and social accountability, are emerging. Once transformed into an open educational resource, clinician-educators and medical education researchers can use and contribute to the functional library. Such continuous expansion will generate better awareness and recognition of diverse perspectives. The functional library will help to innovate and improve the quality of medical education through evidence-informed practices and scholarship.

Patient references in the 2005 and 2015 CanMEDS frameworks.

Background: Patient involvement in postgraduate medical education (PGME) can help residents improve their communication, professionalism, and collaboration. The CanMEDS Framework defines such competencies for physicians and informs teaching and assessment activities in PGME. However, it is unclear how patients are referenced in the CanMEDS Framework and if these references encourage the active involvement of patients in PGME. To inform how patients are referenced in the revisions of the CanMEDS Framework, scheduled for publication in 2025, our aim was to determine how patients are referenced in each the 2005 and 2015 CanMEDS Frameworks. Methods: We used document analysis to examine how the term 'patient(s)' is referenced in the 2005 and 2015 CanMEDS Frameworks. Results: Several 2005 and 2015 CanMEDS Roles include patients in the descriptions but do not reference them in the competencies. Others do not reference patients in the descriptions or competencies, potentially detracting from the importance of involving patients. As it stands, the 2015 Health Advocate is the only Role that describes and references patients working with physicians as partners in care, facilitating potential opportunities for patient involvement in PGME. Conclusion: There are inconsistencies in how patients are described and referenced as potential partners in PGME throughout past and present CanMEDS Frameworks. Understanding these inconsistencies can inform the revision of CanMEDS that is scheduled for publication in 2025.

Contexte: La participation des patients dans la formation médicale postdoctorale (FMPD) peut aider les résidents à améliorer leur professionnalisme et leurs compétences en matière de communication et de collaboration. Le référentiel CanMEDS définit les compétences des médecins et oriente les activités d'enseignement et d'évaluation dans la formation médicale postdoctorale. Cependant, la manière dont les patients sont décrits dans le référentiel CanMEDS n'est pas claire et il n'est pas certain que cette description encourage la participation active des patients dans la FMPD. Pour éclairer la description des patients dans les révisions du référentiel CanMEDS, dont la publication est prévue en 2025, notre objectif était d'examiner comment ils sont présentés dans les référentiels CanMEDS de 2005 et 2015. Méthodes: Nous avons utilisé l'analyse de documents pour examiner les références au terme « patient(s) ¼ dans les référentiels CanMEDS 2005 et 2015. Résultats: Dans les référentiels CanMEDS de 2005 et 2015, les patients sont mentionnés dans la description de certains rôles, mais ils ne le sont pas dans la description des compétences qui y sont associées. Dans d'autres cas, ni la description du rôle ni celle des compétences correspondantes ne font référence aux patients, ce qui peut minimiser l'importance de la participation de ces derniers. Actuellement, le rôle de promoteur de la santé dans le référentiel de 2015 est le seul qui comprend une description et une référence aux patients comme travaillant avec le médecin à titre de partenaires de soins, et qui favorise ainsi la possibilité de faire participer les patients dans la FMPD. Conclusion: Les référentiels CanMEDS passés et présents contiennent des incohérences quant à la description des patients comme partenaires potentiels dans la FMPD. La compréhension de ces incohérences peut éclairer la révision de CanMEDS, dont la publication est prévue en 2025.

Including patients and caregivers in assessment in the pediatric competence by design curriculum: A national consensus study.

Although evidence supports diverse assessment strategies, including patient/caregiver involvement in Competency-Based Medical Education (CBME), few residency programs formally include patients/caregivers in assessment. We aimed to determine the milestones for which patient/caregiver inclusion would be valuable in the Canadian Pediatric Competence By Design (CBD) curriculum.Program directors from 17 Canadian pediatric residency programs were invited to participate in a Delphi study. This Delphi included 209 milestones selected by the study team from the 320 milestones of the draft pediatric CBD curriculum available at the time of the study. In round 1, 16 participants representing 13 institutions rated the value of including patients/caregivers in the assessment of each milestone using a 4-point scale. We obtained consensus for 150 milestones, leaving 59 for re-exposure. In round 2, 14/16 participants rated remaining items without consensus. Overall, 67 milestones met consensus for 'valuable,' of which 11 met consensus for 'extremely valuable.' The majority of these milestones related to communication skills.Patient/caregiver assessment is valuable for 21% of milestones in the draft pediatric CBD curriculum, predominantly those relating to communication skills. This confirms the perceived importance of patient/caregiver assessment of trainees in CBME curricula; formal inclusion may be considered. Future directions could include exploring patients/caregivers' perspectives of their roles in assessment in CBD.

Individual differences in working memory capacity and visual search while reading.

Individual differences in working memory capacity are related to variations in a wide range of cognitive tasks. Surprisingly, effects of individual differences in working memory capacity are somewhat limited in visual search tasks. Here we tested the hypothesis that such an effect would be robust when search was one component of a dual task. Participants were presented strings of letters using rapid serial visual presentation and were required to detect all instances of a particular target letter. In Experiment 1, participants performed the letter search task in three contexts, while: (a) reading a prose passage, (b) processing a stream of random words, or (c) processing a random stream of non-words. In the absence of the dual task of reading prose, and in line with much of the literature on individual differences in working memory capacity and visual search, search performance was unaffected by working memory capacity. As hypothesized, however, higher working memory capacity participants detected more target letters than lower capacity participants in the "true" dual task (searching while reading prose). The hypothesized results from the prose passage were replicated in Experiment 2. These results show that visual search efficiency is dramatically affected by working memory capacity when searching is combined with another cognitive task but not when it is performed in isolation. Our findings are consistent with recent suggestions that visual search efficiency will be affected by working memory capacity so long as searching is embedded in a context that entails managing resource allocation between concurrent tasks.

The perceptions and experiences of medical students in a pediatric buddy program: a qualitative study.

BACKGROUND: Partnership programs between medical students and patients provide students with non-clinical experiences that enhance medical learning, especially with respect to humanistic care. We explored the perceptions and experiences of medical students in a pediatric oncology buddy program. METHODS: Using a basic interpretive qualitative approach, we conducted interviews with 15 medical students at three time points: before meeting his/her buddy (pre-interview), four months into the partnership (4-month interview), and at the end of the partnership (post interview). We then conducted a thematic analysis of the interview data. RESULTS: All students in the program who met the study criteria (N = 15/16) participated. The medical students highlighted that: (a) providing support to buddies and their families is important; (b) providing care to children with serious illnesses is emotionally difficult; (c) developing deep connections with buddies and their families is rewarding; and (d) gaining empathy and personal fulfillment from buddies and their families is inevitable. CONCLUSIONS: This study provides an understanding of medical students' perceptions and experiences in a pediatric oncology, non-clinical buddy program. Tailored one-on-one partnerships between medical students and pediatric oncology patients play an important role in medical education and contributes to the teaching of humanistic care.

Fundamental Teaching Activities in Family Medicine Framework: Analysis of Awareness and Utilization.

INTRODUCTION: In 2015, the College of Family Physicians of Canada, in performing their commitment to supporting its members in their educational roles, created the Family Medicine Framework (FTA). It was designed to assist family medicine educators with an understanding of the core activities of educators: precepting, coaching, and teaching within or beyond clinical settings. Given that an examination of member awareness of FTA has not been previously undertaken, our primary objective was to conduct an evaluation on its utility and application. METHODS: In partnership with College of Family Physicians of Canada Faculty Development Education Committee members, we used a practical participatory evaluation approach to conduct a two-phase mixed-methods evaluation of the FTA. We distributed an electronic survey in French and English languages to Canadian faculty development, program, and site directors in family medicine. We then conducted follow-up interviews with self-selected participants. RESULTS: Of the target populations, 12/15 (80%) faculty development directors (FDDs), 12/18 (66.7%) program directors, and 34/174 (19.5%) site directors completed the electronic survey. Subsequently, 6 FDDs, 3 program directors, and 3 site directors completed an interview (n = 12). Findings indicate that awareness of the FTA was highest among FDDs. Facilitators who encourage teachers to use the FTA and barriers for low uptake were also identified. DISCUSSION: This evaluation illuminated that varied levels of awareness of the FTA may contribute to the low uptake among education leaders. We also suggest future research to address possible barriers that hinder effective applications of the FTA in faculty development initiatives.

A qualitative study of patients' and caregivers' perspectives on educating healthcare providers.

BACKGROUND: Patients/caregivers can be actively involved in the education of healthcare providers (HCPs). The purpose of this study was to explore patients'/caregivers' perspectives on their involvement and roles in the education of HCPs. METHODS: We invited patients/caregivers to participate in one-on-one semi-structured interviews. We analyzed the interview data using conventional content analysis to identify themes. RESULTS: In terms of patient/caregiver involvement in the education of HCPs, we identified that patients/caregivers perceive that it: (a) is challenging because of power-differentials between themselves and HCPs; (b) requires patient training; (c) needs to start early in HCPs' education processes; (d) can improve patient-HCP partnerships; and (e) requires compensation for patients. With regards to the roles that patients can play in educating HCPs, we found that patients/caregivers want to: (a) teach HCPs about patients' expectations, experiences and perspectives through case studies, storytelling, and educational research; (b) provide direct feedback to HCPs; and (c) advise on curricula development and admission boards for HCPs. CONCLUSIONS: Understanding patients'/caregivers' perspectives on this topic can help educational leaders and HCPs improve active patient/caregiver involvement in the education of HCPs. We need to listen to patients'/caregivers' voices in order to make effective changes in current and future health professions education.

CONTEXTE: Les patients et les aidants peuvent participer activement à la formation des prestataires de soins de santé (PSS). L'objectif de cette étude était d'explorer le point de vue des patients et des aidants sur leur participation et leur rôle dans la formation des professionnels de la santé. MÉTHODES: Nous avons invité des patients et des aidants à participer à des entretiens individuels semi-structurés. Nous avons dégagé les thèmes à l'aide d'une analyse de contenu classique des données des entretiens. RÉSULTATS: D'après les patients et les aidants, leur implication dans l'éducation des professionnels de la santé : (a) est un défi en raison du déséquilibre de pouvoir entre eux et les professionnels de la santé; (b) nécessite une formation des patients; (c) doit commencer tôt dans le processus de formation des professionnels de la santé; (d) peut améliorer les partenariats entre les patients et les professionnels de la santé; et (e) suppose que les patients soient indemnisés. En ce qui concerne les rôles que les patients peuvent jouer dans l'éducation des professionnels de la santé, nous avons constaté que les patients et les aidants veulent : (a) enseigner aux professionnels de la santé les attentes, les expériences et les points de vue des patients par le biais d'études de cas, de récits et de recherche en éducation; (b) fournir une rétroaction directe aux professionnels de la santé; et (c) donner des conseils pour le développement decursus et les comités d'admission pour les professionnels de la santé. CONCLUSIONS: Comprendre le point de vue des patients et des aidants sur ce sujet peut aider les éducateurs en poste de gestion et les professionnels de la santé à mieux intégrer la participation active des patients à la formation des soignants. En écoutant la voix des patients et des aidants, nous serons en mesure d'apporter des changements efficaces à la formation actuelle et future des professions de la santé.

An exploration of nursing students' and clinical instructors' perceptions of patient and parent involvement in the assessment of nursing students during pediatric clinical placements: A qualitative study.

AIM: Clinical instructors are typically the sole assessors of nursing students completing their pediatric clinical placement in Canadian children's hospitals, as per their educational institution's assessment criteria and learning objectives. The purpose of this study was to explore nursing students' and clinical instructors' perceptions of and experiences with involving pediatric patients and parents in assessing nursing students during their pediatric clinical placement. DESIGN: We conducted a qualitative descriptive study. METHODS: We completed semi-structured interviews with fourth-year nursing students and pediatric clinical instructors from a University located in a city in central-eastern Canada. We used qualitative content analysis to analyze the data. RESULTS: We found that students and instructors perceived patient and parent involvement in the assessment of nursing students' clinical practice as beneficial for patients, parents, students and instructors. Students and instructors believed patients and parents could contribute to assessing students' communication and therapeutic relationship skills. However, we identified potential challenges including patients' and parents' lack of knowledge regarding nursing skills, as well as added stress for students and parents. CONCLUSION: Future studies should focus on ways of overcoming these challenges before implementing this novel assessment process.

Patient Involvement in Medical Education Research: Results From an International Survey of Medical Education Researchers.

There are demands to involve patients in medical education research (MER). This study surveyed researchers to examine the extent and nature of patient involvement in MER. It obtained 283 completed surveys (response rate of 5%). Of the respondents, 153 (54.1%) indicated that they involve patients in MER. Of these respondents, 102 (66.7%) stated that patients are data sources in MER, 41 (26.8%) noted that patients are involved as advisors and/or reviewers, and/or 22 (14.4%) indicated that patients are involved as team members. These respondents reported that they involve patients to improve the relevance of their MER to patients (n = 99; 64.7%), connect MER to patient outcomes (n = 98; 64.1%), and improve the appropriateness of MER (n = 92; 60.1%). The 130 respondents who do not involve patients in MER do not involve them because they believe that their research topic(s) are irrelevant to patients (n = 68; 52.3%), they have limited resources for patient involvement (n = 40; 30.8%), and/or they do not know how to involve patients (n = 28; 21.5%). Researchers need to consider how they can conduct their MER with patients.

Utilization of evidence-based tools and medical education literature by Canadian postgraduate program directors in the teaching and assessment of the CanMEDS roles.

BACKGROUND: Researchers have shown that clinical educators feel insufficiently informed about how to teach and assess the CanMEDS roles. Thus, our objective was to examine the extent to which program directors utilize evidence-based tools and the medical education literature in teaching and assessing the CanMEDS roles. METHODS: In 2016, the authors utilized an online questionnaire to survey 747 Canadian residency program directors (PD's) of Royal College of Physicians and Surgeons of Canada (RCPSC) accredited programs. RESULTS: Overall, 186 PD's participated (24.9%). 36.6% did not know whether the teaching strategies they used were evidence-based and another third (31.9%) believed they were "not at all" or "to a small extent" evidence-based. Similarly, 31.8% did not know whether the assessment tools they used were evidence-based and another third (39.7%) believed they were "not at all" or "to a small extent" evidence-based. PD's were aware of research on teaching strategies (62.4%) and assessment tools (51.9%), but felt they did not have sufficient time to review relevant literature (72.1% for teaching and 64.1% for assessment). CONCLUSIONS: Canadian PD's reported low awareness of evidence-based tools for teaching and assessment, implying a potential knowledge translation gap in medical education research.

CONTEXTE: La recherche montre que les éducateurs en médecine se sentent insuffisamment informés sur la façon d'enseigner et d'évaluer les rôles CanMEDS. Notre objectif était donc d'examiner dans quelle mesure les directeurs de programmes utilisent des outils fondés sur les données probantes et la littérature en éducation médicale pour enseigner et évaluer les rôles CanMEDS. MÉTHODES: En 2016, les auteurs ont utilisé un questionnaire en ligne pour interroger 747 directeurs de programmes de résidence (DP) agréés par le Collège royal des médecins et chirurgiens du Canada (CRMCC). RÉSULTATS: Parmi les 186 (24,9 %) DP qui ont participé au sondage, 36,6 % ne savaient pas si les stratégies d'enseignement qu'ils utilisaient étaient fondées sur des données probantes et un tiers (31,9 %) estimaient qu'elles n'étaient « pas du tout ¼ fondées sur des données probantes ou qu'elles ne l'étaient que « dans une faible mesure ¼. De surcroît, 31,8 % ne savaient pas si les outils d'évaluation qu'ils utilisaient étaient fondés sur des données probantes et un tiers (39,7 %) estimait qu'ils l'étaient « dans une faible mesure ¼ ou qu'ils ne l'étaient « pas du tout ¼. Les DP ont déclaré qu'ils étaient au courant de l'existence d'études sur les stratégies d'enseignement (62,4 %) et sur les outils d'évaluation (51,9 %), mais qu'ils manquaient de temps pour se familiariser avec la documentation pertinente (72,1 % pour l'enseignement et 64,1 % pour l'évaluation). CONCLUSIONS: Les DP au Canada sont peu familiers avec les outils d'enseignement et d'évaluation fondés sur les données probantes, ce qui suggère un transfert des connaissances lacunaire de la recherche à l'éducation médicale.

Patients' and parents' perspectives of and experiences with assessing nursing students' paediatric clinical practice.

PURPOSE: To explore patients' and parents' involvement in the formative assessment of undergraduate nursing students' paediatric clinical practice. METHODS: We conducted semi-structured interviews with paediatric patients between 14 to 18 years old and parents who received care from a nursing student while admitted to a paediatric tertiary care hospital in Canada. We analysed the data using qualitative content analysis as well as Lincoln and Guba's criteria for establishing trustworthiness. The Consolidated criteria for reporting qualitative studies (COREQ) checklist was completed for the quality appraisal of this article. FINDINGS: Three categories emerged from the data: 1) how patients and parents are currently involved in the formative assessment of nursing students' paediatric clinical practice; 2) how patients and parents would prefer to be involved in the formative assessment of nursing students' paediatric clinical practice; and 3) the potential benefits and challenges of involving patients and parents in the formative assessment of nursing students' paediatric clinical practice. CONCLUSION: This study provided an understanding of patients' and parents' past encounters with nursing students and the elements of care that they have assessed as well as those that they would prefer to assess and provide feedback on, while considering the potential benefits and challenges of their involvement. The findings of this study will assist clinical instructors in determining how and when to involve patients and parents in the assessment of nursing students. Academic institutions offering nursing programmes should consider the study findings when improving or changing formative assessment strategies.

Resident duty hours: Families' knowledge and perceptions in the paediatric intensive care unit.

BACKGROUND AND OBJECTIVES: Resident duty hours remain a controversial topic in the literature. Competing interests include patient safety, resident education, and resident well-being. No studies, however, have sought family members' perspectives on duty hours in the paediatric context. This study aimed to explore family members' knowledge of trainee duty hours, and their perspectives on the balance between shift duration and hand-off frequency. METHODS: We surveyed family members of patients admitted ≥ 24 hours in the paediatric intensive care unit at an academic center. We simultaneously collected daily logs of hours worked by trainees. Descriptive statistics were used to analyze survey responses and trainee duty hours. RESULTS: One-hundred and one family members responded (75%). Respondents demonstrated knowledge of trainees working long duty hours but reported lower averages than the trainee logs (55 versus 66 hours per week and 16 versus 24 hours per shift). Elements related to both potential trainee fatigue and hand-offs raised concern in more than half of respondents. When asked to choose between a familiar trainee working a prolonged shift, or an unfamiliar trainee at the start of their shift, respondents were divided (52% versus 48%, respectively). CONCLUSIONS: Family members of critically ill paediatric patients are aware that trainees provide patient care while working long duty hours with minimal sleep. Despite this awareness, long shifts retain value with some families, possibly due to continuity. Changes to duty hours and hand-off frequency may pose an unrealized harm on family-centered care, as well as patient-provider relationships, and further study is warranted.

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

BACKGROUND: Patients can contribute to resident assessment in Competence by Design (CBD). This study explored the extent, nature, as well as the facilitators and hindrances of patient involvement in resident assessment within and across Canadian specialty/sub-specialty/special programs that are transitioning or have transitioned to CBD. METHODS: We used a two-phase sequential explanatory mixed-methods design. In Phase 1, we surveyed program directors (PDs). In Phase 2, we interviewed PDs from Phase 1. RESULTS: In Phase 1, 63 (62.4%) respondents in the CBD preparation stage, do not know if patients will be involved in resident assessment, 21 (20.8%) will involve patients, and 17 (16.8%) will not involve patients. Of those in the field-testing or implementation stages, 24 (72.7%) do not involve patients in resident assessment, five (15.2%) do involve patients, and four (12.1%) do not know if they involve patients. In Phase 2, 12 interviewees raised nine factors that facilitate or hinder patient involvement including, patients' interests/abilities, guidelines/processes for patient involvement, type of Entrustable Professional Activities, type of patient interactions in programs, and support from healthcare organizations. CONCLUSION: Patient involvement in resident assessment is limited. We need to engage in discussions on how to support such involvement within CBD.

Exploring residents' reactions to and use of parent feedback in a pediatric emergency department: A grounded theory study.

BACKGROUND: Competency-based medical education (CBME) involves workplace-based assessment. In pediatrics, patients' parents can participate in this assessment and generate feedback for residents. Prior to routinely collecting parent feedback, it is important to investigate residents' perspectives on it. AIM: To explore residents' reactions to and use of written parent feedback. METHODS: Using a grounded theory approach, we interviewed residents who received written parent feedback at the mid- and end-points of a pediatric emergency training rotation. RESULTS: Twenty-five residents participated. The residents reacted positively to the feedback. They thought that it complements educators' feedback, can elucidate parents' perspectives and needs, and is something that residents want and need. Although the residents thought that non-specific negative parent feedback is not useful, they believed non-specific positive and constructive parent feedback to be encouraging and useful. They delineated how they use non-specific positive parent feedback to boost their self-confidence and reassure themselves that parents perceive their clinical practices as appropriate. They also elucidated how they use constructive parent feedback to understand what is important to parents, become aware of their own behaviors, and modify their clinical practices. CONCLUSIONS: The findings encourage educators in pediatrics to include parents in resident assessment, especially in the CBME era.