Patient involvement in assessment of postgraduate medical learners: A scoping review

Abstract

Context Competency‐based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent. Methods We conducted a scoping review to map the nature, extent and range of literature examining the inclusion (or exclusion) of patients within the assessment of postgraduate medical learners. Guided by Arskey and O'Malley's framework and informed by Levac et al. and Thomas et al., we searched two databases (MEDLINE® and Embase®) from inception until February 2021 using subheadings related to assessment, patients and postgraduate learners. Data analysis examined characteristics regarding the nature and factor influencing patient involvement in assessment. Results We identified 41 papers spanning four decades. Some literature suggests patients are willing to be engaged in assessment, however choose not to engage when, for example, language barriers may exist. When stratified by specialty or clinical setting, the influence of factors such as gender, race, ethnicity or medical condition seems to remain consistent. Patients may participate in assessment as a stand‐alone group or part of a multi‐source feedback process. Patients generally provided high ratings but commented on the observed professional behaviours and communication skills in comparison with physicians who focused on medical expertise. Conclusion Factors that influence patient involvement in assessment are multifactorial including patients' willingness themselves, language and reading‐comprehension challenges and available resources for training programmes to facilitate the integration of patient assessments. These barriers however are not insurmountable. While understudied, research examining patient involvement in assessment is increasing; however, our review suggests that the extent which the unique insights will be taken up in postgraduate medical education may be dependent on assessment systems readiness and, in particular, physician readiness to partner with patients in this way.

Patient involvement in assessment: How useful is it?

“…The training of doctors is a process of enculturation and 'tacit socialization'. 1 Instilling a sense of identity as a medical professional is, in fact, an explicit goal of many medical education programmes. Social identity approaches suggest that group membership influences an individual's self-concept and that group norms tend DOI: 10.1111/medu.14788…”

“…Although clinicians, as the central actors in assessment systems, have expressed uncertainty and concerns regarding ability, expertise and potential bias of patients in assessment, 2 studies have shown that clinicians themselves are not totally free of bias in their judgement 3 . As such, Khalife et al 1 reignite the debate about the usefulness of patient involvement in assessment within medical education. In this commentary, I will further contrast and compare the decision making of patients (standardised or real) with the processes employed by clinically trained examiners in an effort to help elucidate the usefulness of the patient's voice in competency‐based assessment and guide future research in this area.…”

“…A scoping review published in this issue of Medical Education by Khalife et al highlights the benefits of involving patients in assessing postgraduate medical learners 1 . The authors set the scene by stating that the authentic patient voice is still merely a whisper in contemporary competency‐based assessment in medical education despite the global movement towards greater patient partnership in defining a holistic medical learners' competence for 21st century health care.…”

Is person‐centred medical education an aim or an empty promise?

“…Person-centredness demands that biomedical and experiential expertise coalesce, and it makes intuitive sense that fulfilling the promise of person-centredness depends on involving patients in teaching and assessment. 11 Many patients are eager to do this work, and we have had the privilege of participating in both patient-level and institutional efforts aimed at meaningfully including patients in teaching and assessment. We are heartened that stubborn professional values may be slowly starting to budge, making room for opportunities to transform person-centredness from an aspiration into a fundamental feature of training and care.…”

“…Person‐centredness demands that biomedical and experiential expertise coalesce, and it makes intuitive sense that fulfilling the promise of person‐centredness depends on involving patients in teaching and assessment 11 . Many patients are eager to do this work, and we have had the privilege of participating in both patient‐level and institutional efforts aimed at meaningfully including patients in teaching and assessment.…”