Patients’ Voices and the Assessment of Medical Trainees: A Discourse Analysis

Christina St-Onge; Isabelle Boulais; Linda Bergeron; Vincent Dion; Iris Le Sieur; Mélanie Marceau; Marie-Eve Poitras; Tim Dubé; Daniel J. Schumacher

doi:10.5334/pme.2588

Patients’ Voices and the Assessment of Medical Trainees: A Discourse Analysis

Volume 15 (2026): Issue 1

By: Christina St-Onge , Isabelle Boulais , Linda Bergeron , Vincent Dion , Iris Le Sieur, Mélanie Marceau , Marie-Eve Poitras , Tim Dubé and Daniel J. Schumacher

Open Access

|Jul 2026

Nemir A, Pearson M, Kitchin V, Wilbur K. Real patient participation in workplace-based assessment of health professional trainees: a scoping review. Eval Health Prof. 2024;47:283–295. DOI: 10.1177/01632787231180275
Open DOI Search in Google Scholar Back to article
Khalife R, Gupta M, Gonsalves C, et al. Patient involvement in assessment of postgraduate medical learners: a scoping review. Med Educ. 2022;56:602–613. DOI: 10.1111/medu.14726
Open DOI Search in Google Scholar Back to article
Moreau K, Eady K, Jabbour M. Patient involvement in resident assessment within the Competence by Design context: a mixed-methods study. Can Med Educ J. 2019;10:e84–e102. DOI: 10.36834/cmej.56881
Open DOI Search in Google Scholar Back to article
Rietmeijer CB, Deves M, van Esch SC, et al. A phenomenological investigation of patients’ experiences during direct observation in residency: busting the myth of the fly on the wall. Adv Health Sci Educ. 2021;26:1191–1206. DOI: 10.1007/s10459-021-10044-z
Open DOI Search in Google Scholar Back to article
Gordon M, Gupta S, Thornton D, et al. Patient/service user involvement in medical education: a best evidence medical education (BEME) systematic review: BEME Guide No. 58. Med Teach. 2020;42:4–16. DOI: 10.1080/0142159X.2019.1652731
Open DOI Search in Google Scholar Back to article
Suikkala A, Koskinen S, Leino-Kilpi H. Patients’ involvement in nursing students’ clinical education: a scoping review. Int J Nurs Stud. 2018;84:40–51. DOI: 10.1016/j.ijnurstu.2018.04.010
Open DOI Search in Google Scholar Back to article
Swanson DB, van der Vleuten CP. Assessment of clinical skills with standardized patients: state of the art revisited. Teach Learn Med. 2013;25:S17–S25. DOI: 10.1080/10401334.2013.842916
Open DOI Search in Google Scholar Back to article
Khan KZ, Ramachandran S, Gaunt K, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE guide no. 81. Part I: an historical and theoretical perspective. Med Teach. 2013;35:e1437–e1446. DOI: 10.3109/0142159X.2013.818634
Open DOI Search in Google Scholar Back to article
Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE guide no. 81. Part II: organisation & administration. Med Teach. 2013;35:e1447–1463. DOI: 10.3109/0142159X.2013.818635
Open DOI Search in Google Scholar Back to article
Doyle AJ, Sullivan C, O’Toole M, et al. Training simulated participants for role portrayal and feedback practices in communication skills training: a BEME scoping review: BEME Guide No. 86. Med Teach. 2024;46:162–178. DOI: 10.1080/0142159X.2023.2241621
Open DOI Search in Google Scholar Back to article
Bokken L, Linssen T, Scherpbier A, Van Der Vleuten C, Rethans J. Feedback by simulated patients in undergraduate medical education: a systematic review of the literature. Med Educ. 2009;43:202–210. DOI: 10.1111/j.1365-2923.2008.03268.x
Open DOI Search in Google Scholar Back to article
Castonguay V, Lavoie P, Karazivan P, Morris J, Gagnon R. Perceptions of emergency medicine residents of multisource feedback: different, relevant, and useful information. Ann Emerg Med. 2019;74:660–669. DOI: 10.1016/j.annemergmed.2019.05.019
Open DOI Search in Google Scholar Back to article
Reinders ME, Blankenstein AH, van Marwijk HW, et al. Development and feasibility of a patient feedback programme to improve consultation skills in general practice training. Patient Educ Couns. 2008;72:12–19. DOI: 10.1016/j.pec.2008.01.016
Open DOI Search in Google Scholar Back to article
Brinkman WB, Geraghty SR, Lanphear BP, et al. Effect of multisource feedback on resident communication skills and professionalism: a randomized controlled trial. Arch Pediatr Adolesc Med. 2007;161:44–49. DOI: 10.1001/archpedi.161.1.44
Open DOI Search in Google Scholar Back to article
Mills S. Discourse. 2nd ed. London: Routledge; 2004. DOI: 10.4324/9780203487136
Open DOI Search in Google Scholar Back to article
Hodges BD, Kuper A, Reeves S. Qualitative research: discourse analysis. BMJ. 2008;337:570–572. DOI: 10.1136/bmj.a879
Open DOI Search in Google Scholar Back to article
Varpio L, Ajjawi R, Monrouxe LV, O’Brien BC, Rees CE. Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking. Med Educ. 2017;51:40–50. DOI: 10.1111/medu.13124
Open DOI Search in Google Scholar Back to article
Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26:1753–1760. DOI: 10.1177/1049732315617444
Open DOI Search in Google Scholar Back to article
Jagadeesan R, Kalyan DN, Lee P, Stinnett S, Challa P. Use of a standardized patient satisfaction questionnaire to assess the quality of care provided by ophthalmology residents. Ophthalmology. 2008;115:738–743. DOI: 10.1016/j.ophtha.2007.05.033
Open DOI Search in Google Scholar Back to article
Ju M, Berman AT, Hwang W-T, et al. Assessing interpersonal and communication skills in radiation oncology residents: a pilot standardized patient program. Int J Radiat Oncol Biol Phys. 2014;88:1129–1135. DOI: 10.1016/j.ijrobp.2014.01.007
Open DOI Search in Google Scholar Back to article
Joshi R, Ling FW, Jaeger J. Assessment of a 360-degree instrument to evaluate residents’ competency in interpersonal and communication skills. Acad Med. 2004;79:458–463. DOI: 10.1097/00001888-200405000-00017
Open DOI Search in Google Scholar Back to article
El-Haddad C, Damodaran A, McNeil HP, Hu W. A patient-centered approach to developing entrustable professional activities. Acad Med. 2017;92:800–808. DOI: 10.1097/ACM.0000000000001616
Open DOI Search in Google Scholar Back to article
Dine CJ, Ruffolo S, Lapin J, Shea JA, Kogan JR. Feasibility and validation of real-time patient evaluations of internal medicine interns’ communication and professionalism skills. J Grad Med Educ. 2014;6:71–77. DOI: 10.4300/JGME-D-13-00173.1
Open DOI Search in Google Scholar Back to article
Garra G, Wackett A, Thode H. Feasibility and reliability of a multisource feedback tool for emergency medicine residents. J Grad Med Educ. 2011;3:356–360. DOI: 10.4300/JGME-D-10-00173.1
Open DOI Search in Google Scholar Back to article
Mahoney D, Bogetz A, Hirsch A, et al. The challenges of multisource feedback: feasibility and acceptability of gathering patient feedback for pediatric residents. Acad Pediatr. 2019;19:555–560. DOI: 10.1016/j.acap.2018.12.002
Open DOI Search in Google Scholar Back to article
Klessig J, Robbins AS, Wieland D, Rubenstein L. Evaluating humanistic attributes of internal medicine residents. J Gen Intern Med. 1989;4:514–521. DOI: 10.1007/BF02599551
Open DOI Search in Google Scholar Back to article
Naidoo S, Lopes S, Patterson F, Mead HM, MacLeod S. Can colleagues’, patients’ and supervisors’ assessments predict successful completion of postgraduate medical training? Med Educ. 2017;51:423–431. DOI: 10.1111/medu.13128
Open DOI Search in Google Scholar Back to article
Newcomb A, Trickey AW, Lita E, Dort J. Evaluating surgical residents’ patient-centered communication skills: practical alternatives to the “apprenticeship model.” J Surg Educ. 2018;75:613–621. DOI: 10.1016/j.jsurg.2017.09.011
Open DOI Search in Google Scholar Back to article
Weaver MJ, Ow CL, Walker DJ, Degenhardt EF. A questionnaire for patients’ evaluations of their physicians’ humanistic behaviors. J Gen Intern Med. 1993;8:135–139. DOI: 10.1007/BF02599758
Open DOI Search in Google Scholar Back to article
Makoul G, Krupat E, Chang C-H. Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool. Patient Educ Couns. 2007;67:333–342. DOI: 10.1016/j.pec.2007.05.005
Open DOI Search in Google Scholar Back to article
Qu B, Zhao Y, Sun B. Assessment of resident physicians in professionalism, interpersonal and communication skills: a multisource feedback. Int J Med Sci. 2012;9:228–236. DOI: 10.7150/ijms.3353
Open DOI Search in Google Scholar Back to article
Stausmire JM, Cashen CP, Myerholtz L, Buderer N. Measuring general surgery residents’ communication skills from the patient’s perspective using the Communication Assessment Tool (CAT). J Surg Educ. 2015;72:108–116. DOI: 10.1016/j.jsurg.2014.06.021
Open DOI Search in Google Scholar Back to article
Wood J, Collins J, Burnside ES, et al. Patient, faculty, and self-assessment of radiology resident performance: a 360-degree method of measuring professionalism and interpersonal/communication skills1. Acad Radiol. 2004;11:931–939. DOI: 10.1016/j.acra.2004.04.016
Open DOI Search in Google Scholar Back to article
Claramita M, Majoor G. Comparison of communication skills in medical residents with and without undergraduate communication skills training as provided by the Faculty of Medicine of Gadjah Mada University. Educ Health Change Learn Pract. 2006;19:308–320. DOI: 10.1080/13576280600937887
Open DOI Search in Google Scholar Back to article
Brinkman WB, Geraghty SR, Lanphear BP, et al. Evaluation of resident communication skills and professionalism: a matter of perspective? Pediatrics. 2006;118:1371–1379. DOI: 10.1542/peds.2005-3214
Open DOI Search in Google Scholar Back to article
Byrd A, Iheagwara K, McMahon P, Bolton M, Roy M. Using multisource feedback to assess resident communication skills: adding a new dimension to milestone data. Ochsner J. 2020;20:255–260. DOI: 10.31486/toj.19.0054
Open DOI Search in Google Scholar Back to article
Henkin Y, Friedman M, Bouskila D, Kushnir D, Glick S. The use of patients as student evaluators. Med Teach. 1990;12:279–289. DOI: 10.3109/01421599009006632
Open DOI Search in Google Scholar Back to article
Bogetz AL, Orlov N, Blankenburg R, et al. How residents learn from patient feedback: a multi-institutional qualitative study of pediatrics residents’ perspectives. J Grad Med Educ. 2018;10:176–184. DOI: 10.4300/JGME-D-17-00447.1
Open DOI Search in Google Scholar Back to article
Greco M, Brownlea A, McGovern J. Impact of patient feedback on the interpersonal skills of general practice registrars: results of a longitudinal study. Med Educ. 2001;35:748–756. DOI: 10.1046/j.1365-2923.2001.00976.x
Open DOI Search in Google Scholar Back to article
McKinley SK, Wojcik BM, Kochis M, et al. A pilot study of inpatient satisfaction rating of surgical resident care. J Surg Educ. 2018;75:e192–e203. DOI: 10.1016/j.jsurg.2018.08.007
Open DOI Search in Google Scholar Back to article
Stewart EA, Marzio DH-D, Guggenheim DE, et al. Resident scores on a patient satisfaction survey: evidence for maintenance of communication skills throughout residency. J Grad Med Educ. 2011;3:487–489. DOI: 10.4300/JGME-D-11-00047.1
Open DOI Search in Google Scholar Back to article
Bylund CL, Banerjee SC, Bialer PA, et al. A rigorous evaluation of an institutionally-based communication skills program for post-graduate oncology trainees. Patient Educ Couns. 2018;101:1924–1933. DOI: 10.1016/j.pec.2018.05.026
Open DOI Search in Google Scholar Back to article
Keister DM, Hansen SE, Dostal J. Teaching resident self-assessment through triangulation of faculty and patient feedback. Teach Learn Med. 2017;29:25–30. DOI: 10.1080/10401334.2016.1246249
Open DOI Search in Google Scholar Back to article
Matthews DA, Sledge WH, Lieberman PB. Evaluation of intern performance by medical inpatients. Am J Med. 1987;83:938–944. DOI: 10.1016/0002-9343(87)90655-3
Open DOI Search in Google Scholar Back to article
Reinders ME, Blankenstein AH, Van Der Horst HE, et al. Does patient feedback improve the consultation skills of general practice trainees? A controlled trial. Med Educ. 2010;44:156–164. DOI: 10.1111/j.1365-2923.2009.03569.x
Open DOI Search in Google Scholar Back to article
Tamblyn R, Benaroya S, Snell L, et al. The feasibility and value of using patient satisfaction ratings to evaluate internal medicine residents. J Gen Intern Med. 1994;9:146–152. DOI: 10.1007/BF02600030
Open DOI Search in Google Scholar Back to article
Dijk SW, Duijzer EJ, Wienold M. Role of active patient involvement in undergraduate medical education: a systematic review. BMJ Open. 2020;10:e037217. DOI: 10.1136/bmjopen-2020-037217
Open DOI Search in Google Scholar Back to article
Rassbach CE, Bogetz AL, Orlov N, et al. The effect of faculty coaching on resident attitudes, confidence, and patient-rated communication: a multi-institutional randomized controlled trial. Acad Pediatr. 2019;19:186–194. DOI: 10.1016/j.acap.2018.10.004
Open DOI Search in Google Scholar Back to article
O’Keefe M, Whitham J. Early identification of ‘at-risk’students by the parents of paediatric patients. Med Educ. 2005;39:958–965. DOI: 10.1111/j.1365-2929.2005.02194.x
Open DOI Search in Google Scholar Back to article
Cope DW, Linn LS, Leake BD, Barrett PA. Modification of residents’ behavior by preceptor feedback of patient satisfaction. J Gen Intern Med. 1986;1:394–398. DOI: 10.1007/BF02596425
Open DOI Search in Google Scholar Back to article
Bogetz AL, Rassbach CE, Chan T, Blankenburg RL. Exploring the educational value of patient feedback: a qualitative analysis of pediatric residents’ perspectives. Acad Pediatr. 2017;17:4–8. DOI: 10.1016/j.acap.2016.10.020
Open DOI Search in Google Scholar Back to article
Thomas PA, Hellmann DB. Residents’ attitudes toward patient feedback. Acad Med. 1999;74:90–91. DOI: 10.1097/00001888-199902000-00004
Open DOI Search in Google Scholar Back to article
Malau-Aduli BS. Patient involvement in assessment: How useful is it? Med Educ. 2022;56:590–592. DOI: 10.1111/medu.14802
Open DOI Search in Google Scholar Back to article
Canadian Institutes of Health Research. Strategy for patient-oriented research: Patient engagement framework. https://www.cihr-irsc.gc.ca/e/48413.html (accessed 25 Feb 2025).
Search in Google Scholar Back to article
Holmboe ES. Work-based assessment and co-production in postgraduate medical training. GMS J Med Educ. 2017;34:Doc58. DOI: 10.3205/zma001135
Open DOI Search in Google Scholar Back to article
Ten Cate O. Entrustment decisions: bringing the patient into the assessment equation. Acad Med. 2017;92:736–738. DOI: 10.1097/ACM.0000000000001623
Open DOI Search in Google Scholar Back to article
Sebok-Syer SS, Gingerich A, Holmboe ES, et al. Distant and hidden figures: foregrounding patients in the development, content, and implementation of entrustable professional activities. Acad Med. 2021;96:S76–S80. DOI: 10.1097/ACM.0000000000004094
Open DOI Search in Google Scholar Back to article
Regan de Bere S, Nunn S. Towards a pedagogy for patient and public involvement in medical education. Med Educ. 2016;50:79–92. DOI: 10.1111/medu.12880
Open DOI Search in Google Scholar Back to article
Eijkelboom M, De Kleijn R, Van Diemen W, et al. Patients as feedback providers: exploring medical students’ credibility judgments. Perspect Med Educ. 2023;12:129–140. DOI: 10.5334/pme.842
Open DOI Search in Google Scholar Back to article
McMahon-Parkes K, Chapman L, James J. The views of patients, mentors and adult field nursing students on patients’ participation in student nurse assessment in practice. Nurse Educ Pract. 2016;16:202–208. DOI: 10.1016/j.nepr.2015.08.007
Open DOI Search in Google Scholar Back to article
Gilligan C, Bujnowska-Fedak MM, Essers G, et al. Assessment of communication skills in health professions education; Ottawa 2024 consensus statement. Med Teach. 2024;46:1593–1606. DOI: 10.1080/0142159X.2024.2413021
Open DOI Search in Google Scholar Back to article
Sehlbach C, Bosveld MH, Romme S, et al. Challenges in engaging patients in feedback conversations for health care professionals’ workplace learning. Med Educ. 2024;58:970–979. DOI: 10.1111/medu.15313
Open DOI Search in Google Scholar Back to article
Carraccio C, Englander R, Holmboe ES, Kogan JR. Driving care quality: aligning trainee assessment and supervision through practical application of entrustable professional activities, competencies, and milestones. Acad Med. 2016;91:199–203. DOI: 10.1097/ACM.0000000000000985
Open DOI Search in Google Scholar Back to article
Pomey M-P, Flora L, Karazivan P, et al. Le « Montreal model » : enjeux du partenariat relationnel entre patients et professionnels de la santé. Sante Publique. 2015;1:41–50. DOI: 10.3917/spub.150.0041
Open DOI Search in Google Scholar Back to article
Molloy E, Bearman M. Embracing the tension between vulnerability and credibility: ‘intellectual candour’in health professions education. Med Educ. 2019;53:32–41. DOI: 10.1111/medu.13649
Open DOI Search in Google Scholar Back to article
van de Walle – van de Geijn BFH, Joosten – ten Brinke D, Klaassen TPFM, van Tuijl AC, Fluit CRMG. Upward feedback in nursing: a matter of giving, taking and asking. Nurse Educ Pract. 2020;45:102792. DOI: 10.1016/j.nepr.2020.102792
Open DOI Search in Google Scholar Back to article

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DOI: https://doi.org/10.5334/pme.2588 | Journal eISSN: 2212-277X

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Language: English

Page range: 556 - 568

Submitted on: Mar 20, 2026

Accepted on: Apr 7, 2026

Published on: Jul 6, 2026

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

© 2026 Christina St-Onge, Isabelle Boulais, Linda Bergeron, Vincent Dion, Iris Le Sieur, Mélanie Marceau, Marie-Eve Poitras, Tim Dubé, Daniel J. Schumacher, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 15 (2026): Issue 1