Patient and public engagement in the CanMEDS framework: Which patients? Which publics?

INTRODUCTION: Medical education institutions increasingly employ patient and public engagement (PPE) to inform their learning activities. While this shift is highly welcome, it is equally important to consider whether and how patient and public perspectives have been incorporated in globally influential texts, such as the CanMEDS 2015 Physician Competency Framework, that govern the contexts in which these activities play out, particularly as this framework undergoes revision. METHODS: We explored PPE in the creation and revision of CanMEDS, applying textual analysis to an archive that included the current framework, its drafts and revision documents, earlier iterations (e.g. CanMEDS 2005 and 2000) and ancillary texts. We specifically examined patient and public involvement on committees, in expert working groups and in consultation processes. RESULTS: Findings indicate that despite stated desires to include 'the perspectives of the people who depend on Canadian physicians for their health care', there was minimal PPE in the 3-year revision process that led to CanMEDS 2015. Although data on patient and public perspectives were included in the original CanMEDS 2000 framework, these were imported from a provincially focused project from more than 30 years ago. CONCLUSION: If competency-based medical education systems wish to realise their promise of meeting societal needs, they must embrace strategies that regularly centre the perspectives of the patients and publics who comprise that society in the design and content of their foundational frameworks. To do so effectively, it may be productive for the field to untangle patient engagement from public engagement and more purposefully apply the wisdom that each of these modalities offers.