Patient involvement in medical education: To what problem is engagement the solution?

Context Patient and public engagement is gaining momentum across many domains of health care, inclusive of education and research. In this framing, engagement is offered as a solution to a myriad of problems. Yet, the way problems and solutions are linked together may be assumed, rather than made explicit. In the absence of clarity, there is a risk that solutions that may have worked in one domain of health care could falter, or even create new problems, in another. Methods We use a model from organisational studies as a way to make sense of the relationships between the problems, solutions and stakeholders operating in the name of patient and public engagement in health care. The 'garbage can model' is a playfully phrased but meaningful attempt to decipher the complex world of decision making in organisations. We use this model to guide our framing of the solutions of patient engagement practice and the wide range of problem statements that animate all of this activity. Results Following a discussion of the complexity of the field of patient engagement, we identify strategies for educators to conceptually weave problem statements, solutions and stakeholders together in mosaics of engagement activity. We further suggest a movement away from considering problems to be solved to thinking about polarities to be navigated. Conclusions As patient engagement becomes more embedded in decision-making spaces in health professions education, we need a better understanding of how decisions are actually made in these organisations. We also need to consider that our most treasured solutions may have an uneasy fit, and some unintended consequences, as they enter new domains of health care. Finally, we advocate for critical approaches not just to the solutions of patient engagement, but to understand problem statements as they are defined, upheld and disrupted through all of this work.