**1. Introduction**

The healthcare system has put emphasis on patient-centered care [1] by empowering patients to have an active role, for example, by being involved in their personal care [2] and by contributing to improvement in the care process [3, 4]. Although patients have become increasingly involved in healthcare, their involvement in postgraduate medical education (PGME) is often less prominent. Whereas, patients' perspective and feedback on residents' performance could be valuable for enhancing residents' learning as well as the quality of healthcare in general [5]. Furthermore, expanding the involvement of patients in PGME would be in line with the current trends in healthcare. This study builds on the conception that patients are obvious

members of the educational team in workplace-based learning. We aim at finding topics for patient feedback that patients and residents agree on.

Obviously, feedback and reflection are crucial aspects of residents' learning [6]. Residents receive feedback in the workplace-based learning environment, in which the relationships between patients, residents, and medical supervisors are essential [7]. Feedback is the result of observing performance and has the purpose to minimize the gap between the current performance and the desired goal [8]. Current feedback guidelines within PGME have put an emphasis on providing effective feedback for medical supervisors in order to enhance residents' learning [6, 9]. Medical supervisors give residents feedback on different competency roles based on the competency framework of the Canadian Medical Education Directives for Specialists (CanMEDS), to ensure that residents possess a range of various competencies [10]. On the other hand, Lai et al. noted additional feedback from patients as an educational tool to enhance the consultation skills of medical students as well [11]. Additionally, research has shown that patients can enlighten blind spots and suggest new opportunities for learning [12]. Furthermore, Crotty et al. reported the importance of patient feedback by means of OpenNotes in graduate medical education (GME) [13]. Whereby patients were able to look into the residents' notes and provide feedback. Although residents considered OpenNotes in GME effective, some concerns were made about the patientdoctor relationship [13].

Despite the value patients' feedback could potentially have for residents learning, there have been no studies to our knowledge that focused on the feedback topics that patients actually wish to provide feedback on in order to enhance residents learning. Studies so far have mainly focused on patient feedback regarding the communication skills of residents [3, 14–16], while medical training includes more competencies than communication skills alone [10, 17]. Even so, the current feedback systems that are in place within PGME also involve other dimensions/areas of clinical practice rather than communication skills only. Feedback from patients on other aspects of the medical profession might be valuable for learning as well. Additionally, little is known about both the patient feedback topics for resident enhancement and the effectiveness of feedback from patients.

The purpose of this study is to improve PGME by means of patient feedback. This study provides insights into both patients' and residents' perspectives regarding patient feedback topics, in order to increase its use and effectiveness in postgraduate medical education. Therefore, the research question answered in this study was: What are the feedback topics patients and residents provide for the development of patient feedback into PGME for the purpose of enhancing residents' learning?
