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Problem: Advocates have called for health services to be delivered equitably to all. Academic psychiatry must play a role in this work, given its history of creating and perpetuating the marginalization of people experiencing mental health issues. While medical educators have started teaching concepts such as structural competency and cultural safety, careful consideration of who enters the medical workforce and what values they bring is also important., Approach: The authors report on the first 5 years (2016-2021) of a collaboration with individuals who have used mental health or addiction services or identify as having lived experiences of mental health and/or substance use issues (i.e., service users) to select residents to the general adult psychiatry residency program at the University of Toronto who are committed to working toward health equity and social justice and who bring diverse personal, academic, and community-based experiences. Starting in 2016, a working group of service users and faculty iteratively refined the selection process to add personal letter and interview day writing sample prompts centered on social justice and advocacy., Outcomes: The working group, coled by service users since 2019, defined the problem (lack of attention to health equity and social justice in resident selection) and codesigned the solution by revising writing prompts used in the selection process and their assessment rubrics to emphasize these missing areas. Further, service users directly participated in the implementation by reviewing candidates' personal letters and interview day writing samples alongside faculty and residents. This work serves as an example of meaningful service user engagement in action., Next Steps: To ensure the needs of service users are prioritized, future work must aim for long-term institutional commitment to strengthen service user involvement and power sharing with service user communities in resident selection and at other points along the medical education pathway., (Copyright © 2023 by the Association of American Medical Colleges.)

Although rhetoric abounds about the importance of patient-, person- and relationship-centered approaches to health care, little is known about how to address the problem of dehumanization through medical and health professions education. One promising but under-theorized strategy is to co-produce education in collaboration with health service users. To this end, we co-produced a longitudinal course in psychiatry that paired people with lived experience of mental health challenges as advisors to fourth-year psychiatry residents at the University of Toronto. The goal of this study was to examine this novel, relationship-based course in order to understand co-produced health professions education more broadly. Using qualitative interviews with residents and advisors after the first iteration of the course, we explored how participants made meaning of the course and of what learning, if any, occurred, for whom and how. We found that the anthropological theory of liminality allowed us to understand participants' complex experiences and illuminated how this type of pedagogy may work to achieve its effects. Liminality also helped us understand why some participants resisted the course, and how we could more carefully think about co-produced, humanistic education and transformative learning.

Objective: Co-production involves service providers and service users collaborating to design and deliver services together and is gaining attention as a means to improve provision of care. Aiming to extend this model to an educational context, the authors assembled a diverse group to develop co-produced education for psychiatry residents and medical students at the University of Toronto over several years. The authors describe the dynamics involved in co-producing psychiatric education as experienced in their work., Methods: A collaborative autobiographical case study approach provides a snapshot of the collective experiences of working to write a manuscript about paying service users for their contributions to co-produced education. Data were collected from two in-person meetings, personal communications, emails, and online comments to capture the fullest possible range of perspectives from the group about payment., Results: The juxtaposition of the vision for an inclusive process against the budgetary constraints that the authors faced led them to reflect deeply on the many meanings of paying service user educators for their contributions to academic initiatives. These reflections revealed that payment had implications at personal, organizational, and social levels., Conclusion: Paying mental health service user educators for their contributions is an ethical imperative for the authors. However, unless payment is accompanied by other forms of demonstrating respect, it aligns with organizational structures and practices, and it is connected to a larger goal of achieving social justice, the role of service users as legitimate knowers and educators and ultimately their impact on learners will be limited.

Objective: The authors describe a novel course that pairs service users as advisors to senior psychiatry residents with the goals of improving the residents' understanding of recovery, reducing negative stereotypes about people in recovery, and empowering the service users who participated., Methods: Service users who had experience working as peer support workers and/or system advocates were selected for a broad and deep understanding of recovery and an ability to engage learners in constructive dialogue. They met monthly with resident advisees over a period of 6 months. They were supported with monthly group supervision meetings and were paid an honorarium. Quantitative evaluations and qualitative feedback from the first two cohorts of the course, comprising 34 pairs, are reported here., Results: The first cohort of residents responded with a wide range of global ratings and reactions. In response to their suggestions, changes were made to the structure of the course to create opportunities for small group learning and reflective writing and to protect time for residents to participate. The second cohort of residents and both cohorts of service users gave acceptably high global ratings. Residents in the second cohort described gaining a number of benefits from the course, including an enhanced understanding of the lived experience of recovery and a greater sense of shared humanity with service users. Advisors described an appreciation for being part of something that has the potential for changing the practice of psychiatry and enhancing the lives of their peers., Conclusions: Positioning service users as advisors to psychiatry residents holds promise as a powerful way of reducing distance between future psychiatrists and service users and facilitating system reform toward person-centered recovery-oriented care.

Objective: The authors argue that adopting evidence-based psychiatry will require a paradigm shift in the training of psychiatry residents, and offer some suggestions for how this transformation might be achieved., Methods: The authors review the growing literature that addresses how best to teach evidence-based medicine and highlight several examples of innovative instructional and assessment methods., Results: Little is known about how best to instill among residents the attitudes, knowledge, skills, and behaviors that are necessary to practice evidence-based psychiatry. However, there are indications that the integration of evidence-based medicine instruction into routine clinical care and the alignment of the "hidden curriculum" with evidence-based practice are important., Conclusion: A whole-program approach may be necessary to create the conditions required in postgraduate training to produce evidence-based psychiatrists.