Introduction: Researchers have emphasized the need to integrate patients into medical education, specifically advocating for patient-based assessments within medical curricula. However, there is a critical gap in understanding how patient involvement is conceptualized and operationalized within assessment practices. Thus, we aimed to gain a deeper understanding of the current discourses surrounding the integration of real patients in the assessment of medical trainees.

Methods: We performed a Discourse Analysis using Hodges’ empirical discourse methodology. Coding of the 54 included articles initially focused on “conceptualization,” “ways patients participate,” “opportunities created,” “challenges,” and detailed aspects of “assessment,” including content, development, validation, and format. The team iteratively discussed the codes and themes until they reached a consensus about the data interpretation.

Results: We identified three distinct—yet not always mutually exclusive—discourses: (1) patients as survey-fillers, (2) patients as feedback providers, and (3) patients as part of programmatic assessment.

Discussion: By illuminating these discourses, this study deepens our understanding of why patient involvement takes the forms it does and suggests that moving toward positioning patients as part of programmatic assessment may offer a more meaningful basis for patient partnership in the assessment of medical trainees.