Shaping the future of primary care in Canada: trainee insights on patient and public engagement in health system transformation research.

Access to healthcare in Canada remains a significant issue, with over one in five people lacking attachment to a regular primary care provider. To address this, patients, health professionals, researchers and policymakers are advocating for health system transformation aimed at improving access and achieving the quintuple aim. As a result, research funding increasingly prioritizes health system transformation. However, whilst collaborative approaches such as integrated knowledge translation (IKT) are critical for success, trainees face barriers to integrating patient and public engagement into their research. These challenges include limited time and resources, difficulties in developing meaningful partnerships, tensions between independent intellectual contributions and collaborative research and academic structures that reinforce power imbalances. This commentary presents four trainee experiences that demonstrate successful capacity-building initiatives for trainees to embed patient and public engagement in health system transformation research. The first case study focusses on the Patient Expertise in Research Collaboration (PERC), which supports Transdisciplinary Understanding and Training on Research-Primary Health Care (TUTOR-PHC) trainees in incorporating patient perspectives into primary healthcare research. The second highlights the role of the Integrated Knowledge Translation Research Network (IKTRN) in building trainee capacity through funding. The third explores a trainee experience with the ACCESS Open Minds Network (AOM). The fourth describes a trainee experience within a co-design study, the Enhancing Physical and Community MoBility in OLDEr Adults with Health Inequities Using CommuNity Co-Design (EMBOLDEN). These case studies provide insights into effective strategies for overcoming barriers to patient and public engagement in research. However, opportunities for such engagement remain uneven and depend on limited funding. To foster sustainable support, academic institutions must integrate these capacity-building initiatives, promoting a future of primary care in Canada that is inclusive, patient-centred and responsive to evolving population needs.