Table 1.

Steps of the Process of the Adapted Nominal Group Technique

Steps	Description	Involved Stakeholders	Main Outcomes
1. Initial meeting within a monthly residency training program committee (09/25/2018, CHU Sainte-Justine, duration: 1h)	Identification, definition, and summary of central issues37,49 Sharing of individuals' ideas in a round-robin format Systematic recording of verbal exchanges to regroup ideas and provide clarification and precision, led by facilitator (L.P.T.)	2 program directors of the pediatrics residency training program Chair of the pediatric university department 4 residents (1 in each training level from PGY-1 to PGY-4) 3 chief residents of the pediatrics residency training program 10 other faculty members responsible for research, evaluation committee, neonatology, and intensive care rotations, classes, longitudinal clinic, CBME reform, OSCE evaluations, sur- and subspecialties match process, and representatives from remote clinical teaching facilities	Consensus on a list of 15 issues to explore Synthesis prepared for team members working on information gathering and literature review
2. Review of literature	Outlining of issues that have already been explored regarding trainees as research subjects and what tools have been proposed to solve the various issues	Authors of the article	Updated internal knowledge-based document (grounded in empirical experience and literature) Synthesis of results from first meeting and review of literature for experts participating to the second meeting
3. Second meeting with experts related to central issues to be discussed (11/15/2018, CHU Sainte-Justine, duration: 1.5h)	Simplification and organization of issues raised during initial meeting, separating issues, and recommendations Revision and critical analysis of issues and recommendations was done individually, after the meeting. Comments were then sent by separate emails.	Director of the medical education research center of the University of Montreal Director of medical education, CHU Sainte-Justine Chair of the pediatric residency evaluation committee 1 faculty member who is a clinical researcher 1 expert in clinical ethics President of the IRB at CHU Sainte-Justine 1 chief resident	Consensual strategic document containing 5 issues and their related recommendations Synthesis of experts' definition of issues and recommendations to present for the final meeting
4. Final meeting within a monthly residency training program committee (04/30/2019, CHU Sainte-Justine, duration: 1h)	Presentation of the proposed final version of the report Discussion, clarifications, and approval of the document	Same collaborators as for Step 1 (initial meeting)	Consensual final version of the document Final version and descriptive synthesis of the process to present to the direction of the program
5. Approval	Final approval of the document	Pediatric residency training program direction	No further modifications were made to the proposed final version before approval (04/30/2019)

Abbreviations: PGY, postgraduate year; CBME, competency-based medical education; OSCE, objective structured clinical examination; IRB, Institutional Review Board.