The use of a portfolio in postgraduate medical education - reflect, assess and account, one for each or all in one?

Sylvia Heeneman, Erik W Driessen, Sylvia Heeneman, Erik W Driessen

Abstract

Competency-based education has become central to the training and assessment of post-graduate medical trainees or residents [1]. In competency-based education, there is a strong focus on outcomes and professional performance. Typically, holistic tasks are used to train, practice and assess the defined outcomes or competencies. In residency training, these tasks are part of the day-to-day clinical practice. The performance of residents in the workplace needs to be captured and stored. A portfolio has been used as an instrument for storage and collection of workplace-based assessment and feedback in various countries, like the Netherlands and the United States. The collection of information in a portfolio can serve or be used for a variety of purposes. These are: The collection of work samples, assessment, feedback and evaluations in a portfolio enables the learner to look back, analyze and reflect. The content is used for assessment or making decisions about progress. And the portfolio is used as an instrument for quality assurance processes. In post-graduate medical education, these purposes can be combined but this is not always reported transparently. In this paper, we will discuss the different perspectives, how a portfolio can serve these three purposes and what are opportunities and challenges of combining multiple purposes.

Keywords: feedback; portfolio; postgraduate education; quality insurance; reflection.

References

    1. Hawkins R, Welcher C, Holmboe E, Kirk L, Norcini J, Simons K, Skochelak SE. Implementation of competency-based medical education: are we addressing the concerns and challenges? Med Educ. 2015;49(11):1086–1102. doi: 10.1111/medu.12831. Available from: .
    1. Tillema H. Portfolios as developmental assessment tools. International J Training Develop. 2001;5(2):126–135. doi: 10.1111/1468-2419.00127. Available from: .
    1. van Tartwijk J, Driessen E. Portfolios for assessment and learning: AMEE Guide no. 45. Med Teach. 2009;31(9):790–801. doi: 10.1080/01421590903139201. Available from: .
    1. Smith K, Tillema H. Clarifying different types of portfolio use. Ass Eval Higher Educ. 2003;28(6):625–648. doi: 10.1080/0260293032000130252. Available from: .
    1. Fernsten L, Fernsten J. Portfolio assessment and reflection: enhancing learning through effective practice. Reflect Pract. 2005;6(2):303–309. doi: 10.1080/14623940500106542. Available from: .
    1. Koole S, Dornan T, Aper L, Scherpbier A, Valcke M, Cohen-Schotanus J, Derese A. Does reflection have an effect upon case-solving abilities of undergraduate medical students? BMC Med Educ. 2012;12(1):75. doi: 10.1186/1472-6920-12-75. Available from: .
    1. Sobral DT. Medical students' reflection in learning in relation to approaches to study and academic achievement. Med Teach. 2001;23(5):508–513. doi: 10.1080/01421590126488. Available from: .
    1. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ. 2009;14(4):595–621. doi: 10.1007/s10459-007-9090-2. Available from: .
    1. Mamede S, Schmidt HG, Penaforte JC. Effects of reflective practice on the accuracy of medical diagnoses. Med Educ. 2008;42(5):468–475. doi: 10.1111/j.1365-2923.2008.03030.x. Available from: .
    1. Webb T, Aprahamian C, Weigelt J, Brasel K. The Surgical Learning and Instructional Portfolio (SLIP) as a self-assessment educational tool demonstrating practice-based learning. Curr Surgery. 2006;63(6):444–447. doi: 10.1016/j.cursur.2006.04.001. Available from: .
    1. Pearson D, Heywood P. Portfolio use in general practice vocational training: a survey of GP registrars. Med Educ. 2004;38(1):87–95. doi: 10.1111/j.1365-2923.2004.01737.x. Available from: .
    1. Swallow V, Clarke C, Iles S, Harden J. Work based, lifelong learning through professional portfolios: Challenge or reward? Pharm Educ. 2006;6(2):77–89. doi: 10.1080/15602210600682228. Available from: .
    1. Austin Z, Marini A, DesRoches B. Use of a learning portfolio for continuous professional development: A study of pharmacists in Ontario (Canada) Pharm Educ. 2005;5 doi: 10.1080/15602210500282434. Available from: .
    1. Kjaer N, Maagaard R, Wied S. Using an online portfolio in postgraduate training. Med Teach. 2006;28(8):708–712. doi: 10.1080/01421590601047672. Available from: .
    1. Hrisos S, Illing J, Burford B. Portfolio learning for foundation doctors: early feedback on its use in the clinical workplace. Med Educ. 2008;42(2):214–223. doi: 10.1111/j.1365-2923.2007.02960.x. Available from: .
    1. Driessen E, Van Tartwijk J, Overeem K, Vermunt J, Van Der Vleuten C. Conditions for successful reflective use of portfolios in undergraduate medical education. Med Educ. 2005;39(12):1230–1235. doi: 10.1111/j.1365-2929.2005.02337.x. Available from: .
    1. Driessen E, Muijtjens A, Van Tartwijk J, van der Vleuten C. Web-or paper-based portfolios: is there a difference? Med Educ. 2007;41(11):1067–1073. doi: 10.1111/j.1365-2923.2007.02859.x. Available from: .
    1. Gordon J, Campbell C. The role of ePortfolios in supporting continuing professional development in practice. Med Teach. 2013;35(4):287–294. doi: 10.3109/0142159X.2013.773395. Available from: .
    1. Könings K, van Berlo J, Koopmans R, Hoogland H, Spanjers I, ten Haaf J, van den Vleuten CP, van Merrienboer JJ. Using a Smartphone App and Coaching Group Sessions to Promote Residents' Reflection in the Workplace. Acad Med. 2016;91(3):365–370. doi: 10.1097/ACM.0000000000000989. Available from: .
    1. Keim K, Gates G, Johnson C. Dietetics professionals have a positive perception of professional development. J Am Diet Ass. 2001;101(7):820–824. doi: 10.1016/S0002-8223(01)00202-4. Available from: .
    1. Driessen E, van Tartwijk J, van der Vleuten C, Wass V. Portfolios in medical education: why do they meet with mixed success? A systematic review. Med Educ. 2007;41(12):1224–1233. doi: 10.1111/j.1365-2923.2007.02944.x. Available from: .
    1. Kalén S, Ponzer S, Seeberger A, Kiessling A, Silén C. Continuous mentoring of medical students provides space for reflection and awareness of their own development. Intern J Med Educ. 2012;3:236–244. doi: 10.5116/ijme.50ad.328c. Available from: .
    1. Sargeant J, Lockyer J, Mann K, Holmboe E, Silver I, Armson H, Driessen E, MacLeod T, Yen W, Ross K, Power M. Facilitated reflective performance feedback: developing an evidence-and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2) Acad Med. 2015;90(12):1698–1706. doi: 10.1097/ACM.0000000000000809. Available from: .
    1. Dekker H, Driessen E, ter Braak E, Scheele F, Slaets J, van der Molen T, Cohen-Schontanus J. Mentoring portfolio use in undergraduate and postgraduate medical education. Med Teach. 2009;31(10):903–909. doi: 10.3109/01421590903173697. Available from: .
    1. Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010;32(8):676–682. doi: 10.3109/0142159X.2010.500704. Available from: .
    1. ten Cate O, Scheele F. Viewpoint: Competency-Based Postgraduate Training: Can We Bridge the Gap between Theory and Clinical Practice? Acad Med. 2007;82(6):542–547. doi: 10.1097/ACM.0b013e31805559c7. Available from: .
    1. O'Sullivan P, Reckase M, McClain T, Savidge M, Clardy J. Demonstration of portfolios to assess competency of residents. Adv Health Sci Educ. 2004;9(4):309–323. doi: 10.1007/s10459-004-0885-0. Available from: .
    1. Michels N, Driessen E, Muijtjens A, Van Gaal L, Bossaert L, De Winter B. Portfolio assessment during medical internships: How to obtain a reliable and feasible assessment procedure? Educ Health. 2009;22(3):313.
    1. Gadbury-Amyot C, Kim J, Palm R, Mills G, Noble E, Overman P. Validity and reliability of portfolio assessment of competency in a baccalaureate dental hygiene program. J Dent Educ. 2003;67(9):991–1002.
    1. Van Tartwijk J, Driessen E, van der Vleuten C, Stokking K. Factors influencing the successful introduction of portfolios. Qual High Educ. 2007;13(1):69–79. doi: 10.1080/13538320701272813. Available from: .
    1. Hodges B. Sea monsters & whirlpools: Navigating between examination and reflection in medical education. Med Teach. 2015;37(3):261–266. doi: 10.3109/0142159X.2014.993601. Available from: .
    1. Ng S, Kinsella E, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. Med Educ. 2015;49(5):461–475. doi: 10.1111/medu.12680. Available from: .
    1. Driessen E. Do portfolios have a future? Adv Health Sci Educ. 2016:1–8.
    1. van der Vleuten C, Schuwirth L, Driessen E, Dijkstra J, Tigelaar D, Baartman LK, van Tartwijk J. A model for programmatic assessment fit for purpose. Med Teach. 2012;34(3):205–214. doi: 10.3109/0142159X.2012.652239. Available from: .
    1. Schuwirth L, van der Vleuten C. Programmatic assessment: From assessment of learning to assessment for learning. Med Teach. 2011;33(6):478–485. doi: 10.3109/0142159X.2011.565828. Available from: .
    1. Eva K, Bordage G, Campbell C, Galbraith R, Ginsburg S, Holmboe E, Regehr G. Towards a program of assessment for health professionals: from training into practice. Adv Health Sci Educ Theory Pract. 2016;21(4):897–913. doi: 10.1007/s10459-015-9653-6. Available from: .
    1. Ten Cate O. Entrustability of professional activities and competency-bases training. Med Educ. 2005;39:1176–1177. doi: 10.1111/j.1365-2929.2005.02341.x. Available from: .
    1. Ten Cate O, Hart D, Ankel F, Busari J, Englander R, Glasgow N, Holmboe E, Iobst W, Lovell E, Snell LS, Touchie C, Van Melie E, Wycliffe-Johnes K International Competency-Based Medical Education Collaborators. Entrustment decision making in clinical training. Acad Med. 2016;91(2):191–198. doi: 10.1097/ACM.0000000000001044. Available from: .
    1. Oerlemans M, Dielissen P, Timmerman A, Ram P, Maiburg B, Muris J, van der Vleuten C. Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles. Med Teach. 2017:1–8. doi: 10.1080/0142159X.2017.1270427. Available from: .
    1. Calaman S, Hepps J, Bismilla Z, Carraccio C, Englander R, Feraco A, Landrigan CP, Lopreiato JO, Sectish TC, Starmer AJ, Yu CE, Spector ND, Wwest DC I-Pass Study Education Executive Committee. The creation of standard-setting videos to support faculty observations of learner performance and entrustment decisions. Acad Med. 2016;91(2):204–209. doi: 10.1097/ACM.0000000000000853. Available from: .
    1. Hall P, Byszewski A, Sutherland S, Stodel E. Developing a sustainable electronic portfolio (ePortfolio) program that fosters reflective practice and incorporates CanMEDS competencies into the undergraduate medical curriculum. Acad Med. 2012;87(6):744–751. doi: 10.1097/ACM.0b013e318253dacd. Available from: .
    1. Phillips C. Student portfolios and the hidden curriculum on gender: mapping exclusion. Med Educ. 2009;43(9):847–853. doi: 10.1111/j.1365-2923.2009.03403.x. Available from: .
    1. Catto G. Building on the GMC's achievements. BMJ. 2005;330(7501):1205– 1207. doi: 10.1136/bmj.330.7501.1205. Available from: .
    1. Cain F, Benjamin R, Thompson J. Obstacles to maintaining licensure in the United States. BMJ. 2005;330(7505):1443–1445. doi: 10.1136/bmj.330.7505.1443. Available from: .
    1. Smeenk F. Medisch-specialistische Vervolg-opleidingen in een Veranderende Maatschappelijke Context. In: Smeenk F, Rutten H, van de Laar E, editors. Toegewijde dokters: Waarom de niet-medische competenties geen bijzaak zijn. Antwerpen-Apeldoorn: Garant; 2016. pp. 15–43.
    1. Furmedge D, Griffin A, O'Keeffe C, Verma A, Smith L, Gill D. Paper trials: a qualitative study exploring the place of portfolios in making revalidation recommendations for Responsible Officers. BMC Med Educ. 2016;16 doi: 10.1186/s12909-016-0592-6. Available from: .
    1. Driessen E, van Tartwijk J, Govaerts M, Teunissen P, van der Vleuten C. The use of programmatic assessment in the clinical workplace: A Maastricht case report. Med Teach. 2012;34(3):226–231. doi: 10.3109/0142159X.2012.652242. Available from: .
    1. Dannefer EF, Henson L. The portfolio approach to competency-based assessment at the Cleveland Clinic Lerner College of Medicine. Acad Med. 2007;82(5):493–502. doi: 10.1097/ACM.0b013e31803ead30. Available from: .
    1. Fung M, Walker M, Fung K, Temple L, Lajoie F, Bellemare G, Bryson SC. An Internet-based learning portfolio in resident education: the KOALA™ multicentre programme. Med Educ. 2000;34(6):474–479. doi: 10.1046/j.1365-2923.2000.00571.x. Available from: .

Source: PubMed

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