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Tuesday, March 25, 2008

16 Factors that could Make a Portfolio Succesful in Medical Education?

A couple of weeks ago I was invited to participate in a task force for the development of a web based portfolio for psychiatric residents. I still had two articles about this subject in my "To Blog" drawer.

In medical education the focus has shifted from the acquisition of knowledge to the achievement of competence. Competence has been defined as the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served.

One of the instruments to support the development of competence in an integrated coherent and longitudinal fashion is the portfolio.

In portfolios the student reports on the work done, feedback received, progress made, and plans for improving competence. An advantage of portfolios can be the stimulation of reflection, trying to structure or restructure an experience, knowledge or a problem.

These factors can make a portfolio successful:

  • Portfolio's should be introduced with a hands-on introduction with a proper briefing of students and teachers: a thorough introduction of the portfolio and its intended use

  • Purpose and procedures should be clearly explained. Both students and mentors should receive clear guidelines and support for their use

  • Portfolio design should be centered on informing, training and gaining commitment from both trainers and trainees

  • The portfolio should be part of other educational activities

  • The maintenance of the portfolio should not be time consuming, some have the perception that maintaining a portfolio costs a lot of time, the portfolio should be smart and efficient

  • Students should have proper IT skills

  • Downloading software and the usage of the software should be user friendly

  • An effective portfolio should have a clear and flexible structure, when learners are given a certain amount of freedom to determine their content the portfolio is more appreciated

  • Clear instructions, they want to know what kind of information they were expected to provide

  • Portfolios should be used both for the formative promotion of learning and the summative assessment. They both ensure that portfolio learning maintains its status alongside other assessments

  • The portfolio assessment should be combined with an interview, adding a mentor to support the portfolio also helps

  • It should be integrated with other educational activity

  • Mentors need to support their students in using their portfolio

  • The portfolio's should be assessed with global criteria, portfolio assessment has no effect on students' openness. When not assessed the use of portfolios will tail off

  • Assessment should be part of institutional asesments with a small group of skilled and trained assessors

  • A flexible learner centered format, too much structure implies a greater risk than too little structure

The most important step to make the use of portfolio in medical education useful is to know the following before you start:
purpose, content, mentoring and assessment.

These factors are based on a systematic review published in Medical Education

Should the portfolio be web based or paper based?
In a recent study, it was shown that students spent more time on the web based portfolio and showed a greater sense of ownership of portfolios in this format with respect to both form and content. The students added more personal touches to web based portfolios content and form. Students enjoy presenting their web based portfolio, which motivates them and enhances their sense of ownership. Both ownership and motivation are crucial factors in effective portfolio use.

Mentors were more pleased with the web based portfolios. They are easier to navigate via hyperlinks. They didn't have to leaf through when they were looking for specific information. Paper based portfolios take more time to read or to find specific information. Web based portfolios are more user friendly for the mentors.It can aslo be accessed at different locations. Some mentors prefer accessing the portfolio from their home. To them web based portfolios are easier and quicker to read.

The quality of both types of portfolios didn't differ. So web based portfolios are preferred.
Erik Driessen, Jan van Tartwijk, Cees van der Vleuten, Val Wass (2007) Portfolios in medical education: why do they meet with mixed success? A systematic review
Medical Education 41 (12) , 1224–1233 doi:10.1111/j.1365-2923.2007.02944.x
Driessen, E.W., Muijtjens, A.M., van Tartwijk, J., van der Vleuten, C.P. (2007). Web- or paper-based portfolios: is there a difference?. Medical Education, 41(11), 1067-1073. DOI: 10.1111/j.1365-2923.2007.02859.x

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