Portfolios

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Portfolios The 5 Ws

• David Taylor
• School of Medical Education
• University of Liverpool

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The five Ws

• Who
• What
• Where
• When
• hoW

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Why ?

• There are many ways of assessing knowledge and
  skills
• But we need some way of recording activities
• And developing and demonstrating appropriate
  attitudes

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Who

• Our course is five years long, and is followed by
  two years in foundation posts before the Doctor
  is fully registered and allowed to practice
  independently.

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Who (2)

• We currently use portfolios in years 1,3 5 of
  the undergraduate course F1, F2
• And for consultants, academics and anyone
  seeking promotion

1 2 3 4 5 F1 F2
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What is a portfolio

• It is a collection of documents
• Supported by a commentary
• It can be electronic
• more convenient in the University context
• It can be on paper
• More convenient in the clinical context

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What documents?

• It depends on the reason for the portfolio!
• Diaries
• Log-books
• Case notes
• Examination results
• Longer discursive pieces

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Dewey (1933)

• Reflection is
• A purposeful form of thought provoked in learners
  when they recognize that their understanding is
  incomplete.

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In order to reflect

• 3 things are needed
• something to reflect on
• reflection time modelling
• motivation
• Albanese,2006,Medical Education 40288-290

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What sort of commentary?

• Technical
• What and how of practice
• Facts and theories
• Audit
• Practical
• How decisions are made
• Articulate concerns
• Resolve professional dilemmas
• Critical
• Social and political context and constraints

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What is included

• The portfolios all include examination results
  and the student commentary on them.
• In the first year they also include reflection on
  settling in and adjusting to University life.
• In the third year they include reflections on
  professional attitudes students have experienced
  or observed.

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What is included in later years

• In fifth and subsequent years they also include
  reflection on particular cases/treatment regimes
• In F1/F2 and beyond they will include reflection
  upon critical incidents

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Final year PETA
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Final year PETA Bottom half
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When

• Right from the start and often
• Habit helps
• Novelty is important
• So we focus on different things each year
• Settling in, clinical experiences, ethical
  behaviour, evidence base to medical practice,
  audit, future plans, critical incidents
• It has to be relevant
• In the clinical arena it will focus on cases
  determined by the agreed learning outcomes

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Where

• Wherever the student works
• In the first/second year this is often at the
  computer, so we use electronic portfolios
• In the UK the hospital computers wont talk to
  the internet, so where a VPN cant be set up we
  use.
• Paper, and interviews, formal and informal, with
  the educational supervisors

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How

• How is it assessed?
• Through discussion with a supervisor
• The whole thing?
• The reflective component?
• Parts chosen by the student?
• Parts chosen by the supervisor?

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Marks?

• Best practice currently is to use criteria rather
  than a checklist
• The criteria need aggregating in domains
• KSA
• Burch, Seggie and Gary 2006 SAMJ 96430-433
• The number of raters needed for validity depends
  on the criteria and the domains
• Roberts et al.,2006 Med Educ 40363-370

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How (2)

• It is the main form of assessment for our final
  year students.
• They sit finals at the end of their fourth
  year.
• Their final year is a clinical apprenticeship,
  assessed through the portfolios.
• 5 different assessors (3 meetings each - plus
  referees in the case of difficulty/expected
  difficulty)
• Mid-Year portfolio review (all borderline/fails
  and sample of others)
• End of year review of borderline/fails

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Benefits

• Allows the student to demonstrate insight and
  understanding
• Allows student and staff to observe development
  and progress
• Models the real world
• Goes one step beyond the competencies model
  in developing professionalism
• Provides a focus (and evidence) for the
  discussion between student and doctor

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F1
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Staff
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David Taylors response..