Professional Documents
Culture Documents
4, 1999
SUM M AR Y
it recognizes and encourages the autonom ous and re ective learning that is an integral part of professional education and development;
it is based in the real experience of the learner, and so
enables the consolidation of the connection between
theory and practice;
it allows a range of learning styles to be used according to
the preferences of the learner;
it enables assessm ent within a framework of transparent
and declared criteria and learning objectives;
it can accommodate evidence of learning from a range of
different contexts;
it provides a process for both form ative and summative
asse ssm en t, base d o n either per sonally de rived or
externally governed learning objectives;
it provides a m odel for lifelong learning and continuing
professional development.
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Although different professions have differing speci c requirements for the recording and evidencing of learning, there
are a series of key aspects that are generally recorded in the
portfolio:
As a person matures, there is a shift away from a selfconcept of a dependent personality towards one that is
self-directed.
Accumulated experience becomes a resource for learning.
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to create a clim ate of C PD that relates to an educationaldevelopment, outcomes-de ned model, rather than a process
based on tim e-serving and inputs.
W ithin the eld of medical education pressure to change
the way in which CPD is undertaken and evaluated is being
drive n from m any direc tions: th e rate of c han ge of
bio-technology; organizational change; the structure of
education within the training grades; issues of appraisal and
revalidation; clinical governance; clinical guidelines. The list
is long and growing. Portfolios may offer an opportunity for
these many dimensions to be drawn together to plan and
evaluate educational activity that meets the needs of the
`millennium doctor .
M . Challis
W hat are the major issues in portfolio-based lear ning and assessment?
376
education and personal as well as professional development, has encouraged a move to a problem-based curriculum
and assessment by portfolio as well as traditional exam ination (Boud & Feletti, 1997).
Change in the process of training and continuing professional development for general practitioners has also been
considered by their Royal College. The year 1993 saw the
publication of Occasional Paper 63, from the Royal College
of General Practitioners: Portfolio-based learning in G eneral
Practice . This paper proposes that there is a need for a range
of models to be developed to provide a structural framework
for appropriate education which meets the needs of general
practitioners, and which reinforces or enhances their perceptions of their need for further learning. The m odel explored
in the paper is that of portfolio-based learning, which draws
on a range of educational theories relating to the previous
knowledge and experience of learners, and their preferred
learning styles. M ore recently, the Chief M edical O fficer
reviewed continuing professional development for general
practitioners (DoH, 1998a) and has proposed quite radical
changes in education and development. The main recom mendation is that education should be practice based and
multidisciplinary; patients needs should be given higher
priority; links between education and service delivery should
be more evident. Practice Professional Developm ent Plans
(PPDPs) a form of practice-based portfolio are proposed
as a m eans of making this happen.
The principle of an evidence-based approach to learning
appears to be gaining ground throughout medical education and training.
The examples which follow show how the principles of
portfolio-based learning and assessment have been used in
a range of contexts to support the initial and continuing
development of doctors through out the various stages of
th e ir ed uc ation . T hese ex am ples are by n o m e ans
com prehensive, but they do give an indication of the
possibilities that are already being explored and developed
by medical educators. The examples given are drawn solely
from the United Kingdom. This is deliberate, partly because
extending into the international arena would have made this
document unacceptably large and com plex, but also because
in this way it can be demonstrated that within a single
national framework for medical education, the adoption
and adaptation of the portfolio as a means of recording and
promoting learning is moving forward apace, and taking
maxim um advantage of this highly exible educational tool.
Some of these case studies have been largely written by
colleagues involved in the work described, while others have
been gleaned from the literature. There is thus no comm on
for m at to their presentation, but instead the ` avour
intended by the authors has been preserved.
Yea r 5 U n derg ra d u ate M od u le in G en era l P ra ctice an d
Com m unity H ealth Care
M . Challis
378
GP registrars participating in this scheme were given guidance on how to construct a portfolio containing critical
incidents of their experiences with patients, re ections on
their difficulties and successes in their training period, and
how to use these to trigger re ective learning with their
trainers. They were also encouraged to keep a re ective
journal/diar y. Por tfolio development was supported by
facilitated workshops.
The researchers found that the portfolios were used in
four ways:
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The forms are copied and kept as part of the SpRs training
record. Evidence of activity under each category is presented
in the portfolio, and the SpR is encouraged to talk through
both his/her established learning and future learning needs
on the basis of what has been presented.
Supp ort for por tfolio developm ent is m ainly g iven
through peer-group meetings. There is great comm itment
to the scheme by both trainers and trainees, who see the
bene t of developing an individual document that allows
them to detail their activities and re ect on their learning.
However, this enthusiasm is accompanied by some fear that
the portfolio may become standardized by the Royal College,
which could mean that the portfolios become more syllabus
focused and therefore end up saying more about the training
programm e than about the individual trainee.
Portfolio-based learning was rst offered to GPs in Shef eld from 1994 as a m eans of obtaining half the yearly
requirement for the postgra duate educational allowance
(PG EA). Its efficiency and effectiveness were measured
against the `traditional m odel of PGEA, based on 30 hours
annual attendance at educational events (Challis et al. , 1996).
This was achieved through a crossover comparison, whereby
32 volunteer GPs were divided into two cohorts: each cohort
spent 6 months following the `traditional route to PGEA
accreditation and 6 months following the portfolio-based
learning route.
The model adopted for support was one of co-mentoring
amongst groups of ve or six learners, supported by a facilitator who was also a GP and engaged in the process of portfolio
development. The process was designed to encourage:
a proactive approach to learning and development;
identi cation of individual learning needs;
the development of strategies to meet educational needs
using appropriate learning activities and styles;
structured re ection on experience and practice;
the use of critical incidents (signi cant events) to modify
or reformulate the original objectives of the learning plan;
the completion of a learning cycle by applying new
learning to practice.
The format for the portfolios was not closely de ned, but
participants were asked to present a portfolio that contained:
a le ar n ing plan with sp e ci c lear nin g o bjective s,
appropriate m ethods for meeting these objectives and
demonstration of the application of new learning to professional practice;
a list of critical incidents, showing how these had led to
the formulation of new learning objectives and a revision
of the original learning plan;
a claim for PGEA under the standard three headings of
health prom otion, disease m anagement and service provision, indicating the number of hours claim ed, and types
of learning activity undertaken.
In addition, all participants were asked to submit a selfappraisal of their learning during the year to encourage
continuing re ective learning. This comprised an assessment of features that they believed had helped or hindered
learning, and a learning plan for the forthcoming year.
The portfolios were assessed by the local continuing
medical education (CM E) tutors, who made recommendations to the Director of General Practice Education for the
award of PGEA, using criteria of:
demonstration of having com pleted a learning cycle;
having met the learning objectives of the original learning
plan and/or those arising from critical incidents;
dem onstration of an understa nding of th e learning
process.
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C onclu sion
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What to do
How to do it
W ho is involved
As above
Introduce portfolio to
learners
As above
Monitor progress
Assess/review portfolio
Learner
Complete documentation
M ake recomm endations for progression/additional
support needed
Educational
supervisor/Clinical tutor
384
Learner with
reviewer/assessor
Reviewer/assessor
Leaner with reviewer/assessor
Learner with
reviewer/assessor
A cknowledgem ents
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