July 2002
A Review Of Three Small-Group Sessions: Student Portfolios In Medical School

The number of medical schools introducing student portfolios is increasing rapidly, and the requirement of portfolio material as part of the application for residencies will stimulate still more schools to help their students to develop these materials. There were several presentations on portfolios at the Ottawa Conference; these comments are from three of those sessions.

An electronic portfolio: managing document-based reflective learning and assessment across a five-year medical program
R. Ellaway, H. Cameron, D. Dewhurst, and A. Young, University of Edinburgh.

The University of Edinburgh has a five-year medical school program, and students are required to make five specific entries into their portfolios each year, including two “overview essays” during years four and five. Many of the entries are related to specific courses in the curriculum; some are not. The overview essays are designed to encourage development of reflective practice and are based on cases that students have seen on their clerkships.

Logistics: The electronic portfolio system was built by a group of faculty and staff with commitment to ongoing improvement of the process. The system has a dedicated server, and a student has access only to his/her own portfolio “slot.” Other individuals, such as course planners, graders, and others, may have access to the portfolios of large numbers of students at certain times. When a particular assignment is due, students are given a reasonable window of time in which to complete it. They may request the opportunity to complete an assignment early (e.g., if the case on which an overview essay will be written occurs much earlier than the due date). Once an assignment has been submitted, the student does not have the privilege to return to it to make changes.

Grading of reflective work in this portfolio system is by the students’ tutors or graders from a general pool. There are structured criteria for grading and all graders use a common marking scheme. In some instances, double marking occurs, for quality assurance and for borderline cases.

Each part of the portfolio is graded as part of the appropriate course. The overview essays are marked as part of the portfolio, and “the whole portfolio is the basis of every student’s viva as part of their finals.”

(some of these notes were from e-mail correspondence with Rachel Ellaway)

Development and evaluation of a clinical practice portfolio for medical students
C.E.M. O’Driscoll, J. Beilby, A. Lawless, R. Peterson, K. Pile, and I. Wilson, University of
Adelaide, South Australia

The University of Adelaide uses a paper-based portfolio system that is completely imbedded in the curriculum (in this case, in General Practice coursework) and is much more than a logbook or journal (although their model incorporates this function).

They see several reasons for students to be required to maintain a portfolio:

1. no two students have the same experience in medical school (curriculum being delivered in an increasingly broad range of settings - urban, rural, remote and even overseas);
2. there are gaps between the institution’s objectives and what the students experience;
3. it is constructivist; and
4. learning is non-linear.

They see four main uses for their portfolios:

1. documenting experiences of students;
2. as a reflective learning tool leading to self-directed learning;
3. quality improvement of the curriculum and other aspects of the program; and
4. as an “advance organizer.”

A clinical experience log describes the kinds of patients seen, their conditions, and the skills used in treating them. The other evidences of student progress include feedback to students from preceptors and attendings, specific assessment tasks, and the reflective assignments. In the reflective domain, students prepare weekly unstructured journal reflections, plus three more specific reflections called ROSE (Reflection On Significant Experiences) that relate to key incidents in the student’s experience. Students who have participated in this portfolio preparation process found both structured and unstructured reflections useful. They reflected primarily on preceptors, patients, the doctor-patient relationship and themselves (in their roles as physicians and as persons).

Reflection-on-Practice, an Emerging Dimension in Professionalism. How do we assess it?
Gordon Harper and Peg Hinrichs, Harvard University

In this last related session, some aspects of “reflection-on-practice” were discussed. The leaders first described levels of reflection:

1. noticing, taking seriously;
2. sharing and validating each other;
3. researching (link to others in the field);
4. intervening (link to CQI).

At Harvard, “reflection-on-practice” is used as the central unifying theme for a third-year course that brings students back to campus for half-days weekly. The theme relates directly to communication skills, curiosity, hypothesis generation and CQI, and self-care.

Some ideas related to assessing and using reflective writings were generated during discussion in the group:

1. some schools (Dundee?) have developed checklists for assessing such documents;
2. one-to-one discussion between faculty and student is usually best;
3. the one-to-one discussion can be developed into an OSCE station using a piece of the student’s own reflective writing;
4. present students with samples of good reflection early in the curriculum;
5. when reflective writings are assessed, have two independent assessments;
6. peer review by anonymous readers might also be useful as another assessment;
7. carefully train facilitators involved in reviewing/nurturing reflections by students.

Reported by:
Jeanne Kangas, <jkangas@kcom.edu>
Curriculum Coordinator
Kirkesville College of Osteopathic Medicine