Using a portfolio to stimulate and assess medical students‟ reflection

In my research on reflection and E-PeerFeedback I read the thesis of Erik Driessen. The title of his thesis is: ‘Educating the self-critical doctor’ – Using a portfolio to stimulate and assess medical students‟ reflection. I’m interested in his research on ‘Conditions for successful reflective use of portfolios’ as I hope to find some links to my own research.

In his research he found that:

This study shows that portfolios are a potentially valuable method of assessing and developing students‟ reflective skills in undergraduate medical training, provided certain conditions for effective portfolios are recognised and met. Portfolios have a strong potential for enhancing learning and assessment but they are very vulnerable and may easily lead to disappointment. Before implementing portfolios in education, one should first consider whether the necessary conditions can be fulfilled, including an appropriate portfolio structure, an appropriate assessment procedure, provision of enough new experiences and materials, and sufficient teacher capacity for adequate coaching and assessment.

As part of the research mentors were asked for their definition of reflection. Some of the remarks are interesting:

One mentor described a portfolio without reflection: “…as a collection of facts without questioning the whys and wherefores.” Mentors attached great importance to students addressing why-questions from a position outside their personal perspectives. They saw openness to the opinions of others as a prerequisite for objectivity.

I relate this to the importance of ‘explanation’ in reflection. A student that is able to explain his actions and thoughts shows the ability to reflect. According to theory (e.g. the The framework for reflective pedagoical thinking) the use of explanation has different levels. On a lower level a student gives an explanation with a personal preference given as a rationale. On a higher level the student uses theory as the rationale and considers context factors in his explanation.

Conditions for successful reflective portfolio use

Erik elaborates on the conditions. These are also interesting for my research on E-PeerFeedback. The conditions are:

1. Coaching – As reflection does not come naturally to most students, coaching plays a crucial rol in reflection. This is also my experience for the successfull use of E-PeerFeedback.
2. Structure and guidelines – In the beginning structure is very usefull. When student have learned how to reflect, a more open portfolio structure was preferable. When students start using E-PeerFeedback, a clear structure and guidelines helps them.
3. Experiences and material – In order to reflect, there must be sufficient variety and quantity of interesting experiences as subjects of reflection.
4. Summative assessment – The mentors indicated that the portfolio should be used for summative assessment of reflective skills to ensure that it is taken seriously by students (and mentors).

In the discussion on these findings, Erik refers research in which ‘a supportive teacher (mentoring) of peer feedback is widely recognized as a key factor in the success of reflective portfolios (Pearson, Heywood (2004) and Wade, Warbourgh (1996) and Snadden, Thomas (1998)). This was confirmed in this research. Pearson and Heywood even went so fare as to say that reflection was primarily stimulated by the supervisors and that a portfolio offered little added value as a stimulus of reflection.

References

• Pearson DJ, Heywood P. Portfolio use in general practice vocational training: a survey of GP registrars. Med Educ 2004;38:87-95.
• Wade RC, Yarbourgh DB. Portfolios: a tool for reflective thinking in teacher education? Teaching & Teacher Education 1996;12(1):63-79.
• Snadden D, Thomas ML. Portfolio learning in general practice vocational training – does it work? Med Educ 1998;32:401-6.