|Year : 2021 | Volume
| Issue : 3 | Page : 89-92
Portfolio during community medicine academic residency training in India: Way forward
Gopi Kumbha, Subhakanta Sahu, Bimal Kumar Sahoo, Manish Taywade
Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
|Date of Submission||21-Aug-2021|
|Date of Acceptance||02-Sep-2021|
|Date of Web Publication||25-Nov-2021|
Dr. Manish Taywade
Department of Community Medicine and Family Medicine, Room Number 322, 3rd Floor, Academic Building, All India Institute of Medical Sciences, Bhubaneswar, Odisha.
Source of Support: None, Conflict of Interest: None
Competency-based medical education focusses on performance and outcome. The work-based assessment methods assess the highest level of Miller’s pyramid of assessment (Does). The portfolio is one of the methods needs to be implemented in medical education. Learning and assessment are two vital components of training of any medical resident. Portfolio-based learning not only keeps the resident updated but also increases his/her professional growth exponentially. The portfolio is not a new concept but its use in medical residency is yet to be practised universally.
Keywords: Competency-based medical education, medical education, portfolio, residency community medicine
|How to cite this article:|
Kumbha G, Sahu S, Sahoo BK, Taywade M. Portfolio during community medicine academic residency training in India: Way forward. Amrita J Med 2021;17:89-92
|How to cite this URL:|
Kumbha G, Sahu S, Sahoo BK, Taywade M. Portfolio during community medicine academic residency training in India: Way forward. Amrita J Med [serial online] 2021 [cited 2022 Nov 29];17:89-92. Available from: https://ajmonline.org.in/text.asp?2021/17/3/89/331119
| Introduction|| |
The formative assessment constitutes a fundamental strategy in the learning course of a postgraduate student. Apart from promoting learning, it gives the leverage to endow with feedback to the learner. This fulfills the acquisition of domains of competency as a requisite set by the guidelines by NMC for a postgraduate student during his/her 3-year tenure in community medicine. Portfolio is an excellent technique in which the concerned student recognizes the learning objectives and corresponding outcomes that would emerge from them. Reflection of these objectives in the form of performance allows faculty/teacher to see through the advent in the learning process. The portfolio is an adult learning practice due to its sovereignty and self-independence temperament directed toward the learner. The novel definition of the portfolio can be stated as a collection of drawings or papers that represent a compilation of a person’s work.
Going by its characterization, it is a vivid collection of work of a student that exhibits how much endeavor or progress has been made in achieving goals as laid down by guidelines by competent authority or board. The self-introspective nature intends to encourage students to take the onus of their learning. At the same time, the observers get a powerful instrument to assess how much the predefined objectives have been reached. Feedback is achieved for the critical thinking generated and to chart out methods in generating new ideas and concepts for further refinement of the above-mentioned procedure. Before the introduction of the portfolios in medical education, the concept has already been used in realistic arts in tracking the professional growth of artists. More recently, they have been used in medical education, as a means of encouraging professional growth. Medical education is an art and science to create health profession as per the need of the nation. The portfolio is a compilation of a learner’s various documents and assessments reflecting an improvement in professional domain throughout residency over sometime. It may include referral letters and practice logs.
| Why is it Important to Discuss Portfolio|| |
It is a multipurpose approach with arms like assessment and feedback, scheduling for the future progress and arsenal of the concerned student’s work with achievements. With the advent of entrusted professional activities supplemented by acquiring milestones, this instrument has been extremely valuable in tracking performance in a multidimensional fashion. They are used in a variety of ways that help both the stakeholders (institutions and students) to assess and track the advancement of the learner. The switch to competency-based assessments and employment of frameworks like milestones and entrustable professional activities have paved the way for the portfolio to become a valuable tool in many medical schools. Institutions can evocatively exhibit any appraisal evidence which enables longitudinal tracking and documentation of student achievement as far as the student portfolios are concerned. Portfolios can cultivate the skills of a student in self-assessment and ongoing professional development with suitable supporting processes. The study has shown evidence on the fact that approximately half of U.S. medical schools use some type of portfolio system, in which the majority of portfolios are digital demanding obligatory participation. The portfolio is not merely confined to just collection of pieces of evidence; it demonstrates learning and evidence of reflections along learning objectives. Hence, in the portfolio, the resident needs to have the documentation of goals, all his achievements, and growth progress. Though all portfolios are primarily learning portfolios, some experts further categorize them as learning, structured, and showcase portfolios. The content of the portfolio is used for assessment or making decisions about advancement. It can be used as a quality assurance route.
Portfolio frequently includes self-assessments, learning plans, and reflective essays. It has bidirectional utility, i.e., as a formative learning stool (to help develop self-assessment and reflection skills) and as a summative stool (to determine whether competency has been achieved). Its usefulness gains significance when used for evaluating competencies that are difficult to evaluate in more customary ways such as practice-based enhancement, use of scientific substantiation in patient care, etc. A solution to these would be a system in which the “doctor in making” is assessed frequently on a day-to-day basis by various assessors on the organizing of aspects of his/her medical training, including academic as well as non-academic attributes. Traditionally, workplace-based learning for medical doctors involves encounter of the patient with the students, mostly unobserved by the faculty members. Also, there is hardly any prospect for assessment of basic clinical skills and obtaining feedback for improving students’ performance. As an assessment of clinical performance comprising combination and integration of knowledge, clinical skills, attitude, and professionalism as doctor competencies, the portfolio is suitable to provide judgment of clinical performance. Contribution from students would recommend enhanced performance for portfolio assessment operation. This would lead the students to persuade in creating their portfolio by identifying their growth during residency. The resident should be able to highlight the necessity for ongoing learning and reflection in achieving competencies and sustaining it. It encounters and promotes the holistic development in students with an enormous scope of opportunity for showcasing the skills, abilities, and future perspectives.
| Origin of Portfolios|| |
The framework of the portfolio was initiated in UK in National Vocational Qualifications, in which the accent given on the attainment rather than the process of education undertaken by the learner was given due importance. Learning by the use of portfolio was felt convenient as it held familiarity with experience, acting autonomously, insightful in nature, and linkages between chances to learn and necessities of the learner. Mere development of any portfolio required a sense of self-awareness and expression.
| Need of Use of Portfolio in Medical Education|| |
Education in high school (till matriculation) is primarily formal with the aim of achieving cognitive development to its zenith. However, in adults, it is purely based on identifying problems and questioning the principle of sustaining/contradicting logically. This is in coalition with Kolb’s learning cycle.
How does it look like: Basic structure can be manifested as (a) title page, (b) content page, (c) catalog of learning objectives, (d) short reflective overview, and (e) proof itself.
| How to Use Various Components of the Portfolio During the Residency of Community Medicine|| |
The component of the portfolio may vary as per the purpose and types of portfolio. The basic remains the same which includes reflections learning modules as assessments.
| Types of portfolio|| |
A. Reflective and comprehensive
- (i) Reflective: It primarily addresses the skill of the reflective domain. They can be either part of the curriculum (previously included) or added to the already existing curriculum.
- (ii) Comprehensive: They form part of the program for assessment. The aim is to gage both the student’s learning process and progress. Some parts of reflective domains might be overlapping but it has more varied and diverse contents than others.
B. Learning portfolio, showcase portfolio, assessment portfolio
- (i) Learning portfolio: The learners record the reflections on the experience gained. The contents in it are finalized by the learner himself and used in any training program/residency for self-reflection and influential assessment.
- (ii) Showcase portfolio: It demonstrates the most excellent work of the learner. Like the learning portfolio, the content is controlled by the learner and used for cumulative assessment.
- (iii) Assessment portfolio: Here the content is decided by the designer and is prepared to document what the learner has learned. The reflections are based on explicit learning outcomes such as skills, knowledge, and attitude and helpful in generating proof to estimate the extent of learning assiduously.
C. Paper-based and electronic portfolio
- (i) Paper-based: Content is recorded on papers.
- (ii) Electronic portfolio: Content is recorded electronically by use of computer or computer-based tools.
| Learning Portfolio|| |
Various opportunities residents have in the residency period: clinical postings, clinical rotations, field postings, short-term research projects, thesis, or dissertations. During the residency, the workshops, CMEs, and conference and paper presentation are also mandatory where they can learn. The learning portfolio defined as a collection of work, reflections, and educational experiences shows a student’s work, showcasing skills, abilities, and values. Therefore, learning portfolio is a source of collection of various flavors of work that enriches professional skills.
Components of learning portfolio: The three main components are (1) learning artifacts, (2) critical reflections, and (3) platforms.
- Learning artifacts: This includes documents, files that serve the purpose of learning, and acquisition of knowledge and skills. Few examples of learning artifacts are photos, videos, essays, research papers, reflections of activities, PowerPoint presentations, posters, etc.
- Critical reflections: A post-graduate student’s learning is based on a clinical setup and is learner-centric. After meticulous scrutinizing and analyzing his/her performance (what went right or wrong), specific objectives are set out in the direction of improvement. This enhancement in showcasing arguments in support or against augments thinking skills. Active participation is ensured as a stakeholder which improves the quality of knowledge acquisition.
| How to Assess the Portfolio-based Assessment|| |
The procedure has to be watchfully and meticulously thought of, so that the entire method meets the predesigned objectives. A standardized layout should be formulated for effective assessment of a portfolio.
- (i) By learner himself: This enables to get a picture of what has been already learned and what remains still yet. Students understand the requirements and in the due process achieve the desired goals.
- (ii) Assessment by an external source (teacher): The teacher has to have a familiarity with the entire portfolio and its intentional principle and hence the role is very critical to assess the level of learning. Its ability to cover both the formative and summative assessment is an added credibility to its feature.
The way forward and conclusion: The role of medical educators is more powerful toward strengthening the use of portfolio in medical education during residency. The bright future of residents can be developed with a greater number of evidence by using the portfolio. A better learning program promotes a positive effect and action on learner’s knowledge, skills, and attitude. There is flourishment of attitude, empathy, and unbiased system of assessment in medical education during the residency in India. The goal of a successful, efficient, and competent medical professional for the future is to handle medical crisis and emergencies. Competencies are learned during the residency in community medicine using the portfolio. The formative assessment is the best judge of learning during residency and also help in continued professional development. Lifelong learning will be easier with using the portfolio.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharma S, Sharma V, Sharma M, Awasthi B, Chaudhary S. Formative assessment in postgraduate medical education—Perceptions of students and teachers. Int J Appl Basic Med Res 2015;5(Suppl. 1):S66.
Iyengar KP, Jain VK, Sakthivel P, Malhotra N, Ish P. Competency-based novel medical curriculum in India.Postgrad Med J 2021 [Internet]. Available from: https://pmj.bmj.com/content/postgradmedj/early/2021/02/08/postgradmedj-2020-139690.full.pdf. [Last accessed on 7 Aug 2021].
Lim JL, Chan NF, Cheong PY. Experience with portfolio-based learning in family medicine for master of medicine degree. Sing Med J 1998;39:543-6.
Paulson FL, Paulson PR, Meyer CA. What makes a portfolio? Educ Leadership1991;48:60-3.
Azer SA. Use of portfolios by medical students: Significance of critical thinking. Kaohsiung J Med Sci 2008;24:361-6.
Thomas DS. The use of portfolio learning in medical education. Med Teach 1998;20:192-9.
Heeneman S, Driessen EW. The use of a portfolio in postgraduate medical education—Reflect, assess and account, one for each or all in one? GMS J Med Educ 2017;34:Doc57.
Mulder H, Ten Cate O, Daalder R, Berkvens J. Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training. Med Teach 2010;32:e453-9.
Daugherty KK, Cumberland DM. The use of portfolios in US pharmacy schools. Am J Pharm Educ 2018;82:6239.
Hill TL. The portfolio as a summative assessment for the nursing student. Teach Learn Nurs 2012;7:140-5.
Jarvis RM, O’Sullivan PS, McClain T, Clardy JA. Can one portfolio measure the six ACGME general competencies? Acad Psychiatry 2004;28:190-6.
Joshi MK, Gupta P, Singh T. Portfolio-based learning and assessment. Indian Pediatr 2015;52:231-5.
Ekayant F, Risahmawati , Fadhilah M. Portfolio assessment implementation in clinical year of community medicine module: Students perspective. Adv Health Sci Res 2017;10:44-8.
O’Sullivan PS, Reckase MD, McClain T, Savidge MA, Clardy JA. Demonstration of portfolios to assess competency of residents. Adv Health Sci Educ Theory Pract 2004;9:309-23.
Simosko S. APL: A Practical Guide for Professionals. London: Kogan Page; 1991.
Royal College of General Practitioners. Portfolio-Based Learning in General Practice. London: RCGP; 1993. Occasional paper; 63.
Piaget J. The Child’s Concept of the World. Londres: Routldge & Kegan Paul; 1929.
Riegel KF. Dialectic operations: The final period of cognitive development. Hum Dev 1973;16:346-70.
Sheehan M, Kearns D. Using Kolb: Implementation and evaluation of facilitation skills. Indus Commercial Train. 1995;27:8-14.
Driessen E. Do portfolios have a future? Adv Health Sci Educ Theory Pract 2017;22:221-8.
Eva KW, Bordage G, Campbell C, Galbraith R, Ginsburg S, Holmboe E, et al
. Towards a program of assessment for health professionals: From training into practice. Adv Health Sci Educ Theory Pract 2016;21:897-913.