Portfolios and Competency: Pre #meded chat

One hour before our planned #meded chat my quickly written blog post has generated comments from 25 different participants. They are just as varied as you would imagine. Please do that the time to read through them all but I’d like to summarise the main points I have taken away so far.

  • Can the most important learning be codified? Do text based reflections miss out on some of the learning that takes place in face-to-face discussions and feedback, therefore diminishing their authenticity? Not everyone wants to share their innermost thoughts. Are we obliged to be open?
  • Is the main function of a portfolio to act as aid to learning or to demonstrate competency in what has been learned already? Many report that it feels more like the latter and that this leads to resentment that time is being spent documenting rather than learning. Two US students have given wonderful accounts of the impact of their portfolios on their learning. Yes, it has taken a lot of effort on their part and that of their mentors but it has been worth it. They now feel in control of their education, but are keen to point out that ticking of a list of competencies is not part of the process.
  • Some doctors do feel that progress and skills achieved should be documented. Why? But they are also concerned that a tick-box approach may not reflect real-world competency. (In a time-based, apprenticeship model it would not be assumed that you would stop performing a task because you had mastered it. You might perform it more often, honing the skill.)
  • One student reflects on the painfulness of having to get feedback on how the simplest of tasks could be performed better. Is this a too reductionist concept of a skill? What about considering why the test is needed in the first place and how the results will be interpreted? How can we use portfolios to develop the situational understanding which is so essential to being a capable professional?
  • What is the place of global assessment in assessing competency? Is there any evidence that breaking down competence into checklists is any more reliable or valid than the global assessment of a skilled colleague who has had many hours contact with the student or doctor? Have we introduced checklists because we are not sure that these mentoring relationships still exist?
  • There are mentions of ‘clunky’ interfaces too. Improving the front-end of portfolio tools may help, but it will not resolve deeper issues around engagement and belief in the underlying constructs.
  • How can we ensure that portfolios are truly about aspiring to excellence and development?
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