An Introduction to Portfolio Assessment

Dr Madawa Chandratilake

MBBS (Colombo), MMEd (Dundee), PhD (Dundee)Senior Lecturer in Medical EducationFaculty of MedicineUniversity of Kelaniya

Madawa Chandratilake

What do you think is the primary role of a doctor in today’s context?

Dealing with uncertaintyMaking clinical decisions[e.g. Bleakley A & Marshall R (2013); Luther VP & Crandall SJ (2011)]

[Uncertainty in decision making:Situation where the current state of knowledge is such that • the order or nature of things is unknown, • the consequences, extent, or magnitude of circumstances, conditions, or events is unpredictable, and • credible probabilities to possible outcomes cannot be assigned.

(http://www.businessdictionary.com)]

Clinical reasoning Critical thinking

Our assessment should assess the ability of our trainees in dealing with uncertainty.

• Am I ready to practise my discipline?

• Am I progressing toward the desired direction?

Have any of you ever asked these questions from yourself?

• What are the key requirements for practising medicine in today’s context?

Reflective practice

• What is reflective practice?– What did I do well?– What didn’t I do well?– How can I improve?

• Reflective practice is the corner stone of practising medicine

• Portfolio is one of the effective methods of encouraging reflective practice.

Madawa Chandratilake

ASSESSMENT SETTING increased authenticity

TREND

What is a portfolio?

• A purposeful collection of papers and other forms of evidence to demonstrate that learning has taken place, annotated with the student’s reflections on what has been learned in terms of the learning outcomes.

[Davis MH, Friedman Ben David M, Harden RM, Howie P, Ker J, McGhee C, Pippard MJ. & Snadden D. (2001). Portfolio assessment in medical students’ final examinations. Medical Teacher 23: 357-366.]

Portfolio Log book

A collection of evidence for learning

+Reflection upon evidence &

learning

If portfolio is a collection of ‘work’……

=?A collection of evidence

of learning

They are different!

Key elements

• Outcomes• Purposeful collection • Evidence• Reflection

Outcomes

• Outcomes

Doctor as a practitioner

1. Clinical skills and patient management2. Communication skills

3. Population health & health systems

4. Information management

Doctor as a scientist5. Scientific basis of Medicine

6. Critical thinking & research

Doctor as a professional

7. Professional values, attitudes & ethics

Outcomes of the MBBS programme

PGIM outcomes for Board Certification

• Subject expertise• Teaching• Research and audit• Ethics and medico-legal issues• Information technology• Life-long learning

Purposeful collection

• Who should select the evidence?–Person who maintains the

portfolio– There can be some evidence

prescribed by the academic staff

• Should be relevant to the outcomes

Evidence

• Case reports • Certificates

• Letters of rewards / condemnations received

• Abstracts / articles

Reflection

• In relation to each outcome

A short description of events

– What were my strengths?

– What were the challenges / educational gaps?

– What actions did I take to bridge those educational gaps?

– How successful were my actions?

Reflection

An iterative process

A completed portfolio

Frequently Asked Questions

(FAQs)

Is the introduction of portfolios a fancy idea?

• No. we are already late!

• It has now become a universal practice in all stages (undergraduate, postgraduate, and continuing medical education) of medical training.

Why can’t you use MCQs, OSCEs, reports, etc. rather than portfolios?

• Other assessment methods on their own cannot assess your ability to reflect.

• Portfolio helps make sense of all other assessments

• Reflective practice is the cornerstone of the practice of medicine.

Can the ‘evidence’ be the same for more than one person?

• Some evidence can be common and other may be individualised.

• Although the evidence are the same reflection on the evidence SHOULD BE DIFFERENT.

Will I need support to complete my portfolio?

• Definitely, YES.

• But you need to be PROACTIVE. – The support will be provided by

‘mentors’. – They are not your ‘assessors’. – You need to meet mentors regularly to

get feedback when you have written something

• Peer feedback is also acceptable.

Should I be good at written English?

• Yes, but not to the level of Shakespeare.

• English is one of the generic skills.

• Take this as an opportunity.

Completing the portfolio is so easy! It is a matter of copying from somebody. Isn’t it?

You would have thought so. BUT

• Plagiarism is an unprofessional act and such persons should not be allowed to practise medicine.

• Mentors and assessors can easily detect plagiarism.

Will I be able to complete my portfolio nearer the assessment starting from scratch? • A big mistake!

• You need to collect evidence for the portfolio from the beginning.

• Regularly, your progress should be discussed with your mentor.

Any more questions?

Trainee portfolio for radiology

Part III – Formative learning process a. Case Records

(local and overseas - minimum of 5 cases from following imaging modality per year – U/S, CT, Plain films, Fluoroscopy, MRI and at least 2 cases from Mammography NM and Paediatrics etc)

b. Continuous Professional Development (CPD) activities (Seminars, conferences attended)

c. Generic skills courses (Communication skills, Information technology, Ethics)

An example for Part III(a) reflectionCase 1 Case 2 Case 3 Case 4 Case 5

Background information

What did you do well?

What were the challenges you faced?

Measures taken for overcoming the challenges

What did you learn?

Important:• Should not necessarily be a very ‘dramatic’ patient presentation• It may be something very routine which you may learned out of this• Reflection is not about blaming yourself• Showing that you are good at reflection in practice and reflection on practice

Case 1

Background information 65 years old male, previously healthy, presented trauma department with sudden circulatory collapse with RHC pain

What did you do well? Identifying a liver mets and bleeding around the liver with an old U/S machine

What were the challenges you faced?

To confirm my suspicion of necrotising liver metastasis with the old U/S machine

Measures taken for overcoming the challenges

Did a subsequent U/S before surgery with the same machine. Confirmed the diagnosis of NM by identifying the increased bleeding (spreading beyond the liver)

What did you learn? Even with old machine NM can be confirmed by doing serial U/S scansShould be done as soon as possible to avoid masking by peritoneal blood

An example for Part III (b) and (c) reflection

• What is / are the goals / objectives of engaging in the CPD activity?

• What did you learn?

• How did / do you use what you learned in your practice?

Part IV – Innovation • Research • Audit • Publications

Part V – Teaching/sharing ability • Lectures/Teaching (local and overseas)• Clinical presentations

An example for Part IV and V

• What did you do well in your research / audit / publication?

• What areas do you think you should improve?

• What measures did / do you take to address these needs?

• (Were your measures successful?)

Thank you

madawachandratilake@gmail.commnchandratilake@kln.ac.lk