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An electronic learning portfolio for reflective continuingprofessional development

Tim Dornan,1 Carmen Carroll 1 & John Parboosingh2

Objectives These were to measure the uptake and use of

an electronic learning portfolio to support reflective

continuing professional development, and to charac-

terize attitudes towards its use and obstacles to its

adoption.

Design Uncontrolled, longitudinal intervention study

with quantitative and qualitative evaluation.

Participants Physicians with a specialty interest in endo-crinology and diabetes mellitus, registered for continu-

ing professional development with the Royal College of

Physicians, London.

Intervention All registered consultants were offered a

1-year free trial of PC Diary. Those who accepted were

offered a training workshop.

Main outcome measures Quantitative and qualitative

responses to a simple questionnaire. Two researchers

independently used a template approach to analyse

free-text responses and jointly agreed a final system of

coding.

Results 22% of registered consultants applied to parti-

cipate; 14% attended training workshops. Of registered

participants, 94% returned the questionnaire. PC Diary

was used by 34%, but only 10% used it regularly.

Among the registrants, 54% asked to continue their

subscription for a second year, and 40% asked for

further training. There were emotive expressions of

both like and dislike, often coupled with statements

about the individual’s learning style. Time pressures

and lack of computer access, literacy and support were

dominant obstacles to adoption.

Conclusions There was considerable support for

reflective learning using an electronic portfolio. Accep-

tability and use were influenced by individual learning

style, resources, training and technical support, and

these were often inadequate. The balance for consult-

ants between workload demands and support provided

did not favour a reflective type of learning.

Keywords Attitudes; diabetes mellitus, methods;

education, continuing, *methods; endocrinology,

methods; London; professional competence, standards;

questionnaires.

Medical Education 2002;36:767–769

Introduction

The aim of this study was to measure the uptake and

use of an electronic learning portfolio developed to

support reflective continuing professional development

(CPD), and characterize attitudes towards its use and

obstacles to its adoption.

Methods

The Royal College of Physicians and Surgeons of

Canada (RCPSC) has developed an electronic learning

portfolio named PC Diary.1 Entries are made as

questions, together with the zone of expertise to which

each question relates (focusing learning on the user’s

practice), the stimulus for the question (e.g. care of an

individual patient, audit, reading), the time spent

answering it, and the sources consulted. The user has

to make a commitment to change practice, to seek

further information, or not to change practice. Notes,

references, and an evaluation of the strength of

evidence on which the commitment was based can be

recorded. The diary also records group CPD attend-

1Department of Diabetes/Endocrinology, Hope Hospital, Salford,

Manchester, UK 2The Royal College of Physicians and Surgeons of Canada, Ottawa,

Ontario, Canada

Correspondence: T. Dornan, Hope Hospital, Stott Lane, Salford,

Manchester M6 8HD, UK

Developing professional skills

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ance, and provides a to-do list to note events in daily

clinical life which are worthy of study at a later time. PC

Diary functions as a personal learning planner, targets

behaviour rather than abstract learning, allows users to

survey whether they have followed through their com-

mitments to change and intentions to seek further

information, and can filter contents by any parameter.

Thus it supports reflection in framing questions,

seeking answers, deciding what action to take, and

reviewing performance against self-determined goals.

All 439 consultants in diabetes/endocrinology who

were registered for CPD with the London Royal

College of Physicians were offered 1 year’s free use of

the PC Diary. Every applicant was accepted, invited to

attend a training workshop, and sent email updates andtips on diary use. The RCPSC provided on-line

support. After a year, all participants were sent an

anonymous single-page questionnaire asking about

their current use, whether they would like to continue,

whether they wanted further training, and their reac-

tions to PC Diary. Freehand responses were tran-

scribed verbatim. C.C. and T.D. coded them

independently, using a template method,2 discussed

their interpretations, and ascribed an agreed final code

to each.

ResultsOf the 439 consultants, 95 (22%) applied and were

registered, and 60 (14%) attended a training workshop.

Of the registered participants, 89 (94%) returned the

questionnaire and 87 ticked a box describing their use

& PC diary. Of the 87, 10 (11%)1 decided not to use it,

18 (21%) planned to use it but never set it up on their

computer, 29 (33%) set it up but did not use it, 21

(24%) set it up but used it infrequently, 6 (7%) used it

twice per month or more and 3 (3%) used it once per

week or more on average. Among the participants, 47

(54%) wished to continue their subscription for another

year and 35 (40%) wished to receive further training.

Acceptability

There were positive and negative reactions. Some

people who had not started using the Diary remained

committed to do so, even in the face of initial failure.

Some participants liked it because it enhanced or

helped them manage their learning, or fitted with their

learning style. Others expressed strong dislike.

Time

This was a dominant theme. Even participants who

strongly approved and started using the Diary did not

persevere, because of a workload that gave them no time

for learning, self-confessed poor time management, or

difficulty changing the way they used time. Even when

use of the Diary had been adopted, availability of time

and the need to change work habits remained problems.

Some questionnaire responses described it as time well

spent, others as time wasted. Some participants were

pleased to find how much time they were already

spending on CPD and to receive credit for it.

Computer use

Inexperience, technical problems, difficulty connecting

to the internet, lack of a suitably located computer andvarious shades of personal reaction to computer use

made up another dominant theme. Lack of informa-

tion technology (IT) support in the hospital and

incompatibility with locally provided software, hard-

ware and networks created problems. It was common

practice to carry out CPD during evenings and

weekends because of lack of time during working

hours or inadequate IT access in the workplace or

both. Those who lacked self-confidence in IT skills

could be disheartened by failure. Keyboard data entry

was a problem for some.

Programme attributes

The self-directed learning portfolio attracted favourable

comment, although some found making entries a chore.

It was suggested that the system could be improved by

electronic logging of time spent, integration with an

electronic reference manager, and a summary format

which was more compatible with UK reporting

requirements.

Key learning points

Nearly a quarter of consultants registered for

continuing professional development in diabetes/

endocrinology applied to use PC Diary.

Uptake and use of the system was considerablylower than that.

There was a wide variety of reactions, depending

at least in part on the individual’s learning style.

Training, support, and a work climate conducive

to learning are needed for successful electronic

portfolio use.

Electronic portfolio for reflective continuing professional development • T Dornan et al.768

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Learning processes

Respondents commented on the compatibility of PC

Diary with their own learning processes, for example:

It does stimulate reflective learning and this is

rewarding.

Emotional reactions

Learning, the concept of PC Diary and the use of IT

elicited positive emotions, particularly from people who

were conversant with IT.2 There were negative emotions

about the same factors, particularly concerning techni-

cal difficulty in using the programme. Other major

reasons for negative emotion were time pressure,

workload, and lack of sympathy from the trusts which

employed the consultants.

DiscussionRegarding our first objective, more than one-fifth of

consultants were receptive to IT-supported reflective

CPD. The training we provided, whilst resource-

intensive, was unequal to the needs of some partici-

pants. We did not have the resources to provide

continuing support, an important component of port-

folio learning,3 and this may help to explain the poor

subsequent use of PC Diary.

Concerning the second objective of the study, ques-

tionnaire responses demonstrated both positive and

negative attitudes, which were influenced by training

and technical factors, but which also showed theimportance of individual learning style. As described

elsewhere,4 some people valued a portfolio approach to

managing their learning, and the electronic presenta-

tion was attractive to those who liked IT. Others

disliked the whole concept, or found it more trouble

than it was worth.

With regard to obstacles to adoption of the Diary, the

questionnaire showed many consultants to be wholly

self-taught or unskilled in IT use, using their own

computers at home because they had no equipment, or

equipment of very poor quality, at work. Poor or non-

existent support by hospital IT departments was a

common experience. Many people struggled against

heavy schedules and workloads to find time for their

learning.

These observations suggest that training, support,

and a work climate conducive to learning are needed for

successful electronic portfolio use.

Acknowledgements

We thank Catherine Crossley for administration of the

project, Marcia Gowenlock for her help in arranging

training workshops, Thekla Piga and staff of the

RCPSC for support, and Novo Nordisk for generous

financial support.

Contributors

TD planned the study, trained participants, analysed

the data and wrote the paper. CC second-coded the

qualitative data and commented on the manuscript. JP

devised PC Diary, trained participants and commented

on the manuscript.

Funding

Financial support was provided by Novo Nordisk.

There was no other external funding for the project.3

References

1 Parboosingh J. Learning portfolios: potential to assist health

professionals with self-directed learning. J Cont Educ Health Prof 1996;16:75–81.

2 King N. Template analysis. In: G Symon, C Cassell, eds.

Qualitative Methods and Analysis in Organisational Research: a

Practical Guide. London: Sage; 1998;4 pp. 118–34.

3 Grant A, Dornan TL. What is a learning portfolio? Diabet Med

2001;18 (Suppl. 1):1–4.

4 Campbell CM, Parboosingh JT, Gondocz ST, Babitskaya G,

Lindsay E, De Guzman RC, et al. Study of physicians’ use of a

software program to create a portfolio of their self-directed

learning. Acad Med 1996;71 (Suppl. 10):S49–S51.

Received 19 September 2001; editorial comments to authors 23

November 2001; accepted for publication 22 January 2002

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