Students’ reflections in a portfolio pilot: Highlighting professional issues

Figures & data

Table

Practice points

Students’ reflections in the learning and assessment portfolio in GP include sufficient professional issues of cognitive, affective and practical dimensions, notwithstanding a standardized format and a limited timeframe. Mentors can increase the acceptance of the portfolio with students. A final examiner interview is recommended to deepen students’ reflections and to supply feedback.

Box 1 The portfolio: learning outcomes, content and areas for assessment

Learning outcomes

The student is expected to

• analyse his/her strengths and weaknesses in GP consultations, reflect on learning achieved, what areas need further development and how this development may take place

• discuss and critically examine characteristic attributes of GP, illustrated by two case summaries from practice, reflect on learning achieved and on how further development may take place

Content

Documentary evidence

• Assessment protocols (self-assessment and feedback) from practice (communication skills; history taking; physical examination; differential diagnoses; problem solving; management plan; explanation with patient and relationship/efficient use of time)

• Checklist of practical skills from practice (provide lifestyle advice to patients; examine patients with neck/shoulder pain or low lumbar pain; consult with old patients with multiple complaints; document patients’ records; write hospital referral letters; write sick-notes; examine children in child welfare clinic and accompany the GP on home visits)

• Feedback sheet from video seminar

• Two case summaries (each 250–500 words), critical incidents or routine clinical experiences

Reflections

• One 500-word reflection on consultation skills, linked to documentation from practice and video group

• Two 250–500-word reflections, one on each case summary, linked to one or more of the 11 characteristic attributes of GP (WONCA Europe 2005)

Areas for assessment

in each of the three reflections

• Reflection on learning achieved, further learning needs and a learning plan

• Use of documentary evidence/GP attributes

in the whole portfolio

• Structure and written language

Box 2 Characteristic attributes of GP (WONCA Europe 2005)

Accessibility – first contact for all health care problems

Co-ordinating care – with other professionals in primary care and with other specialities

Patient-centred approach – centred on patient and context

Patient–doctor relationship

Longitudinal continuity of care

Specific decision-making process – based on incidence and prevalence

Non-specific undifferentiated symptoms

Simultaneously manage acute and chronic health problems in individual patients

Promote health and well-being – prevention

Community orientation – responsible for the health of the community

Holistic modelling – physical, psychological, social, cultural and existential dimensions

Essential application features – attitudinal, scientific and contextual aspects – are important for all doctors to apply the above core competencies in real life in the workplace setting.

Table 1.  Students’ reflections on their consultation skills (number of comments in brackets)

Codes	Sub-themes	Themes
Time management	Structure (51)	Process skills (103)
Negotiate agenda
Keep interview on task
Summarize periodically
Listen attentively to the patient's opening statement, without interrupting or directing patient's response	Active listening (17)
Moving from open to closed questions
Facilitate patient's response by the use of silence
Actively determine and explore patients’ ideas, concerns and expectations	Patient's perspective (13)
Pick up verbal and non-verbal cues
Use empathy to communicate understanding of patient's feelings
Write notes without interference with dialogue or rapport	Building relationship (11)
Deal sensitively with embarrassing and disturbing topics
Use concise, easily understood language Provide clear information Relate explanation to patient's perspective	Reaching shared understanding (11)
Self-concept and self-confidence Awareness of one's own feelings Awareness of one's own issues of concern	Self-awareness (20)	Perceptual skills (41)
Internal clinical reasoning	Clinical reasoning (11)
Future communication skills training	Communication skills (10)
Ask relevant questions to explore patient's problems Formulate management plan Maintain continued learning	Scientific aspects (21)	Content (34)
Elicit and interpret signs in physical examination Future practical skills training	Practical skills (13)
Co-ordinated care	Primary care (4)	Context (4)

Table 2.  Students’ reflections on their case summaries (number of comments in brackets)

Codes	Sub-themes	Themes
Reaching shared understanding Sharing power and responsibility Personal relationship and trust	Patient–doctor relationship (36)	Patient-centred care (89)
Physical, psychological, social, cultural and existential dimensions	Holistic modelling (21)
Oriented to the individual Patient's belief, concerns, expectations, feelings and needs	Patient-centred approach (18)
Longitudinal continuity of care	Longitudinal continuity (14)
First medical contact – open and unlimited access Full range of health conditions	Accessibility (13)	Primary care management (35)
Co-ordinate with other professionals in the primary care setting	Co-ordinating care (15)
Interface with other specialities
In balance with available resources	Community orientation (7)
Disease in early stage, non-specific signs Use time as a tool, tolerate uncertainty Effective and efficient use of diagnostic and therapeutic interventions	Non-specific undifferentiated symptoms (12)	Specific approach to patients’ problems (24)
Decision making based on incidence and prevalence Decision making based on knowledge of patients and community	Specific decision-making process (7)
Hierarchical management of problems	Simultaneously manage acute and chronic health problems (3)
Prevention	Promote health and well-being (2)
Awareness of one's own feelings Awareness of one's own issues of concern Awareness of one's own attitudes	Self-awareness (24)	Perceptual skills (37)
Identifying ethical aspects of clinical practice	Ethics (6)
Future communication skills training	Communication skills (7)
Recapitulate basic and clinical science Read and assess medical literature Maintain continued learning	Scientific aspects (24)	Content (24)
Impact of the community	Contextual aspects (3)	Context (3)

WONCA Europe 2005. http://www.woncaeurope.org/Web%20documents/European%20Definition%20of520family%20medicine/Definition%20EURACTshort%20version.pdf

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