Does a summative portfolio foster the development of capabilities such as reflective practice and understanding ethics? An evaluation from two medical schools

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Practice points

Portfolios should be linked to graduate capabilities such as reflective practice and understanding ethics to help drive learning towards specified outcomes. Students should be required to build their portfolio prospectively thus promoting regular review of progress and encouraging self-direction and reflection. The explicit request to produce a reflective document is associated particularly with the development of skills in reflective practice and self-direction. Students perceive portfolio preparation as an effective learning tool for the development of capabilities such as reflective practice and ethical judgment, whereas other capabilities such as effective communication require complementary techniques and other modes of assessment.

Table 1.  Capability/competency framework for portfolio examination.

University 1 Graduate capabilities	University 2 Philosophy and learning outcomes	ACGME 2007 Competencies	CanMEDS 2005 Competency framework	GMC – Tomorrow's doctors 2003	Numbers refer to the questionnaire
Social and cultural aspects of health & disease	Respect different cultures, recognises social and economic forces in health	Knowledge of social-behavioral sciences	Identify & respond to the determinants of health in the community	Integrate the behavioral and social sciences into medicine	20, 21 & 22
Effective communication	Managing and presenting written information	Comprehensive written communication	Accurately convey information	Communicate effectively	5, 6 & 7
Teamwork	Work effectively as a member of a team	Evaluate feedback Work effectively in a team	Participate effectively in an inter-professional team	Respond constructively to performance review Demonstrate effective team-working	17, 18 & 19
Self-directed learning & critical evaluation	Skills to continue learning Critical appraisal	Set learning & improvement goals	Maintain professional activities Critically evaluate information	Integrate new knowledge Plan professional development	11, 12 & 13
Ethics and legal responsibilities	Respect patient autonomy	Compassion & integrity Accountability Patient respect	Develop ethical relationships with patients	Duty to protect patients Understand the rights of patients	8, 9 & 10
Reflective practice	Reflective Practice Recognises problems	Identify strengths & limitations	Recognize the limits of their expertise	Recognize personal & professional limits	14, 15 & 16

The numbers in the final column refer to the question numbers in the questionnaire in Appendix 1.

Table 2. University 1 and University 2 combined questionnaire responses (n = 526) to the three questions linked to each capability (1578 responses) expressed as percentage from both medical schools.

Capability	Disagree	Neutral	Agree	Chi-square (df = 6)
Reflective practice	22%	16%	63%	622.0*
Ethical and legal principles	29%	23%	48%	162.7*
Self-directed learning	33%	19%	48%	197.9*
Social and cultural aspects	33%	20%	47%	167.3*
Teamwork	38%	25%	37%	50.8*
Effective communication	42%	24%	34%	73.3*

*Significant at the p < 0.001 level.

Table 3. Questionnaire responses expressed as percentage comparing University 1 (n = 411) to University 2 (n = 115).

Capability	University	Disagree	Neutral	Agree	P value*
Reflective practice	Uni 1	24%	16%	60%	<0.001
	Uni 2	14%	14%	72%
Ethical and legal principles	Uni 1	33%	22%	45%	<0.001
	Uni 2	16%	26%	58%
Self-directed learning	Uni 1	37%	19%	45%	<0.001
	Uni 2	28%	20%	52%
Social and cultural aspects	Uni 1	34%	19%	48%	0.77
	Uni 2	30%	26%	43%
Teamwork	Uni 1	44%	24%	32%	<0.001
	Uni 2	18%	27%	56%
Effective communication	Uni 1	47%	25%	29%	<0.001
	Uni 2	23%	23%	54%

*Significant difference University 1 versus University 2, Kruskal-Wallis test.

Table 4. University 1 and University 2 combined questionnaire responses expressed as percentage of each gender comparing male (n = 211) to females (n = 315).

Capability	Gender	Disagree	Neutral	Agree	P value*
Reflective practice	male	29%	17%	54%	<0.001
	female	17%	15%	68%
Ethical and legal principles	male	34%	22%	44%	<0.001
	female	26%	23%	51%
Self-directed learning	male	41%	16%	43%	<0.001
	female	28%	21%	51%
Social and cultural aspects	male	40%	18%	42%	<0.001
	female	28%	22%	50%
Teamwork	male	44%	27%	29%	<0.001
	female	34%	23%	43%
Effective communication	male	49%	20%	31%	<0.001
	female	37%	27%	36%

*Significant difference male versus female, Kruskal-Wallis test.

ACGME. 2007. Accreditation council for graduate medical education outcomes Project. http://www.acgme.org/outcome/comp/compCPRL.asp (accessed May 2008).

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