Letters to the Editor

Key factors to consider in choosing an appropriate platform for implementing a learning portfolio

Dear Sir

Portfolios have been increasingly utilized as a tool to enhance self-directed education. Most articles on the subject of medical portfolios describe the use of the portfolio in the educational endeavour and usually presuppose the method of delivering or recording the portfolio described to be the most appropriate method (Snaddan & Thomas, 1998; Lonka et al., 2001; Duque, 2003). This is an important issue to consider as implementation may affect its long-term acceptance by the learner. If the delivery platform is not suited to the learner, the implementation may fail outright or have a lower acceptance rate (Dornan et al., 2002). There are a variety of different ways in which a portfolio can be delivered and managed including paper-based, handheld computer, and Internet access.

We have recently begun implementing a learning portfolio for our senior residents. The first step in development was to select the appropriate delivery model. To do this a needs assessment utilizing a modified Delphi approach was used. We found ten key issues that needed to be considered. An ideal portfolio would:

1. Be easy to learn and use.

2. Have a clear rationale for collecting the data.

3. Be secure from unauthorized viewing.

4. Only store the minimum personal information required.

5. Be accessible anywhere to enter information.

6. Persist with the learner after completing the training program.

7. Not use technology that becomes obsolete rendering future review impossible.

8. Be compatible with other portfolios that may be used post training.

9. Be scalable to add new items the training program wishes to capture.

10. Be easily searched by the learner for reflection and by the program for audit.

Although these points were developed in the context of post-graduate medical education, they can be generalized to all areas of medical education. Each training program is unique and the appropriate platform will vary between programs. In order to develop a portfolio that will be used over the long-term it is important to consider these issues. Each program should perform its own needs assessment to choose the appropriate platform. Our key issues can serve as a starting point for discussion.

Darren Hudson

14314-43 Ave.

Edmonton, Alberta,

Canada, T6H 5S1

Email: [email protected]

Negative marking can be justified in marking schemes for healthcare professional examinations

Dear Sir

Concerns over examination score escalation by candidates guessing led to the development of score correction (Downing, 2003). This became viewed as discouragement of guessing (Burton, 2002), but in candidate, and even faculty, folklore as negative marking and penalisation (Hammond et al., 1998).

The advocates of negative marking feel candidates do not deserve to pass through guessing, the opponents that raw scores correlate with adjusted scores, so it adds little (Downing, 2003). Worse than this, it may adversely affect responses, so reducing the validation argument (Burton, 2002).

Not all examinations have adopted correction for guessing. Advice on strategies dependent on marking scheme, personal guessing ability and confidence are available (Hammond et al., 1998). Number-right scoring encourages candidates to answer every question, but clinicians should not undertake clinical practice as though they know everything (Muijtjens et al., 1999). Burton (2002) states that number-right scoring is preferable to negative marking, accepting that guessing will affect examination results, but goes on to defend negative marking as, in clinical practice, over-confidence in incorrect answers rather than an admission of no knowledge can be dangerous. Admitting partial or a lack of knowledge with a strategy for rectification is preferable.

Therefore, there is a logical rationale for the use of negative marking. The real question is how could this be implemented? In a multiple-choice best option format, the options are on a continuum to reflect real life outcomes (Case & Swanson, 2001). If an option was deemed a negative outcome then it should receive a negative mark. The mark for a question could be anything from +x to −y. The values of x and y could be derived in a number of ways. Real clinical outcome data could be used although this is unlikely to be available for all options. Expert opinion is the most likely source. It could be used to decide the best response, +x and the positive scores and also the worst response, −y and negative scores. Further the values of x and y could be corrected within and between questions as appropriate. Could x = y, x > y or x < y or any? Is it possible to do more harm with the incorrect answer, than good, with the correct answer?

Negative marking should be used in clinical written examinations. However, it should reflect negative clinical outcomes rather than be used to discourage guessing. Exactly how this could be implemented and utilized is another challenge.

Mike Tweed

Clinical Senior Lecturer

Wellington School of Medicine & Health Sciences

Wellington

New Zealand

Email: [email protected]

Handheld computers are a neglected teaching resource

Dear Sir

By failing to acknowledge the role of personal digital assistants (PDAs or handheld computers), UK medical schools are missing out on a valuable teaching resource. PDAs have been in use by doctors for several years (McAlearney et al., 2004; McLeod et al., 2003), but until now there has been no data on PDA use in UK medical students. Using an online questionnaire of all undergraduate medical students in one UK medical school, we undertook an evaluation of PDA usefulness and uptake. Of 1158 students, 40% responded to the questionnaire. Less than 10% of medical students owned a PDA but these students did use them regularly. Of non-users, 39% had considered getting a PDA. Expense was the main reason for non-acquisition in 50% of non-users, with 61% of these prepared to purchase a PDA if priced under £100. Lack of information was the next most frequent reason for non-acquisition. These factors are contributing to the relatively low uptake of PDA usage by the population despite significant interest. As many PDAs can now be purchased for £70–£100 these barriers could be easily surmounted by providing basic information and support.

Respected universities in the USA such as UCLA are making it compulsory for students to purchase a PDA (http://www.medstudent.ucla.edu/pdareq). UCLA quote two primary reasons for this: To enable “point of contact” access to information resources, and to prepare students for practising medicine in the 21st century. As the number of medical students in the UK expands, and more learning is provided remotely, new ways of providing quality education through this technology must be prioritized. (The full text of this research can be found at http://www.rhcn.org.uk/pda.)

Genevieve Thueux, Jessica C Watson,

Julian M Jenkins and David J Cahill

11 High Street, Easton, Bristol BS5 6DL, UK

Email: [email protected]

A teaching ward experience: role blurring is not the answer

Dear Sir

Teaching wards have constituted simulated learning environments; dedicated orthopaedic teaching wards; urban hospital wards; or clinical education wards since the mid 1990s (Wahlström & Sandén, 1998; Reeves & Freeth, 2002; Ker et al., 2003; Ponzer et al., 2004). In February 2003 medical and nursing educators at the University of Manchester examined the efficacy and feasibility of creating a teaching ward within one university teaching hospital. This interprofessional learning experience brought together three BNurs (Hons) and four MB ChB students to work in teams sharing their knowledge and skills related to practice.

Data from the one-to-one and focus group interviews undertaken with students post-study revealed that despite enjoying the opportunity to engage in integrated working and learning, the students felt there could be too much sharing. This construct was similarly supported by the facilitators’ reflective diary notes documented after each of the teaching sessions. In essence, the students made it clear that interprofessional education was not the panacea it was thought to be; but that it could result in health professionals’ losing their unique identity. Moreover, the students felt that as each profession had a different role, different job and different agenda, a large proportion of their professional education should remain discipline specific. For this reason it could be suggested that blurring of the professional boundaries is not a wholly positive educational outcome from interprofessional learning as it can lead to role confusion and professional ambiguity.

Dr Ann Wakefield, Lecturer in Nursing,

The University of Manchester,

School of Nursing Midwifery and Health Visiting,

Coupland 3 Building, Coupland Street,

Manchester, M13 9PL, UK.

Email: [email protected]

Caroline Boggis

Associate Director for the

Curriculum and Student Support

University of Manchester

Manchester, UK

Mark Holland

Consultant Physician

South Manchester University Hospitals Trust

Manchester, UK