Introduction
Methods
Review process
Phase 1
Phase 2
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Context: The external factors that affect portfolio use for the support of SRL. These factors could still exist without the portfolio present.
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Mechanism: The processes set in motion by portfolio use that influence the degree and/or level of SRL. These processes would not exist without the portfolio present.
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Outcome: SRL that is generated by portfolio use.
Results
Study characteristics
Overview of identified CMOs
Contexta | Mechanismb | Outcomec |
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It was difficult to ensure protected time within the clinical hospital setting (WPL): | Learners thought that time spent on the portfolio reduced the time available to spend on patients (AP) | Learners doubted the educational benefit of the portfolio [42] |
– Learners did not have a personal work and/or storage space within the hospital (WPL) – The busy, frenetic pace of the clinical setting (WPL) – Summative assessment; more specifically, requirements regarding the (number of) portfolio reports (SA) | Learners struggled to collect the required portfolio forms, because they usually did not have access to their portfolio at the workplace. But also because they were reluctant to add to the workload of colleagues by asking them to observe and provide feedback on routine procedures (M). Consequently, the portfolio requirements induced stress, anxiety, and other negative feelings (F) | Learners doubted the educational benefit of the portfolio [39] |
Context | Mechanism | Outcome Self-assessment (+) |
The busy, frenetic pace of the clinical setting, which can result in the training year passing by without any concrete developments (WPL) | The portfolio provided a structure to document information during busy workdays (DC). Subsequently, this documentation reminded learners of what happened before and thus provided an opportunity to look back (DR) | Learners reviewed their weak and strong points [44] |
Learners documented frank and open portfolio reports about their deficiencies and how they had tried to remedy them (DC) | Learners were aware of their feelings, attitudes and concerns [37] | |
Distilling clinical experiences into portfolio reports helped to analyze these experiences (DC) | Learners engaged in constructive self-criticism, thereby clarifying thoughts and feelings and identifying proficiencies and deficiencies in performance [35] | |
The portfolio facilitated that all information was stored in one place (DR) | Learners identified gaps in learning [32] | |
Context | Mechanism | Outcome Self-assessment (−) |
– Learners did not have a personal work and/or storage space within the hospital (WPL) – The busy, frenetic pace of the clinical setting (WPL) – Summative assessment; more specifically, requirements regarding the (number of) portfolio reports (SA) | Learners struggled to collect the required portfolio forms, because they usually did not have access to their portfolio at the workplace. But also because they were reluctant to add to the workload of colleagues by asking them to observe and provide feedback on routine procedures (M). Consequently, the portfolio requirements induced stress, anxiety, and other negative feelings (F) | Learners did not experience the portfolio as help in the identification of strengths and weaknesses in one’s own performance [39] |
Context | Mechanism | Outcome Reflection (+) |
– Time-pressure (WPL) – Upcoming job interviews (WPL/A) | Learners documented short, superficial, selective and/or strategic portfolio reports (DC), because of time constraints, the idea that the portfolio was a record of achievement (AP), and privacy concerns (CP). Nevertheless, these short notes helped in remembering the events that had taken place (DR) | Although documented reflections were superficial, learners could engage in deep reflection at a later moment when they were reminded of the events that had taken place [33] |
The busy, frenetic pace of the clinical setting (WPL) | Brief dedicated time to write in the portfolio needed to be secured (CP) | Reflections could be captured as they happened [41] |
The busy, frenetic pace of the clinical setting (WPL) | Learners experienced limited time for reflection. Yet portfolio writing was considered to take up no additional time, as it was possible to do this in between the regular tasks and responsibilities (AP) | Learners engaged in reflection [44] |
The busy, frenetic pace of the clinical setting made it difficult to synthesize learning experiences (WPL) | However, documenting in the portfolio provided an intentional deliberate moment to pause and think about what had happened during the day (DC) | Learners engaged in reflection [43] |
Learners documented frank and open portfolio reports about their deficiencies and how they had tried to remedy them (DC) | Learners engaged in reflection [37] | |
Distilling clinical experiences into portfolio reports helped to analyze these experiences (DC) | ||
The portfolio helped to capture what was happening during education (DC) | Learners engaged in reflection [45] | |
The portfolio mimicked authentic professional situations since real medical cases were used to fill the portfolio. This reduced the gap between theory and practice (DR/PC) | Learners engaged in reflection [31] | |
The portfolio facilitated that all information was stored in one place (DR) | Learners engaged in reflection [32] | |
Supervisors emphasized the importance of reflection (M) | Learners engaged in reflection [33] | |
Context | Mechanism | Outcome Reflection (−) |
– Low resource country with scarce human resources (GC) – Learners and supervisors were not aware of nor experienced with reflective thinking and writing. (ES) | Learners thought that they should not reveal any weaknesses, deficiencies, or mistakes in their portfolio and should only include evidence of competency (AP) | Although reflection was happening, it was almost unconscious, and very seldom documented [40] |
Context | Mechanism | Outcome Feedback (+) |
Eastern face-saving culture (GC) | Learners feared that (negative) feedback would result in uncomfortable situations with teachers (I/F). However, the digital portfolio format provided learners the opportunity to read feedback when alone, which diminished fear (PC/F) | Learners were able to learn from the feedback that was provided [36] |
Sensitive or otherwise neglected topics were discussed more easily as they were part of the portfolio and needed to be discussed. This broadened the focus of discussions between learners and supervisors and/or stimulated the relationship between them (M) | ||
Supervisors were able to provide valuable feedback when learners documented complete portfolio reports (M). Feedback was considered valuable by learners in case it concerned specific clinical cases, as this feedback promoted further thought and actions (AP). Moreover, learners enjoyed it when supervisors paid enough attention to provide them with individualized feedback, which promoted a positive self-image of learners (F) | Learners actively sought and kept feedback. Provided feedback was used retrospectively (i.e., reading documented feedback to seek solutions after a problem is encountered) and prospectively (i.e., changing practice after reading feedback) [36] | |
Supervisors were able to provide valuable feedback when learners documented complete portfolio reports (M) | Feedback promoted further research and thought into a topic [46] | |
Context | Mechanism | Outcome Feedback (−) |
The number of interesting cases available in the clinical setting varied (WPL) | When there was a lack of interesting cases, learners wrote brief reports in their portfolio. These brief reports were followed by brief feedback from supervisors (M) | Learners perceived portfolio feedback to have little utility for personal development and, as a result, their feedback-seeking motivation declined [36] |
Unsatisfying technological infrastructure at the hospital (WPL) | Learners were forced to complete portfolio entries at home after work. Due to the time delay learners experienced difficulties in writing optimal submissions. These submissions received suboptimal feedback in return (M) | Learners perceived portfolio feedback to have little utility for personal development and, as a result, their feedback-seeking motivation declined [36] |
The heavy clinical workload of supervisors (WPL) | Supervisors often did not react (in due time), as there was no reminder function in the portfolio. As a consequence, trainees (repeatedly) checked their portfolio without finding any feedback, which resulted in frustration (PC/F) | Learners perceived portfolio feedback to have little utility for personal development and, as a result, their feedback-seeking motivation declined [36] |
Workplace learning (WPL) | Feedback was already provided during bedside teaching (M) | Learners perceived portfolio feedback to have little utility for personal development and, as a result, their feedback-seeking motivation declined [36] |
Summative assessment; more specifically, requirements regarding the (number of) portfolio reports (SA) | The mandatory number of submissions resulted in a high frequency of feedback. Therefore, single feedback moments had low news value (M) | Learners perceived portfolio feedback to have little utility for personal development and, as a result, their feedback-seeking motivation declined [36] |
Learners found it difficult to perform a learning needs assessment individually (ES) | Learners experienced a lack of guidance and clear instructions on how to complete the portfolio (M/PC). As a consequence, trainees felt uncertain about what they should write in their portfolios (F) and were inclined to make inauthentic submissions. This type of submission evoked superficial or generic feedback by teachers (M) | Learners perceived portfolio feedback to have little utility for personal development and, as a result, their feedback-seeking motivation declined [36] |
Due to the number of trainees rotating between the departments and the genericity of provided feedback, learners distrusted supervisors’ ability to remember individual learners and their performance well enough to provide individualized feedback (I/M) | Learners perceived portfolio feedback to have little utility for personal development and, as a result, their feedback-seeking motivation declined [36] | |
Delayed feedback was experienced as less meaningful. Since learners believed that supervisors were not able to remember the past experience well enough to provide accurate feedback (I/M) | Feedback-seeking motivation declined [36] | |
Context | Mechanism | Outcome Learning objectives and plans (+) |
The busy, frenetic pace of the clinical setting made it difficult to synthesize learning experiences (WPL) | However, documenting in the portfolio provided an intentional deliberate moment to pause and think about what had happened during the day (DC) | Learners thought how lessons learned could be applied in the future [43] |
Distilling clinical experiences into portfolio reports helped to analyze these experiences (DC) | Learners directed future progression, as they charted their own course of professional development [35] | |
The portfolio facilitated that all information was stored in one place (DR) | The portfolio helped to set goals for the future [32] | |
Context | Mechanism | Outcome Learning objectives and plans (−) |
– Learners did not have a personal work and/or storage space within the hospital (WPL) – The busy, frenetic pace of the clinical setting (WPL). – Summative assessment; more specifically, requirements regarding the (number of) portfolio reports (SA) | Learners struggled to collect the required portfolio forms, because they usually did not have access to their portfolio at the workplace. But also because they were reluctant to add to the workload of colleagues by asking them to observe and provide feedback on routine procedures (M). Consequently, the portfolio requirements induced stress, anxiety, and other negative feelings (F) | Learners did not experience the portfolio as help in the achievement of learning objectives [39] |
– Low resource country with scarce human resources (GC). – Learners and supervisors were not aware of and experienced with reflective thinking and writing (ES) | Learners thought that they should not reveal any weaknesses, deficiencies, or mistakes in their portfolio and should only include evidence of competency (AP) | Learners were reluctant to document learning needs [40] |
Context | Mechanism | Outcome Monitoring (+) |
The busy, frenetic pace of the clinical setting, which can result in the training year passing by without any concrete developments (WPL) | The portfolio provided a structure to document information during busy workdays (DC). Subsequently, this documentation reminded learners of what had happened before and thus provided an opportunity to look back (DR) | Learners looked back and mapped their development [44] |
Existing documentation of (learning) events provided the opportunity to reconsider past events (DR) | Learners gauged their own progress, as returning to previous reports helped to see what they had learned and how they had progressed [33] |
A model of how portfolio use works for the support of SRL during WPL
Contextual factors
Portfolio (-related) mechanisms
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Portfolio mechanisms: primary mechanisms inherent to portfolio use that seem to affect SRL directly.
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Portfolio-related mechanisms: mechanisms related to portfolio use that seem to affect the primary portfolio mechanisms and thereby also SRL.