Portfolio Learning – The Good, The Bad and The Ugly!

Phil Rayner GP Trainer and Lead Programme

Director – Nottingham GP StP

Objectives of this Session

• Share experiences of working with trainee portfolios

• Review the theory behind portfolios• Use examples to identify why some learners

struggle• Identify how we as PDs/ TPDs can support

portfolio learning?• If time practice our own reflective writing skills

For example

• GP trainees have an e-portfolio• Contributes to evidence for WPBA• 3rd component of MRCGP• Comprises – PDP, Shared Learning log,

Asessments, PSQ, MSF, Procedures Log, Supervisor reports, Educators notes.

• Demonstrates – curriculum coverage, competency attainment.

But why have a portfolio at all?

• Record of learning?• Tool for assessment?• Promotes reflection?• Improves learning efficiency?• Promotes ‘deeper’ learning?• Learner led?

Reflection

‘A Tick Box Exercise or Learning for All?’– Macaulay & Winyard BMJ 17/11/12

Part of GMC core guidance in GM PracticeWe are all required to ‘reflect regularly on our standards of medical practice’

So what’s the theory behind reflection?

• In essence-

• Thinking leads to Emotion leads to Action!

John Dewey (1933)

• ‘Active, Persistent and careful consideration of any belief’

David Boud (1985)

• ‘Exploring Experience to lead to new Understanding & Appreciation’

Stephen Kremmis (1985)

• ‘Active process, …from experiences, …relates to theory or previous learning and leads to an action plan’

Chris Johns (1995)

• ‘Personal process, … assessment understanding and learning from experiences, … leads to change for the individual and new learning.’

Donald Schon (1987)

• Described ‘Professionals working in the swampy lowlands’.

• Outlined ‘reflection in action’ & ‘reflection on action’

Jack Mezirow (1981)

• ‘Ultimately the outcome of reflection is Learning’

• It broadens knowledge• It develops skills• It changes attitudes

But only if done well?!

Examples of GP trainee learning log entries

The Good, The Bad and The Ugly?

What do you think about them?How would you help this trainee?How do we promote learning from a log entry?

The ISCE model

• Information Provided• Self Awareness• Critical Analysis• Evidence of Learning

From Atkins & Murphy

There's also Kolb (1984)

Or Gibbs (1988)

Practising reflection

• Reflective writing exercises?• Superficial reflectors – how do we help them?• Attitudinal barriers- how do we break them

down?• Activity!

Suggestions?

• Clear objectives of the reflective process• Teach learners how to reflect (use a critical

reflection checklist?)• Make it easy to record• Discuss reflections with someone (but are they

trained to do this?)• Make reflective practice and debriefing central

to clinical activities• ‘Informal’ case discussion can also count!

Consider 1 of these pictures – what do you see, how does it make you feel, how could you relate it to your practice?

For proper reflection you need

• Open-mindedness• A commitment to self-enquiry• Motivation• A readiness to change practice

Richardson & Maltby (1995)

‘Critical’ Reflection

• Linking past present and future experience• Integrating the cognitive and emotional

experience• Considering the experience from multiple

perspectives• Re framing the experience• Stating the lessons learnt• Planning for future learning or behaviour

Summary

• Shared experiences of working with trainee portfolios

• Reviewed the theory behind portfolios• Used examples to identify why some learners

struggle• Discussed how we as PDs/ TPDs can support

portfolio learning.• Practised our own reflective writing skills

Questions?