Portfolios in medical education at the University of Maastricht

The Faculty of Medicine of the University of Maastricht uses portfolios since 2001. Portfolios are introduced in the early stages of the program with the aim to train medical students in reflective skills. In the later years portfolios will also be used to monitor, coach and assess working in clinical situations.
On this page you can find more information about the portfolio system of the Faculty of Medicine of the University of Maastricht.

Goals

The new curriculum of the medical School of the University of Maastricht is structured around a Dutch National Framework for Medical Education (Metz e.a. 2001). In this framework, four roles for the doctor can be distinguished:

  • Role as medical expert
  • Role as scientist
  • Role as health care worker
  • Role as person

In the new curriculum of the Maastricht Medical School these four roles play an important role. To be able to adequately fulfil these roles, the students have to both acquire theoretical knowledge and practise in situations as realistic as possible.

A new curriculum

In traditional medical curricula in the Netherlands, there is clear distinction between the first four years of the program focusing on theory and the last two years focusing on practical experience. Research showed that this distinction is problematic, because students do not sufficiently use theory in medical practise and because their theoretical knowledge is often not structured in a way which is not adequate for tackling practical medical problems.

Key issue in the new curriculum is to find a more productive balance between theory and practise. To achieve this, students work in the clinic in an earlier stage of their study: year three. Theory plays a more important role in the last two years of the program.

Being able to reflect on one’s own action as a medical professional is regarded an important skill. Reflection implies distinguishing strong and weak points in one’s own performance (using theory), and subsequently work on improvement of the weak points in a systematic manner.
In the first two years of the program reflective skills are already trained.

The new curriculum was introduced in 2001 and has now reached the third year of the program.

Why a portfolio?

Portfolios are introduced in the early stages of the program with the aim to train medical students in reflective skills (compare Driessen et.al. 2002).
In their portfolios students systematically look back on their actions as for instance scientist, analyse these actions and designate alternative methods of action. The portfolio is discussed at least twice a year with a mentor.
In the later years of their studies, students will also use the portfolio to show how they perform in clinical situations and how they have developed in the various roles.

In addition to training reflective skills, three other reasons for an early introduction of portfolio in the new curriculum of the Maastricht Medical School can be distinguished.

  • create a mentoring system in which student could receive pastoral care during their studies.
  • give students more responsibility for their learning and assessment.
  • make the portfolio part of the assessment system, stimulating students to review and integrate all assessment feedback.

The portfolio system

Experience with portfolio systems outside and within medical training were used to develop a portfolio for first-year and second-year medical students.
Literature on portfolios suggests that the factors contributing to portfolio effectiveness include:

  • a clear portfolio structure
  • a supportive mentor system
  • an appropriate assessment procedure

Portfolio structure

In the portfolio reflection is structured around four professional roles of the doctor, based on the Dutch National Framework for Medical Education.

Professional roles were chosen to express competence, because these proved to be easier to comprehend than abstractly formulated competencies.
The portfolio has been given structure by including sections, one for each professional role. Self-assessment and analysis of the student’s own performance is thus organised on a role-by-role basis, underpinned by systematic reference to illustrative materials (compare the template for the year 2 portfolio).

The structure of the portfolio is as follows:

  • Curriculum vitae
  • Role as medical expert
  • Role as researcher
  • Role as health care worker
  • Role as person
  • General
  • Summary of strengths and weaknesses analysis
  • Report of progress interview and/or of exit interview/ advice
  • Annexes

Global requirements are set for each professional role using a template. Both an electronic and a paper template are available. The students themselves determine content and form of their portfolio. The students are free in their choice of materials.

For each professional role, a number of probing questions has been formulated to guide the student in writing the introspective part. Posing probing questions is a way to encourage reflection on learning. The questions structure the students’ reflections.

For each professional role, the students analyse their professional development thus far, draw conclusions from the analysis and set learning objectives for the coming period.

Mentoring system

A single mentor provides support for twenty students in developing their portfolios and provides general pastoral guidance.

At least twice a year, student and mentor conduct an individual interview;

  • a progress interview
  • an end of year interview

During these interviews, the student's performance in each area of competence (role) is evaluated, strong and weak points identified and new learning objectives formulated for the coming period.

This should stimulate students to better identify the focus of their studies and to actively steer their learning. Thus, the students develop skills that are relevant to their subsequent studies and future profession, such as self-reflection and a critical and focused learning attitude.

The mentor’s responsibility goes beyond supervising the portfolio. He/she also has a general pastoral function. If a student has a problem or a question that has consequences for his studies, he may direct himself to his mentor. If he has problems of a structural nature, the mentor can refer the student to a student counsellor or other, specialised professionals.

Assessment procedure

For the end of year assessment, the mentor does not assess his own students' portfolios. He only serves as coach and advisor.

We introduced multiple portfolio discussion moments in the assessment procedure:

Progress and exit interviews

If a mentor is not satisfied with the quality of the portfolio, he brings this up during the interviews. Those aspects that did not work out too well, may be improved before the final assessment. By so doing, the student receives intermediate feedback on the quality of his portfolio. By including this type of feedback loops into the portfolio procedure, in effect, a combination of information is achieved by building in several moments of measurement.

Assessment

If this procedure is followed correctly, assessment by the assessment committee at the end of the year will not lead to unexpected outcomes.
The committee has access to the documented intermediate evaluations and can take these into account in its assessment. A drawback is that, as a result of this, the committee’s assessment by the assessment committee is not fully independent.
The assessment procedure is organised sequentially:

  • If it is difficult to determine the quality of the portfolio, more than one assessor from the assessment committee is involved in the procedure.
  • If mentor, student and/or assessor disagree on the assessment of the performance shown in the portfolio, an additional assessor will be involved.
  • Subsequently, the complete assessment committee discusses the portfolio.
  • If at the start of the procedure mentor, student and assessor agree on the quality of the performance shown in the portfolio, only one member of the assessment committee reads and grades the portfolio: 'insufficient', 'sufficient' or 'with merit'.

Electronic portfolios or portfolios on paper

Experiments are caries out using electronic portfolios instead of portfolios on paper. Students use Microsoft Word as HTML editor to work on their portfolios (compare example). Evaluations show satisfactory results (Seegers, 2003 - in Dutch).
At this moment experiments are caried with the aim to identify adequate tools for distributing the portfolio.

Publications

The experiences with the portfolio are monitored by research projects.

First of all students and mentors were interviewed. The results of these studies were published in Medical Teacher and in Tijdschrift voor Medisch Onderwijs. An article about the effect of the portfolio will be send to Educational Assessment in 2003.

Furthermore the portfolio assessment procedure was object of some studies. These studies resulted in various publications: