Abstract
BackgroundSince 2007 a portfolio of learning has become a requirement for assessment of postgraduate family medicine training by the Colleges of Medicine of South Africa. A uniform portfolio of learning has been developed and content validity established among the eight postgraduate programmes. The aim of this study was to investigate the portfolio’s acceptability, educational impact, and perceived usefulness for assessment of competence.MethodsTwo structured questionnaires of 35 closed and open-ended questions were delivered to 53 family physician supervisors and 48 registrars who had used the portfolio. Categorical and nominal/ordinal data were analysed using simple descriptive statistics. The open-ended questions were analysed with ATLAS.ti software.ResultsHalf of registrars did not find the portfolio clear, practical or feasible. Workshops on portfolio use, learning, and supervision were supported, and brief dedicated time daily for reflection and writing. Most supervisors felt the portfolio reflected an accurate picture of learning, but just over half of registrars agreed. While the portfolio helped with reflection on learning, participants were less convinced about how it helped them plan further learning. Supervisors graded most rotations, suggesting understanding the summative aspect, while only 61% of registrars reflected on rotations, suggesting the formative aspects are not yet optimally utilised. Poor feedback, the need for protected academic time, and pressure of service delivery impacting negatively on learning.ConclusionThis first introduction of a national portfolio for postgraduate training in family medicine in South Africa faces challenges similar to those in other countries. Acceptability of the portfolio relates to a clear purpose and guide, flexible format with tools available in the workplace, and appreciating the changing educational environment from university-based to national assessments. The role of the supervisor in direct observations of the registrar and dedicated educational meetings, giving feedback and support, cannot be overemphasized.
Highlights
Since 2007 a portfolio of learning has become a requirement for assessment of postgraduate family medicine training by the Colleges of Medicine of South Africa
How practical and acceptable is the portfolio? Most supervisors felt that the portfolio was practical and feasible to complete, while only half of the registrars agreed with this (Table 1)
Recommendations Moving towards service-based learning and workplacebased assessment relating to the outcomes for family medicine training in South Africa [43,63], this study provides some evidence that the portfolio can work, provided some conditions are met, : 1. Having a clear purpose and guideline for the portfolio
Summary
Since 2007 a portfolio of learning has become a requirement for assessment of postgraduate family medicine training by the Colleges of Medicine of South Africa. The aim of this study was to investigate the portfolio’s acceptability, educational impact, and perceived usefulness for assessment of competence. Worldwide educational thinking and assessment of health professionals have moved towards a focus on competence in real world situations [1,2,3,4]. Public accountability has created a focus on outcomes, with an emphasis on abilities of the professional, de-emphasizing time-based training and promoting greater learner-centeredness [5]. This has been very inadequate, with first year trainees in internal medicine not being observed more than once by a faculty member in a patient encounter involving history taking and a physical examination [11]. Other studies have shown that physicians fail to elicit over half of patient complaints and that many of the public’s complaints about physicians relate to communication problems [13]
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