Postgraduate Medicine Research Articles

Survey of student perception of medical education environment among emergency medicine residents of an academic medical centre in Northern India.

BackgroundThe specialty of emergency medicine is in its infancy state in the long history of the Indian health sciences education system. Little analytical published data is available at the moment in India regarding the quality of medical education as perceived by the students.Roff et al. (Med Teach 19: 295–299, 1997) developed a methodology using a Delphi panel to standardize the measurement of medical education known as the Dundee Ready Education Environment Measure (DREEM), which is widely utilized.The purpose of this survey is to investigate student perceptions of medical education environment among emergency medicine residents of an academic medical centre in Northern India using the DREEM tool.MethodsThe DREEM questionnaire was administered to the students undergoing 3-year post-graduate emergency medicine training in our residency programme. A total of 35 students enrolled from all 3 years of the residency programme completed the survey in May 2013. The results were analysed using STATA 9.0.ResultsThe reliability coefficient which was calculated using Cronbach’s alpha for the totality of items of this study was 0.92, which indicates high internal consistency.The mean (95 % CI) for the overall DREEM was 139.8 (133.3, 146.2), which showed excellent educational environment among the medical students.ConclusionsThe DREEM score is a universal tool for assessment of education provided by health science institutes. With a total score of 139.8, the study conducted at our institute showed comparable results to the original DREEM study conducted by Roff et al. The good scores in all the five subscales reveal an excellent educational programme and learning environment as perceived by the students enrolled at our institution.

Improving the Quality of Postgraduate Education in Traditional Japanese Kampo Medicine for Junior Residents: An Exploratory Survey Conducted in Five Institutions in the Tohoku Area.

Traditional Japanese (Kampo) medicine has been widely applied in general medicine in Japan. In 2001, the model core curriculum for Japanese medical education was revised to include Kampo medicine. Since 2007, all 80 Japanese medical schools have incorporated it within their programs. However, postgraduate training or instruction of Kampo medicine has not been recognized as a goal for the clinical training of junior residents by Japan's Ministry of Health, Labour and Welfare; little is known about postgraduate Kampo medicine education. This exploratory study investigated attitudes about Kampo medicine among junior residents in Japanese postgraduate training programs. A questionnaire survey was administered to junior residents at five institutions in the Tohoku area of Japan. Questions evaluated residents' experiences of prescribing Kampo medicines and their expectations for postgraduate Kampo education and training. As a result, 121 residents responded (response rate = 74%). About 96% of participants had previously received Kampo medicine education at their pre-graduate medical schools and 64% had prescribed Kampo medications. Specifically, daikenchuto was prescribed to prevent ileus and constipation after abdominal surgery and yokukansan was prescribed to treat delirium in the elderly. Residents received on-the-job instruction by attending doctors. Over 70% of participants indicated that there was a need for postgraduate Kampo medicine education opportunities and expected lectures and instruction on how to use it to treat common diseases. In conclusion, we have revealed that junior residents require Kampo medicine education in Japanese postgraduate training programs. The programs for comprehensive pre-graduate and postgraduate Kampo education are expected.

The need for family medicine

WONCA – the World Organization of Family Doctors – is committed to universal health coverage (UHC) through a family medicine approach. Training our young students and doctors is vital to ensure that future family doctors have the skills and expertise to deliver this care. WONCA fully subscribes to the eight key competencies, for which WHO has identified the critical aspects the family doctors ought to be educated in, in order to be able to provide high-quality primary care, and further has devised global standards for all postgraduate family medicine education programmes, which can assist those who want to develop or improve their FM training programme developed.

The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink.

RAKESH AGGARWAL1, NITHYA GOGTAY2, RAJEEV KUMAR3 AND PEUSH SAHNI4, FOR THE INDIAN ASSOCIATION OF MEDICAL JOURNAL EDITORS* 1Former Editor, Indian Journal of Gastroenterology; 2Editor, Journal of Postgraduate Medicine; 3Editor, Indian Journal of Urology; and 4Editor, The National Medical Journal of India. Correspondence to: Peush Sahni, President, Indian Association of Medical Journal Editors, The National Medical Journal of India, All India Institute of Medical Sciences, New Delhi 110 029, India. india.editors@gmail.com

Developing and successfully implementing a competency-based portfolio assessment system in a postgraduate family medicine residency program.

The use of portfolios in postgraduate medical residency education to support competency development is increasing; however, the processes by which these assessment systems are designed, implemented, and maintained are emergent. The authors describe the needs assessment, development, implementation, and continuing quality improvement processes that have shaped the Portfolio Assessment Support System (PASS) used by the postgraduate family medicine program at Queen's University since 2009. Their description includes the impetus for change and contextual realities that guided the effort, plus the processes used for selecting assessment components and developing strategic supports. The authors discuss the identification of impact measures at the individual, programmatic, and institutional levels and the ways the department uses these to monitor how PASS supports competency development, scaffolds residents' self-regulated learning skills, and promotes professional identity formation. They describe the "academic advisor" role and provide an appendix covering the portfolio elements. Reflection elements include learning plans, clinical question logs, confidence surveys, and reflections about continuity of care and significant incidents. Learning module elements cover the required, online bioethics, global health, and consult-request modules. Assessment elements cover each resident's research project, clinical audits, presentations, objective structured clinical exam and simulated office oral exam results, field notes, entrustable professional activities, multisource feedback, and in-training evaluation reports. Document elements are the resident's continuing medical education activities including procedures log, attendance log, and patient demographic summaries.The authors wish to support others who are engaged in the systematic portfolio-design process or who may adapt aspects of PASS for their local programs.

Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine.

The script concordance test is a relatively new format of written assessment that is used to assess higher-order clinical reasoning and data interpretation skills in medicine. Candidates are presented with a clinical scenario, followed by the reveal of a new piece of information. The candidates are then asked to assess whether this additional information increases or decreases the probability or likelihood of a particular diagnostic, investigative, or management decision. To score these questions, the candidate's decision in each question is compared with that of a reference panel of expert clinicians. This review focuses on the development of quality script concordance questions, using expert panellists to score the items and set the passing score standard, and the challenges in the practical implementation (including pitfalls to avoid) of the written assessment.

Rwandan family medicine residents expanding their training into South Africa: the use of South-South medical electives in enhancing learning experiences.

BackgroundInternational medical electives are well-accepted in medical education, with the flow of students generally being North–South. In this article we explore the learning outcomes of Rwandan family medicine residents who completed their final year elective in South Africa. We compare the learning outcomes of this South-South elective to those of North–South electives from the literature.MethodsIn-depth interviews were conducted with Rwandan postgraduate family medicine residents who completed a 4-week elective in South Africa during their final year of training. The interviews were thematically analysed in an inductive way.ResultsThe residents reported important learning outcomes in four overarching domains namely: medical, organisational, educational, and personal.ConclusionsThe learning outcomes of the residents in this South-South elective had substantial similarities to findings in literature on learning outcomes of students from the North undertaking electives in the Southern hemisphere.Electives are a useful learning tool, both for Northern students, and students from universities in the South. A reciprocity-framework is needed to increase mutual benefits for Southern universities when students from the North come for electives. We suggest further research on the possibility of supporting South-South electives by Northern colleagues.

Perceptions of faculty in health care and social sciences on teaching international students

BackgroundIncreased cultural diversity of higher education (HE) students has created both learning opportunities and teaching challenges for vocational health care programs. An internationalized curriculum reflects sociocultural issues in professional practice and enhances intercultural competency amongst students. However, the literature is limited in seeking the key perspective of those delivering the curriculum. This study explores the awareness of health care teaching staff on issues related to internationalization, perceived responsibility in supporting international students, and teaching practices toward an inclusive curriculum. MethodsAn anonymous questionnaire was developed, consisting of different types of questions (Y/N, Likert scale, and multiple choice) with opportunities for free text on each main theme. The questionnaire was sent to all 205 staff members with a teaching remit at Cardiff University Schools of Postgraduate Medicine, Healthcare Sciences, Pharmacy, and Social Sciences. Key findingsIn all, 102 responses were received. Despite 70% of respondents feeling that the responsibility for an improved learning experience for international students lies beyond them—with the University, their School, or students themselves—inclusive teaching practices that consider cultural diversity are widely reported. Some individuals feel unprepared to teach international students, citing a lack of cultural knowledge and training. The proportion of international students is perceived as the most important aspect of internationalization. Other key components of national and institutional HE strategies, such as “internationalization abroad”, appear to be relatively unimportant. Findings from this study provide a basis for all higher education institutions educating health and social care professionals to reflect critically on the realities of engaging with the internationalization of vocational programs.

Personal Continuity of Care in a University-Based Primary Care Practice: Impact on Blood Pressure Control.

Continuity of care is an important quality outcome of patient care. This study aimed to investigate the relationship between personal continuity and blood pressure (BP) control among the patients with hypertension in an academic primary care centre. Between January and May 2012, we conducted a retrospective review of medical records of patients with hypertension who had been followed up for at least 1 year in the Primary Care Clinic, University of Malaya Medical Centre, Malaysia. In this setting, doctors who provided care for hypertension included postgraduate family medicine trainees, non-trainee doctors and academic staff. Systematic random sampling (1:4) was used for patient selection. BP control was defined as less than 130/80 mm Hg for patients with diabetes mellitus, proteinuria and chronic kidney disease and less than 140/90 mm Hg for all other patients. Continuity of care was assessed using the usual provider continuity index (UPCI), which is the ratio of patient visits to the usual provider to the total number of visits to all providers in 1 year. A UPC index of zero denotes no continuity while an index of one reflects perfect continuity with only the usual provider. We reviewed a total of 1060 medical records. The patients’ mean age was 62.0 years (SD 10.4). The majority was women (59.2%) and married (85.7%). The mean number of visits in a year was 3.85 (SD 1.36). A total of 72 doctors had provided consultations (55 postgraduate family medicine trainees, 8 non-trainee doctors and 9 academic staff). The mean UPCI was 0.43 (SD 0.34). Target BP was achieved in 42% of the patients. There was no significant relationship between BP control and personal continuity after adjustment for total number of visits. Continuity of care was not associated with BP control in our centre. Further studies are needed to explore the reasons for this.

Cultivating a Thinking Surgeon: New Perspectives on Clinical Teaching, Learning and Assessment

I like the title of this book. It presupposes that we already have a thinking surgeon, a fact that is often forgotten in this age of modernising medical careers and educational theory. The book is by two authors, one of whom is a practising surgeon and associate postgraduate dean, the other an educationalist with a background in teaching who presently holds a Chair of Education in Postgraduate Medicine. The book is designed for both teachers and learners in surgical practice. It seeks to provide challenging new perspectives that seriously question much that the current climate of education provides, by showing examples of arguments, ideas, processes and language in which to think and talk about education rationally and logically. It is divided into two sections: the first dealing with the educational foundation for cultivating a thinking surgeon, the second a more practical section on teaching, learning and assessing in surgical settings. I found it very heavy reading. Much of it is written in educational jargon. The premise is that surgical teaching will have to change in the new circumstances of the 21st century. The authors state that in the past the clinical setting was viewed as the arena in which surgeons could demonstrate clinical cases and instruct the learner in clinical and operative procedures. They feel that this approach is not commensurate with the current pressures on ways of working and that new methods and approaches to education will be required. New models of education are presented in the first section and the chapter on ‘Reflection’ is very revealing educationally. The chapter includes statements such as ‘having an experience is not the same as understanding its meaning’ and that Habermas' work on reflection ‘drives towards the ideals of empowerment and emancipation…reflection is about critique, evaluation and liberation’. I was also intrigued to learn that suitable starting points for reflection included writing a letter to a friend and experimenting with a variety of forms, e.g. prose, poetry and drama. I was sorry to see that it did not involve phoning a friend! Perhaps there is a tendency to accept that the traditional form of training provided well-trained but poorly educated surgeons. By the end of this book, I had the distinct impression that by following its recommendations we would end up with a well-educated and educationally eloquent surgeon who was poorly trained. Somewhere among all the educational jargon is a very good book with some practical common sense. As a surgeon, I found the second section of the book much better than the first, which gave one the feel of a tree-hugging medical educationalist, with designer stubble, a suede waistcoat, cords and sandals conducting holistic teaching rather than a professional surgeon. When I read the book, there was a certain sense of deja vu. I realised that for the past 20 years I'd actually been teaching and educating in the way outlined in this book but had not appreciated the terminology applied to my teaching methodology. I realise now that, over those years, my trainees have reflected, conceptualised, become emancipated, developed propositional, procedural and metacognitive knowledge over the post-ward round cup of tea. This has probably been common to many surgical firms and explains why there have been such excellent and thinking surgeons produced in this country in the past. To whom would I recommend the book? Certainly to candidates studying for a degree in medical education who will find it invaluable. It is well referenced, beautifully produced and extremely up-to-date. I would also recommend that all practising surgeons read it and form their own opinion on changes in medical education.

Queen’s Simulation Assessment Tool

The use of high-fidelity simulation is emerging as an effective approach to competency-based assessment in medical education. We aimed to develop and validate a modifiable anchored global assessment scoring tool for simulation-based Objective Structured Clinical Examinations (OSCEs) of resuscitation competence in postgraduate emergency medicine (EM) trainees. The Queen's Simulation Assessment Tool was developed using a modified Delphi technique with a panel of EM physicians. Ten standardized resuscitation OSCE scenarios were administered to EM trainees, and their video-recorded performances were scored by 3 independent and blinded EM attending physicians using the Queen's Simulation Assessment Tool. Correlational analyses and analysis of variance were applied to measure the discriminatory capabilities and interrater reliability of each scenario. A fully crossed generalizability study was conducted for each examination. Emergency medicine postgraduate trainees at Queen's University (n = 19-25 per station) participated in the study over 3 years. Interrater reliability showed acceptable levels of agreement for each scenario (mean Spearman ρ = 0.75 [0.63-0.87]; mean interclass correlation coefficient, 0.69 [0.58-0.87]). Discriminatory validity was strong, with senior residents outperforming junior residents in all but 1 of the 10 scenarios. Generalizability studies found the trainee and trainee by scenario interactions as the largest contributors to variance, with G coefficients ranging from 0.67 to 0.84. Resident trainees reported comfort being assessed in the simulation environment (3.8/5) and found the simulation-based examination valuable to their learning (4.6/5). This study describes the development and validation of a novel modifiable anchored global assessment scoring tool for simulation-based OSCE assessment of resuscitation competence in postgraduate EM trainees.

Achieving competency in wound care: an innovative training module using the long-term care setting.

Structured academic teaching on wound care was developed, based on the long-term care (LTC) setting, with the goal of ensuring that postgraduate family medicine residents attain competency in assessment and treatment of wounds and pressure ulcers (PUs). The curriculum for the 1-month learning module was based on clinical practice guidelines for the prevention, assessment, and treatment of PUs and wounds. The learning techniques used include a learners' needs assessment, a small-group didactic session, interdisciplinary bedside case discussions and a toolkit. The curriculum is delivered in four weekly, 90-minute interdisciplinary teaching sessions during the mandatory 1-month geriatrics rotation for postgraduate family medicine trainees. Competency is evaluated by the end of the module by reviewing trainees' documentation of a thorough objective clinical wound assessment, diagnosis of underlying cause, significant contributing risk factors and proposed treatment plan. This approach can be used to train family medicine, hospitalist, and geriatric residents in other acute or LTC teaching facilities where there is a prevalence of PUs.

Factors associated to the career choice of family medicine among Japanese physicians: the dawn of a new era.

BackgroundDespite recent developments in post-graduate family medicine training in Japan, the numbers of junior doctors entering family medicine residencies are still limited. The objective of this qualitative study was to investigate the possible factors associated to the career choice of family medicine, especially in the context of the newly established family medicine programs in Japan.MethodsFrom December 2010 to January 2011, we distributed a semi-structured questionnaire about career choice to 58 physician members of the Japan Primary Care Association, and 41 of them responded. Four researchers used the Modified Grounded Theory Approach (Kinoshita, 2003) for three-stage conceptualization.ResultsWe extracted a conceptual model of the choice of newly established family medicine as a career in Japan, consisting of six categories and 77 subordinate concepts from 330 variations. The subcategories of personal background affecting the family-medicine career choice were characteristics (“self-reliance,” “pioneering spirit”), career direction (“community/rural-orientedness,” “multifaceted orientation”) and experience (e.g., “discomfort with fragmented care”). We divided the influencing factors that were identified for career choice into supporters (e.g., “role model”), conflict of career choice (e.g., “anxiety about diverse/broad practice”), and the dawn of a new era in family medicine in Japan (e.g., “lack of social recognition,” “concern about livelihood,” and “too few role models”).ConclusionsAlthough the dawn of a new era seemed a rather negative influencer, it was unique to our study that the dawn itself could attract those with a “pioneering spirit” and an “attitude of self-training.” Unlike previous studies, the positive factors such as lifestyle and the short residency program were not shown to be part of family medicine's attractiveness. In contrast, “concern about livelihood” was specific among our respondents and was related to career choice in the dawn period. “Community-orientedness” and “multifaceted orientation” (which have aspects in common with previous studies' findings) would appear to be universal regardless of cultural and medical system differences. In our study, these universal factors were also found to be part of the attractiveness of family medicine from the practitioners' viewpoints, and these factors may become great influencers for family medicine candidates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12930-014-0011-2) contains supplementary material, which is available to authorized users.

UK postgraduate medicine examinations: opportunities for international candidates

The medical profession is global, and ambitious trainee physicians around the world are eager to attain internationally recognised postgraduate medical qualifications. The MRCP(UK) and specialty certificate examinations of the Federation of Royal Colleges of Physicians of the United Kingdom provide such qualifications, and between 2002 and 2013, the number of international candidates attempting these examinations grew substantially. Delivering these proven and reliable UK-based examinations in other countries has many local benefits: it enhances careers, strengthens medical training and improves standards of patient care. In collaboration with international colleagues, the Federation is committed to continued growth that extends these benefits to all physicians, wherever they work and live.

Derivaciones en los centros de salud de Andalucía según el sexo de profesionales y pacientes: un análisis de género

It has been identified differences of medical care practice in primary care related to physician's sex. Simultaneously, there are gender inequalities in the assignment of health resources. Both aspects give rise to an increasing growing interest in the management and provision of health services. To examine the differences in the referral practice made by female and male primary care physicians working in health centers in Andalusia, to consider whether there are disparities in referrals received by men and women, and to examine the interaction between patient's sex and physician's sex. Observational, cross-sectional, and multicenter study. 4 health districts in Andalucía and their physicians. 382 physicians. referral rate per visit (RV), referral rate per patient quota (RQ), patient's sex, physician: sex, age, postgraduate family medicine specialty, size of the patient quota by sex, mean number of patients/day by sex, mean age of the patient quota by sex, and proportion of men in the quota. Health center: urban / rural, size of the team, enrolled population, and postgraduate family medicine specialty's accreditation. databases of health districts. 2010. Bivariate and multivariate multilevel analysis of the referral rate per visit with mixed Poisson model. In 2010 382 physicians made 129,161 referrals to specialized care. The RQ was 23.47 and the RV was 4.92. The RQ in women and men was 27.23 and 19.78 for women physicians, being 27.37 and 19.51 for male physicians. The RV in women and men was 4.92 and 5.48 for women physicians, being 4.54 and 4.93 for male physicians. There are no differences in referral according to physician's sex. However, there are signs that might indicate the existence of gender inequality, and women patient received less referrals. There are no physician-patient's sex interaction.

Importance of international networking in academic family medicine.

European family medicine/general practice (FM/GP) has travelled the long and successful journey of profiling the discipline and has produced valuable position papers on education and research. Nowadays, academic medicine is one of the pillars in the future development of FM/GP in Europe. A common European curriculum on undergraduate and postgraduate family medicine is needed. Also, a sound international platform of teaching institutions and/or teachers of family medicine would foster the further development of family medicine as an academic discipline. This would stimulate students and teachers to engage in international exchange to gain new knowledge and experiences, present their work and ideas abroad and prepare the conditions for further exchange of students and teachers. Established departments of FM/GP, led by a teacher who is a family physician/general practitioner, at each Medical School in Europe should provide students with knowledge and skills related to the core attributes of FM/GP. International exchanges of teachers and students should foster the development of a common curriculum on FM in Europe and foster improvement in the quality of FM education.

Triggers for reflection: exploring the act of written reflection and the hidden art of reflective practice in postgraduate medicine

This study explored in depth the factors that trigger Specialist Trainees’ reflection and why documented evidence may not always encapsulate their practice. Specialist Trainees in the UK are required to record reflections on their clinical experiences and evidence of their professional development in an e-portfolio. Fifteen qualitative semi-structured interviews were undertaken. Semi-structured interviews were conducted with first year general medical Specialist Trainees in one Deanery in the North of England. Thematic framework analysis of the qualitative interviews generated categories. Four categories emerged from the qualitative data analysis: help/hindering forces; strategic and superficial entries; triggers for reflection; and the role of others, including Educational Supervisors. This study identified clear triggers for reflection but the art of writing it down often seems superficial, sometimes hurried, sometimes selective and often strategic. There is some evidence from this series of semi-structured interviews to suggest that reflective entries are limited by time constraints and also privacy concerns regarding the reliability of security systems within the e-portfolio. Findings suggest that the e-portfolio, in its current form, may not be the most appropriate way of encouraging written accounts of reflective practice.

Can We Share Multiple Choice Questions across Borders? Validation of the Dutch Knowledge Assessment in Family Medicine in Flanders

Background. One of the methods to test knowledge of Family Medicine trainees is a written exam composed of multiple choice questions. Creating high-quality multiple choice questions requires a lot of experience, knowledge, and time. This study explores the opportunity to run the Dutch knowledge assessment in Flanders as well, the use of this test for formative purposes. Methods. The study test was performed in a Flemish sample of postgraduate Family Medicine (FM) trainees and FM trainers. The Dutch test, adjusted to the Flemish context, was analyzed according to the classical test theory: difficulty factor and discriminating power of the items and reliability of the test. Results. 82 of the 154 items well divided the group into two equal parts of correct and incorrect responders. The distribution of the discrimination index, of the items with an acceptable difficulty factor, was [−0.012–0.530]. The item-test-correlation shows that 52 items do not fit, and 87 items need revision in varying degrees. The test reliability was 0.917. Conclusion. The test was highly reliable, but many MC questions appeared to be too easy and poorly discriminative. Therefore, we question the test validity and recommend reconsideration of the items based on difficulty before it is applied and used as a mandatory formative test.

Reliability testing of a portfolio assessment tool for postgraduate family medicine training in South Africa

BackgroundCompetency-based education and the validity and reliability of workplace-based assessment of postgraduate trainees have received increasing attention worldwide. Family medicine was recognised as a speciality in South Africa six years ago and a satisfactory portfolio of learning is a prerequisite to sit the national exit exam. A massive scaling up of the number of family physicians is needed in order to meet the health needs of the country.AimThe aim of this study was to develop a reliable, robust and feasible portfolio assessment tool (PAT) for South Africa.MethodsSix raters each rated nine portfolios from the Stellenbosch University programme, using the PAT, to test for inter-rater reliability. This rating was repeated three months later to determine test–retest reliability. Following initial analysis and feedback the PAT was modified and the inter-rater reliability again assessed on nine new portfolios. An acceptable intra-class correlation was considered to be > 0.80.ResultsThe total score was found to be reliable, with a coefficient of 0.92. For test–retest reliability, the difference in mean total score was 1.7%, which was not statistically significant. Amongst the subsections, only assessment of the educational meetings and the logbook showed reliability coefficients > 0.80.ConclusionThis was the first attempt to develop a reliable, robust and feasible national portfolio assessment tool to assess postgraduate family medicine training in the South African context. The tool was reliable for the total score, but the low reliability of several sections in the PAT helped us to develop 12 recommendations regarding the use of the portfolio, the design of the PAT and the training of raters.

The national portfolio of learning for postgraduate family medicine training in South Africa: experiences of registrars and supervisors in clinical practice

BackgroundIn South Africa the submission of a portfolio of learning has become a national requirement for assessment of family medicine training. A national portfolio has been developed, validated and implemented. The aim of this study was to explore registrars’ and supervisors’ experience regarding the portfolio’s educational impact, acceptability, and perceived usefulness for assessment of competence.MethodsSemi-structured interviews were conducted with 17 purposively selected registrars and supervisors from all eight South African training programmes.ResultsThe portfolio primarily had an educational impact through making explicit the expectations of registrars and supervisors in the workplace. This impact was tempered by a lack of engagement in the process by registrars and supervisors who also lacked essential skills in reflection, feedback and assessment. The acceptability of the portfolio was limited by service delivery demands, incongruence between the clinical context and educational requirements, design of the logbook and easy availability of the associated tools. The use of the portfolio for formative assessment was strongly supported and appreciated, but was not always happening and in some cases registrars had even organised peer assessment. Respondents were unclear as to how the portfolio would be used for summative assessment.ConclusionsThe learning portfolio had a significant educational impact in shaping work-place based supervision and training and providing formative assessment. Its acceptability and usefulness as a learning tool should increase over time as supervisors and registrars become more competent in its use. There is a need to clarify how it will be used in summative assessment.