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      The use of a portfolio in postgraduate medical education – reflect, assess and account, one for each or all in one? Translated title: Die Verwendung eines Portfolios in der postgraduierten medizinischen Weiterbildung – reflektieren, beurteilen und nachweisen: jedes einzeln oder alles in einem?

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          Abstract

          Competency-based education has become central to the training and assessment of post-graduate medical trainees or residents [ 1]. In competency-based education, there is a strong focus on outcomes and professional performance. Typically, holistic tasks are used to train, practice and assess the defined outcomes or competencies. In residency training, these tasks are part of the day-to-day clinical practice. The performance of residents in the workplace needs to be captured and stored. A portfolio has been used as an instrument for storage and collection of workplace-based assessment and feedback in various countries, like the Netherlands and the United States. The collection of information in a portfolio can serve or be used for a variety of purposes. These are:

          1. The collection of work samples, assessment, feedback and evaluations in a portfolio enables the learner to look back, analyze and reflect.

          2. The content is used for assessment or making decisions about progress. And

          3. the portfolio is used as an instrument for quality assurance processes.

          In post-graduate medical education, these purposes can be combined but this is not always reported transparently. In this paper, we will discuss the different perspectives, how a portfolio can serve these three purposes and what are opportunities and challenges of combining multiple purposes.

          Zusammenfassung

          Die kompetenzbasierte Ausbildung ist zum zentralen Element in der Weiterbildung und Beurteilung von postgraduierten medizinischen Auszubildenden oder Assistenzärzten geworden [ 1]. In kompetenzbasierter Ausbildung gibt es eine klare Fokussierung auf Ergebnisse und professionelle Leistungen. Typischerweise werden holistische Aufgaben verwendet, um definierte Ergebnisse oder Kompetenzen zu üben, zu praktizieren und zu bewerten. Während der Facharztausbildung sind diese Aufgaben Teil des klinischen Alltags. Die Leistung der Assistenzärzte am Arbeitsplatz muss erfasst und dokumentiert werden. Ein Portfolio ist als Instrument für die Speicherung und Sammlung von Beurteilung und Feedback am Arbeitsplatz in verschiedenen Ländern, wie den Niederlanden und den Vereinigten Staaten, verwendet worden. Die Sammlung von Informationen in einem Portfolio kann verschiedenen Zwecken dienen oder für verschiedene Zwecke verwendet werden. Diese sind:

          1. Die Sammlung von Arbeitsproben, Beurteilungen, Feedback und Evaluationen in einem Portfolio ermöglicht dem Lernenden zurückzublicken, zu analysieren und zu reflektieren.

          2. Der Inhalt dient der Bewertung oder den Entscheidungen über den Fortschritt. Und

          3. das Portfolio wird als Instrument für Qualitätssicherungsprozesse verwendet.

          Innerhalb der postgraduierten medizinischen Weiterbildung können diese Zwecke kombiniert werden, aber dies wird nicht immer transparent berichtet. In diesem Artikel werden die verschiedenen Perspektiven erörtert, wie ein Portfolio diese drei Zwecke erfüllen kann und was die Möglichkeiten und Herausforderungen sind, um verschiedene Nutzungen zu kombinieren.

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          Most cited references40

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          Entrustability of professional activities and competency-based training.

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            Facilitated Reflective Performance Feedback: Developing an Evidence- and Theory-Based Model That Builds Relationship, Explores Reactions and Content, and Coaches for Performance Change (R2C2).

            To develop and conduct feasibility testing of an evidence-based and theory-informed model for facilitating performance feedback for physicians so as to enhance their acceptance and use of the feedback.
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              Effects of reflective practice on the accuracy of medical diagnoses.

              Reflective practice has been suggested to be an important instrument in improving clinical judgement and developing medical expertise. Empirical evidence supporting this suggestion, however, is absent. This paper reports on an experiment conducted to study the effects of reflective practice on diagnostic accuracy. Participants were 42 internal medicine residents in hospitals in 2 states in the northeast of Brazil. They diagnosed 16 clinical cases. The experiment employed a repeated measures design, with 2 independent variables: the complexity of clinical cases (simple or complex), and the reasoning approach induced to diagnose the case (participants were instructed to diagnose each case either through pattern recognition or reflective reasoning). The dependent variable was the accuracy of the diagnosis provided for each case. All participants participated in each of the 2 levels of both independent variables. A main effect of case complexity emerged. There was no statistically significant main effect of reflective practice. However, a significant interaction effect was found between case complexity and mode of processing (F[1,41] = 4.48, P < 0.05), indicating that although reflective practice did not make a difference to accuracy of diagnosis in simple cases, it had a positive effect when diagnosing complex cases. Reflective practice had a positive effect on diagnosis of complex, unusual cases. Non-analytical reasoning was shown to be as effective as reflective reasoning for diagnosing routine clinical cases. Findings support the idea that reflective practice may particularly improve diagnoses in situations of uncertainty and uniqueness, reducing diagnostic errors.
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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                15 November 2017
                2017
                : 34
                : 5 , Postgraduate education/Weiterbildung
                : Doc57
                Affiliations
                [1 ]Maastricht University/MUMC, Department of Pathology, HX Maastricht, The Netherlands
                [2 ]Maastricht University, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
                [3 ]Maastricht University/MUMC, Department of Educational Development and Research, HX Maastricht, The Netherlands
                Author notes
                *To whom correspondence should be addressed: Sylvia Heeneman, Maastricht University/MUMC, Department of Pathology, Peter Debyelaan 25, NL-6229 HX Maastricht, The Netherlands, Phone: +31 43 3876629, E-mail: s.heeneman@ 123456maastrichtuniversity.nl
                Article
                zma001134 Doc57 urn:nbn:de:0183-zma0011345
                10.3205/zma001134
                5704619
                29226225
                92f9181e-fccc-4a89-b58a-0c24c36c75d4
                Copyright © 2017 Heeneman et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

                History
                : 08 November 2016
                : 20 March 2017
                : 07 February 2017
                Categories
                Article

                postgraduate education,feedback,portfolio,reflection,quality insurance

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