Tochel Claire, Haig Alex, Hesketh Anne, Cadzow Ann, Beggs Karen, Colthart Iain, Peacock Heather
NHS Education for Scotland, Edinburgh, UK.
Med Teach. 2009 Apr;31(4):299-318. doi: 10.1080/01421590902883056.
Portfolios in post-graduate healthcare education are used to support reflective practice, deliver summative assessment, aid knowledge management processes and are seen as a key connection between learning at organisational and individual levels. This systematic review draws together the evidence on the effectiveness of portfolios across postgraduate healthcare and examines the implications of portfolios migrating from paper to an electronic medium across all professional settings.
A literature search was conducted for articles describing the use of a portfolio for learning in a work or professional study environment. It was designed for high sensitivity and conducted across a wide range of published and unpublished sources relevant to professional education. No limits for study design or outcomes, country of origin or language were set. Blinded, paired quality rating was carried out, and detailed appraisal of and data extraction from included articles was managed using an online tool developed specifically for the review. Findings were discussed in-depth by the team, to identify and group pertinent themes when answering the research questions.
Fifty six articles from 10 countries involving seven healthcare professions met our inclusion criteria and minimum quality threshold; mostly uncontrolled observational studies. Portfolios encouraged reflection in some groups, and facilitated engagement with learning. There was limited evidence of the influence of a number of factors on portfolio use, including ongoing support from mentors or peers, implementation method, user attitude and level of initial training. Confounding variables underlying these issues, however have not been fully investigated. A number of authors explored the reliability and validity of portfolios for summative assessment but reports of accuracy across the disparate evidence base varied. Links to competency and Quality Assurance frameworks have been demonstrated. There were conflicting reports about whether the different purposes of portfolios can be combined without compromising the meaningfulness of the contents. There was good evidence that the flexibility of the electronic format brought additional benefits to users, assessors and organisations, and encouraged more enthusiastic use. Security of data remained a high priority issue at all levels, and there was emerging evidence of successful transfer between electronic portfolio systems.
The evidence base is extensive, but contains few high quality studies with generalisable messages about the effectiveness of portfolios. There is, however, good evidence that if well implemented, portfolios are effective and practical in a number of ways including increasing personal responsibility for learning and supporting professional development. Electronic versions are better at encouraging reflection and users voluntarily spend longer on them. Regular feedback from a mentor enhances this success, despite competing demands on users' time and occasional scepticism about the purpose of a portfolio. Reports of inter-rater reliability for summative assessments of portfolio data are varied and there is benefit to be gained from triangulating with other assessment methods. There was insufficient evidence to draw conclusions on how portfolios work in interdisciplinary settings.
研究生医疗保健教育中的档案袋用于支持反思性实践、进行总结性评估、辅助知识管理流程，并且被视为组织层面和个人层面学习之间的关键联系。本系统评价汇总了关于研究生医疗保健领域档案袋有效性的证据，并探讨了在所有专业环境中档案袋从纸质形式转换为电子形式的影响。
对描述在工作或专业学习环境中使用档案袋进行学习的文章进行文献检索。检索旨在实现高敏感性，并涵盖与专业教育相关的广泛已发表和未发表的来源。未对研究设计、结果、原产国或语言设置限制。进行了盲法配对质量评级，并使用专门为该评价开发的在线工具对纳入文章进行详细评估和数据提取。团队深入讨论了研究结果，以便在回答研究问题时识别和归纳相关主题。
来自10个国家、涉及七个医疗保健专业的56篇文章符合我们的纳入标准和最低质量阈值；大多数为非对照观察性研究。档案袋在一些群体中鼓励反思，并促进参与学习。关于若干因素对档案袋使用的影响，证据有限，这些因素包括来自导师或同伴的持续支持、实施方法、用户态度和初始培训水平。然而，这些问题背后的混杂变量尚未得到充分研究。一些作者探讨了档案袋用于总结性评估的可靠性和有效性，但不同证据基础上的准确性报告各不相同。已证明与能力和质量保证框架存在联系。关于档案袋的不同目的能否在不损害内容意义的情况下合并，存在相互矛盾的报告。有充分证据表明，电子格式的灵活性给用户、评估者和组织带来了额外好处，并鼓励更积极地使用。数据安全在各级仍然是一个高度优先的问题，并且有新证据表明电子档案袋系统之间成功进行了转换。
证据基础广泛，但高质量研究较少，关于档案袋有效性的可推广信息不多。然而，有充分证据表明，如果实施得当，档案袋在许多方面都是有效且实用的，包括增强个人对学习的责任感和支持专业发展。电子版更能鼓励反思，用户会自愿在上面花费更多时间。尽管用户时间紧张且偶尔对档案袋的目的持怀疑态度，但来自导师的定期反馈会增强这种效果。关于档案袋数据总结性评估的评分者间可靠性报告各不相同，与其他评估方法进行三角测量会有好处。没有足够的证据就档案袋在跨学科环境中的作用得出结论。
