Clinical Research Centre, Malmö University Hospital, Sweden.
Med Teach. 2010;32(12):e532-40. doi: 10.3109/0142159X.2010.509420.
Portfolios are highlighted as potential assessment tools for professional competence. Although students' self-reflections are considered to be central in the portfolio, the content of reflections in practice-based portfolios is seldom analysed.
To investigate whether students' reflections include sufficient dimensions of professional competence, notwithstanding a standardized portfolio format, and to evaluate students' satisfaction with the portfolio.
Thirty-five voluntary final-year medical students piloted a standardized portfolio in a general practice (GP) attachment at Lund University, Sweden. Students' portfolio reflections were based upon documentary evidence from practice, and aimed to demonstrate students' learning. The reflections were qualitatively analysed, using a framework approach. Students' evaluations of the portfolio were subjected to quantitative and qualitative analysis.
Among professional issues, an integration of cognitive, affective and practical dimensions in clinical practice was provided by students' reflections. The findings suggested an emphasis on affective issues, particularly on self-awareness of feelings, attitudes and concerns. In addition, ethical problems, clinical reasoning strategies and future communication skills training were subjects of several reflective commentaries. Students' reflections on their consultation skills demonstrated their endeavour to achieve structure in the medical interview by negotiation of an agenda for the consultation, keeping the interview on track, and using internal summarizing. The importance of active listening and exploration of patient's perspective was also emphasized. In students' case summaries, illustrating characteristic attributes of GP, the dominating theme was 'patient-centred care', including the patient-doctor relationship, holistic modelling and longitudinal continuity. Students were satisfied with the portfolio, but improved instructions were needed.
A standardized portfolio in a defined course with a limited timeframe provided ample opportunities for reflections on professional issues. Support by mentors and a final examiner interview contributed to the success of the portfolio with students. The interview also allowed students to deepen their reflections and to receive feedback.
组合被强调为专业能力的潜在评估工具。尽管学生的自我反思被认为是组合的核心，但实践组合中的反思内容很少被分析。
调查在标准化组合格式的情况下，学生的反思是否包含足够的专业能力维度，并评估学生对组合的满意度。
35 名志愿参加的最后一年医学学生在瑞典隆德大学的普通实践（GP）实习中试用了标准化组合。学生的组合反思基于实践中的文件证据，旨在展示学生的学习成果。使用框架方法对反思进行了定性分析。对学生对组合的评估进行了定量和定性分析。
在专业问题方面，学生的反思提供了临床实践中认知、情感和实践维度的综合。研究结果表明，学生更强调情感问题，特别是对自身情感、态度和关注点的自我意识。此外，伦理问题、临床推理策略和未来的沟通技巧培训也是一些反思性评论的主题。学生对咨询技能的反思表明，他们通过协商咨询议程、保持咨询的轨道和使用内部总结，努力实现医学访谈的结构化。积极倾听和探索患者观点的重要性也得到了强调。在学生的案例总结中，说明了 GP 的典型特征，主题是“以患者为中心的护理”，包括医患关系、整体建模和纵向连续性。学生对组合感到满意，但需要改进说明。
在规定的课程和有限的时间内使用标准化组合为专业问题的反思提供了充足的机会。导师和最终考官面试的支持有助于学生成功完成组合。面试还允许学生深化反思并获得反馈。
