Making portfolios work in practice

BACKGROUND: A portfolio captures learning from experience, enables an assessor to measure student learning, acts as a tool for reflective thinking, illustrates critical analytical skills and evidence of self-directed learning and provides a collection of detailed evidence of a person's competence. AIMS: This paper reports data on how assessors and nursing students match learning outcomes and/or competencies to their practice and then reconstruct those experiences into the format required by the portfolio documentation. The data were gathered as part of a larger study to evaluate the use of portfolios in the assessment of learning and competence in England. METHODS: This three phase stakeholder evaluation was designed to gain the views of those involved in designing, implementing and using portfolios in nurse education. In phase 2, 122 students and 58 nurse teachers were interviewed about their perceptions of portfolio use, and a further 32 students and 26 assessors were interviewed after they had been observed taking part in an assessment process. Thematic data analysis was used. FINDINGS: Assessors and students underwent a complex process of deconstructing learning outcomes/competences to fit these to their practice. These then had to be reconstructed through the written medium to fit the structure of the portfolio. Confirmation that this met teachers' expectations was essential to allay feelings of insecurity. CONCLUSIONS: To achieve maximum benefit from the portfolio as a learning tool to link theory and practice, there needs to be a clear fit between the model of portfolio and the professional practice that is to be assessed. Outcomes and competences, as well as the type of evidence required to demonstrate their achievement, and integration of the whole experience should match the students' stage of professional and academic development. Over-complex approaches to practice assessment, particularly in the early stages of students' careers, can detract from clinical learning in favour of learning how to complete the portfolio successfully.     

Using portfolios for clinical practice learning and assessment: the pre-registration nursing student's perspective

Portfolios have been introduced to help to integrate theory and practice and thereby address the issue of the theory-practice divide. Although there has been much theoretical discussion about portfolio use in clinical placements, few studies have focused on the students' perceptions regarding their use. To obtain adult branch pre-registration nursing students' perspectives on using portfolios for their clinical practice learning and assessment, postal questionnaires were sent to 253 diploma of nursing students with a reminder to all students three weeks later. The response rate was 69% (174/253). This paper reports on the qualitative findings of the study, which employed both quantitative and qualitative methods. Although students stated that portfolios helped them in their development of self-awareness and independent learning, they indicated that portfolios do not sufficiently address the assessment of their clinical skills and the integration of theory and practice. They considered that portfolios could be greatly improved in three areas, namely in the conflict between using portfolios for both assessment and learning, the amount of support and guidance students feel they receive with their portfolio use and the portfolio design.     

Students' perceptions on the use of portfolios in pre-registration nursing education: a questionnaire survey

BACKGROUND: Portfolios encourage both personal and professional development through the process of reflective practice and critical analysis. In clinical placements portfolios are used both as a learning tool and as an assessment tool. OBJECTIVES: To determine nursing students' perceptions on the use and effectiveness of portfolios in their education as well as their perceptions on the use of the portfolio as both an assessment and learning tool in clinical placement. DESIGN: Postal questionnaire survey. SETTINGS: Higher Education Institute in the UK. PARTICIPANTS: 90 first and 84 third year pre-registration diploma of nursing students. METHODS: Postal questionnaires were sent to 131 first year and 122 third year students, with a reminder 3 weeks later. The total response rate was 69% (174/253), with a response rate of 69% (90/131) for first year students and a response rate of 69% (84/122) for third year students. RESULTS: Students felt that portfolios were very time-consuming, causing them a great deal of anxiety, and were not very effective in developing and assessing their learning and competence. Using portfolios for both assessment and learning creates a conflict. Any assessment reduces the honesty and learning value of reflective writing and of the portfolio. Additionally, students become increasingly demoralized with portfolio use over time with experience. The study suggested three main linked reasons for this, namely the conflict between using portfolios for both assessment and learning, the design of the portfolio and the amount of support and guidance students feel they receive with their portfolio use. CONCLUSIONS: Portfolios can be very effective as an assessment and learning tool, but it is essential that both students and mentors receive clear guidelines on and comprehensive support with their use. They should be designed in such as way that they are relevant, clear and user-friendly for both students and mentors.     

Portfolio assessment: practice teachers' early experience

Experience was recognised to be a vital source of learning as long ago as 1762 [Emile, Everyman, London, 1993] and reflection on practice experience may be one way forward in addressing nursing's anxieties concerning the practice theory gap. However, despite the acceptance that subjectivity in the process seems inevitable and potentially important, little is understood of the practitioner's experience of practice assessment. Two questionnaires sought the views of specialist community nursing practitioner (SCNP) programme (United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) 2001) practice teachers (PTs) on the introduction of the portfolio approach to practice assessment. These were distributed to 62 and 76 PTs and the response rates were 32% and 50%, respectively. Responses of those PTs from the three specialisms participating in the piloting of the portfolio approach were compared with those using an existing approach. An action research method was adopted which attempted to use established theory to explain the challenges presented by the introduction of this approach and ultimately to raise the PT group's awareness of assessment issues. Both qualitative and quantitative data were collected and the findings support the use of the portfolio approach to practice assessment. The PT experience of portfolio use was found to be a largely positive one. PTs reported the utility of the portfolio in prompting student self-evaluation of learning. Concerns were expressed by PTs around the quality of portfolio evidence although many felt that it had promoted students' reflection on practice. Inter-PT reliability in practice assessment was identified as a topic for PT continuing professional development. Many sources of evidence, including patient feedback, were used by PTs in their assessment of students although PTs using the portfolio approach used less first-hand experience of students' practice in their assessments of competence, relying more on written evidence, than those PTs using a traditional approach to practice assessment.     

A framework for portfolio development in postgraduate nursing practice

Aims and objectives. The aim of this study is to explore the introduction of portfolios into the first year of an MSc in Nursing Programme. Background. This paper outlines a framework for portfolio development in postgraduate nursing practice. The framework is being piloted, within the Irish context, with students in the first year of a Masters in Nursing programme and has the potential to be developed for other nursing programmes at postgraduate level. Design and method. An action research approach has been chosen to study the implementation of the portfolio and the development of a framework to guide this initiative. To date the development of the framework is being piloted as part of the ‘taking action’ phase of a first action research cycle. Results. In its current stage of development the framework is constructed to embrace the core concepts of specialist nursing practice and the nursing management competencies, from current Irish health care documents. In addition the portfolio is anchored around personal development planning and is supported by the use of action learning tutorials and academic and practice facilitators. The first evaluating phase will take place later this year and will involve the collection of data from students, facilitators and lecturers. Conclusion. The introduction of the portfolio at postgraduate level has highlighted, to date, issues of confidentiality in committing experiences to paper, issues around its assessment, and issues around sharing this document with other students. Relevance to clinical practice. Portfolio development at postgraduate level emphasizes linking theory and practice and stresses the importance of reflection on practice. The portfolio can also be used by nurses to develop their clinical career pathways and encourage personal development planning.     

Assessment of portfolios in professional education

Student-centred methods are increasingly being used to carry out learning, teaching and assessment activities in professional education. These methods underpin current curriculum design, and evidence suggests that they have been successful in reducing the perceived theory-practice gap and making professionals fit for practice in the chosen discipline. A portfolio is a common method of assessment in many programmes. A tripartite approach to assessing the portfolio, involving the student and his or her practice supervisor in the assessment process, brings together the assessment of theory and practice, and makes the process even more transparent. The tripartite approach to assessing portfolio is used in the mentorship preparation programme at the author's university, which also prepares the student to become an assessor. Thus the assessment process becomes part of the learning experience and is valued by the tutor, student and practice supervisor. This article describes a small-scale study carried out with a colleague on the use of portfolios as a tool for assessment in a short programme via a tripartite approach involving the practice supervisor, student and tutor.     

The clinical portfolio as an assessment tool

Portfolio assessment is one of the tools being closely examined in the educational community as a method of authentic assessment. This form of assessment has the unique ability to capture learning over time in a way that tests or grades may not. This article examines how Regents College, a nontraditional assessment-based institution, created a clinical portfolio assessment option for their baccalaureate nursing students. Through self-reflection on their educational and professional experiences, students develop a clinical portfolio that comprehensively illustrates their ability to apply the nursing process and make clinical decisions in practice.     

The clinical achievement portfolio: an outcomes-based assessment project in nursing education

Dynamic healthcare market forces impel educators to search for innovative methods of academic assessment to measure learning outcomes. The clinical achievement portfolio is a creative and systematic tool for documenting continuous improvement of student clinical learning. The authors describe the use of the portfolio as a pilot project aimed at introducing reflective thinking and measuring clinical learning in undergraduate nursing education. Potential benefits of the clinical portfolio and implications for future research are proposed.     

Developing benchmarks for prior learning assessment. Part 2: Practitioners

Part 1 of this article examined a study into the use of benchmarking for prior learning assessment (PLA). This article outlines the benchmarks and practitioner guidelines that emerged from the study. The guidance is based on the benchmarks for practice and is intended to encourage PLA practitioners and adult learners to purposefully apply proven assessment theory to a variety of personal and professional goals and needs, by developing a portfolio. The basic principles and processes necessary for effective, systematic assessment of prior learning are identified and discussed.     

From process to outcome: the effect of portfolio assessment on student learning

Literature suggests that assessment may influence student learning in a positive or negative way. Despite the support for the use of portfolio assessment, relatively little is known about its effect on student learning. The purpose of this study was to evaluate the effectiveness of portfolio assessment in enhancing student learning. Students undertaking the Bachelor of Nursing programme in a University in Hong Kong participated in the study. Twelve of the students who underwent portfolio assessment described, in individual semi-structured interviews, their experience and perceptions of this form of assessment. This paper reported on the qualitative findings of the study, which employed both qualitative and quantitative methods. Three themes emerged from the students' accounts: (1) the students favoured the use of portfolio assessment; (2) the process of preparing portfolios yielded positive academic and affective outcomes; and (3) unexpected findings in the form of spontaneous collaborative learning and apparent increased interest in learning during the process of preparing portfolios for those students who lacked motivation. The qualitative findings contribute to a better understanding of the use of portfolio assessment and have implications for teaching.     

An evaluation of a standards based portfolio

In undergraduate and postgraduate nursing studies, the essay type assignment is commonly used to assess student learning. The literature suggests that of the alternatives for the assessment of learning, the use of portfolios may be an effective tool. A portfolio is generally conceptualized as a collection of the students best work or a collection of work that evidences incremental development. For a particular unit of learning, 'Nursing Business', second year undergraduate students in the Bachelor of Nursing programme were required to complete a portfolio. The assessment directed the students to meet specific criteria which in turn reflected the learning outcomes. Therefore the portfolio in this study is more appropriately described as a standards based portfolio (SBP). A SBP is a series of student work that seeks to address pre-determined learning outcomes.This study is an evaluation of student perceptions of a SPB and of interest to the study was the relationship between theory and practice, the availability of resources to complete the assignment and the contribution the portfolio made to the process of learning.     

An evaluation of a standards based portfolio

In undergraduate and postgraduate nursing studies, the essay type assignment is commonly used to assess student learning. The literature suggests that of the alternatives for the assessment of learning, the use of portfolios may be an effective tool. A portfolio is generally conceptualized as a collection of the students best work or a collection of work that evidences incremental development.For a particular unit of learning, 'Nursing Business', second year undergraduate students in the Bachelor of Nursing programme were required to complete a portfolio. The assessment directed the students to meet specific criteria which in turn reflected the learning outcomes. Therefore the portfolio in this study is more appropriately described as a standards based portfolio (SBP). A SBP is a series of student work that seeks to address pre-determined learning outcomes.This study is an evaluation of student perceptions of a SPB and of interest to the study was the relationship between theory and practice, the availability of resources to complete the assignment and the contribution the portfolio made to the process of learning.     

ANALYSES/LITERATURE REVIEWS: Evaluating Competence Using a Portfolio: A Literature Review and Web-Based Application to the ACGME Competencies

Background: The Accreditation Council for Graduate Medical Education is shifting its focus from a structure and process system of graduate medical education to one that is outcomes based, requiring all residents in training to achieve competence in six broad domains and presenting educators with the challenge of evaluation.

Summary: We searched the literature and reviewed all articles relating to portfolio assessment in medicine. In addition, we reviewed articles that addressed standard tools currently in use for resident performance assessment. The use of a portfolio allows one to incorporate a variety of assessment tools needed to evaluate the diverse domains of competence and also fosters reflective learning, which is key to professional development. From lessons learned through this review, we developed a Web-based evaluation portfolio for residency training that we describe here in the hope of facilitating this process for others.

Conclusions: Web-based portfolio assessment provides an ideal venue for the evaluation of competence and has the ability to provide educators with a research infrastructure to practice evidence-based education.     

The use of professional portfolios and profiles for career enhancement

Since 1995, registered nurses and midwives have been obliged to develop and maintain a professional portfolio of evidence reflecting the learning activities that they have undertaken and how these have informed and influenced their practice. The aim of this article is to demonstrate that rather then just a retrospective account of continuing professional development activities, a portfolio can be used as a vehicle for engaging in self-assessment and personal development planning. Possible structures and type of evidence are explored and portfolios in the context of gaining accreditation for prior experiential learning, and in particular for those nurses in advanced clinical roles, are discussed.     

A mobile clinical e-portfolio for nursing and medical students, using wireless personal digital assistants (PDAs)

This paper outlines the development and evaluation of a wireless personal digital assistant (PDA) based clinical learning tool designed to promote professional reflection for health professionals. The “Clinical e-portfolio” was developed at the University of British Columbia School of Nursing to enable students immediately to access clinical expertise and resources remotely, and record their clinical experiences in a variety of media (text, audio and images). The PDA e-portfolio tool was developed to demonstrate the potential use of mobile networked technologies to support and improve clinical learning; promote reflective learning in practice; engage students in the process of knowledge translation; help contextualize and embed clinical knowledge whilst in the workplace; and to help prevent the isolation of students whilst engaged in supervised clinical practice. The mobile e-portfolio was developed to synchronise wirelessly with a user’s personal Web based portfolio from any remote location where a cellular telephone signal or wireless (Wi-Fi) connection could be obtained. An evaluation of the tool was undertaken with nurse practitioner and medical students, revealing positive attitudes to the use of PDA based tools and portfolios, but limits to the use of the PDA portfolio due to the inherent interface restrictions of the PDA.     

Clinical simulations: development and validation

Simulations used as an educational strategy can mimic clinical reality bringing real life activity into the learning environment. This paper presents a conceptual approach to simulation development and validation that is applied to develop assessment simulations for both childbirth and triage situations. A process-based method of presenting information to the learner in the assessment phase is incorporated in simulations developed from actual clinical cases. The uncertain conditions of assessment are recognized as mirroring practice reality and validation of this construct and that of expertise are considered. Use of these simulations has the potential to provide learners with the opportunity to experience dimensions of simulated practice reality and educators with an experiential strategy that can be used to prepare students and also clinicians who are unfamiliar with new clinical practice areas.     

Assessing interprofessional competence using a prospective reflective portfolio

Abstract

The assessment of interprofessional competence or capability following interprofessional education (IPE) remains essential if we are to ensure future practitioners who are able to work in teams and collaborate for improved health outcomes. Any IPE curriculum must design and describe its theoretical stance and this also applies to how learning will be assessed. This article reports on a study of the use of an IPE portfolio by students across 10 professions as a flexible framework for students to demonstrate their learning. Using a qualitative approach, the completed portfolios of a proportion of students from medicine, social work, and speech and language therapy were read, and a sub-set of students were interviewed to gain their perceptions of this assessment process. The findings are discussed in the light of the value of reflection for learning to consolidate interprofessional understanding. The study highlights how emotional and cognitive learning triggers lead to new understandings for collaborative practice reached only because students were able to reflect on their experiences. The portfolio is now summative and includes other assessment components.     

Reflective practice: a meaningful task for students

AIMS: To ascertain whether students found reflection to be a meaningful activity, whether there are perceived benefits associated with reflective practice and whether it is a valid process on which to assess the outcomes of a course relating to the competencies of specialist practice. METHOD: The attitudes of students attending a one-year degree course were examined using a focus group interview and a web discussion board. The evaluation of the focus group interviews and web-based discussion postings are discussed. FINDINGS: Reflective writing is considered a key component of portfolio assessment because it provides evidence of skills development and increasing clinical competence. There was no consensus on whether or not reflection is a meaningful activity. The students' learning style is pertinent to their perception of the usefulness of reflection. CONCLUSION: The findings indicated the scepticism with which some students approached the task, but they also identified that reflection had a positive impact on the practice of students more able to embrace the process in a meaningful way. There is scope to extend this work to examine the use of reflection in developing the growing body of practice knowledge that underpins nursing.