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Using reflective portfolios: A case study of medical students

© Amanda Kendle

A previous article, Introduction to Portfolios, discussed the three main types of portfolios used for assessment as being developmental, showcase or reflective. This article will focus on the use of a reflective or artefact portfolio, illustrated through a case study of the use of these in a course for medical students.

The aim of a reflective portfolio is to encourage students to reflect on their experiences in a way which deepens their understanding of important key principles. It may include personal, journal-like narrative from students in response to particular questions, or, in attempts to cover particular objectives, students may choose artefacts such as newspaper articles or extracts from conversations on which to base their reflections. Some students have little experience with reflecting on incidents and gain much by being required to do so for assessment, while others who are naturally good at reflecting on their experiences find that writing this reflection down helps deepen it further.

In the case of the medical course, reflective portfolios were used to assess areas like ethical behaviour, continuing education, learning styles and issues of cultural differences. Students were asked to address a series of aims relating to these areas by choosing appropriate incidents or artefacts and reflecting on what these had helped them to learn about the different areas. For example, students attached to obstetrics wards often had very special experiences, such as being thanked in the Birth Notices section of the newspaper or even having a baby named after them! While these incidents would usually be lighthearted stories to share at the pub, reflecting on them in writing can attach additional layers of meaning, helping students to consider the various roles of health professionals at births and the development of appropriate relationships between patients and doctors. In this case, the experience of writing their portfolio would be enhanced with a one-to-one interview or conversation about their portfolio with a practising clinician, with the hope that for some, this would be the beginning of a mentoring relationship.

At first, these medical students were reluctant to write their portfolios. The vast majority of their previous assessment at medical school had involved extremely traditional methods such as essays and multiple-choice tests. There were concerns about sharing their deep thoughts – although they would only be confidentially read and discussed with one other person – and objections to the idea that they would be marked on how well they reflected. Yet by the end of the year-long task, most students were converted. A number of students commented on how interesting it was to read back on their portfolio entries at the end of the year, and intended to keep their portfolio to read again in several years’ time, to see how much their opinions and knowledge had changed. Many were especially pleased to have practising doctors read their personal views and discuss them openly, without criticism. Above all, they admitted that despite some apprehension, writing down their reflections over a year of medical school really had helped them clarify their ideas on a number of key themes.

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