Understanding the process of Portfolio-Supported Learning & Assessment (PSLA) with reference to the learning attitudes of Postgraduate Medical Students (SpRs) at the Queen's School of Anaesthesia

Abstract

Rapidly changing technology, the knowledge explosion and socio-economic transformations owing to globalisation have made it necessary for most people to learn throughout life. The terms such as `lifelong learning' and `continuous professional development' have become part of the educational lexicon as never before. Yet the formal education system alone cannot provide lifelong education for career development and there is research interest in promoting individual responsibility for becoming a self-directed autonomous learner. However, this idea is inconsistent with the prevailing teaching and assessment practices, namely, didactic teaching methods and norm-referenced summative assessment, where students are excluded from the process of deciding targets for learning, setting criteria and standards for assessment, designing assessment schemes and implementing them. Methods and techniques which are claimed to transfer the control of the educational and assessment process form teacher to student such as `Problem-Based Learning' and `Portfolio- Based Assessment', have been seen by researchers in the field of assessment as suitable alternatives to foster autonomy and intrinsic motivation in students. Although medical education in the UK has taken the lead in adopting `Problem Based Learning', teacher education is considerably ahead in the case of `Portfolio-Based Assessment'. Recently, medical education has also started to introduce `Portfolio-Based Assessment' in some colleges. However, its effectiveness in the context of medical education is yet to be established. This study, therefore, attempts to understand the process of `Portfolio-Based Assessment' with reference to the learning attitudes of postgraduate medical students (SpRs) in the context of the Queen's School of Anaesthesia situated in the north of England. The basic aim of this study was to evaluate the effectiveness of PBA in transforming the attitudes of the SpRs. The study revealed that it was very difficult to measure any change in attitude. Moreover, it was realised that in comparison to measuring change in attitudes it was more important to understand the process of intervention of the PBA in order to evolve remedial measures to make it more effective. This early finding considerably changed the focus of the study, research questions and methods. I also realised that the relationship between the effectiveness of the portfolio and the attitudes of SpRs was symbiotic, and so it was also important to understand these attitudes in order to understand the dynamics of portfolio use. The final aim was to understand the process of PBA, rather than to prove any particular theory or measure change in attitudes. Hence, the methodology adopted was more qualitative and naturalistic in nature than quantitative, with the aim of studying the process of PBA through a flexible methodology, and without any pre-conceived theories about the portfolio.

However, findings concerning the process of PBA are situated in my understanding of theories of learning and current approaches to assessment within a particular context. The fieldwork combined two separate questionnaires distributed to all 90 SpRs, of whom about 50% responded. In order to understand their perceptions regarding the portfolio, nondirective interviews were carried out with 24 SpRs. Content analysis of the 24 portfolios was carried out to explore the extent to which the SpRs had developed the portfolios and the amount and type of reflection in which they engaged. Non-directed interviews and the content analysis of the portfolios raised questions about the SpRs' professionalism and their attitudes towards self-directed learning. To obtain a better understanding of these issues, focused interviews of 16 SpRs, based on the content analysis of the portfolios, were conducted. The understanding developed from this study and the findings and suggestions that have emerged from it are applicable mainly to postgraduate medical education. However, three propositions emerged from this study which may be relevant to the use of the portfolio for professional development in other educational contexts: (i) The term `Portfolio-Based Assessment' is a misnomer, since a portfolio does not become so central to the assessment process that it can be used to assess all types of ability. It may be concluded that a portfolio only supports the existing assessment system. (ii) The process of portfolio preparation itself leads to learning, while in the case of most of the other assessment processes the learning loop is completed after assessors have provided feedback. The portfolio should therefore be treated as a tool for both assessment and learning, and the term `Portfolio-Supported Assessment and Learning (PSLA)' is more appropriate. (iii) Other assessment methods may be used simultaneously for summative as well as for formative assessment without affecting the quality of formative assessment to a great degree. However, the use of portfolio for both purposes of assessment simultaneously creates a conflict and to a large extent reduces its potential for encouraging the trainees to engage in self-assessment and reflection, thus defeating the basic purpose for which it was introduced. It may be concluded that the same portfolio should not be used for both purposes of assessment. The emergence of the above propositions from the study may be considered as an original contribution to knowledge in this field. Further debate and studies are required in order to develop theories based on these propositions.