109 Polarity map | 5 Introduction Over the last two decades, portfolios have become an established component of undergraduate and postgraduate medical training programmes.1,2 Portfolios are often integrated into the assessment programme and may fulfil a role for formative assessment, summative assessment and/or accountability.1,2 Furthermore, portfolios are used to support self- regulated learning (SRL), which refers to ‘the degree to which students are metacognitively, motivationally, and behavio[u]rally active participants in their own learning process’.3(p167) Portfolio use is considered to support various SRL processes, in particular feedback seeking, reflection, self-assessment, goal setting and monitoring.1,2 Accordingly, portfolios are often implemented to target multiple purposes.4 However, in educational practice it proves to be complicated to serve different purposes with one portfolio.1,5-7 This is exemplified by perceptions of learners, who often experience their multipurpose portfolio to be an instrument for faculty rather than a tool from which their own learning could benefit.8-10 Apparently, the value of portfolio use for SRL can be compromised if assessment and/or accountability need to be served as well. Often discussed in this context is the combination of (summative) assessment and support of reflection for learning in one portfolio.1,5,11-13 The interdependency between these purposes can cause tensions during portfolio use. Although reflective skills are considered vital for (future) physicians and therefore important during assessment of competence, learners may be reluctant to document in-depth reflections in their portfolios, as they fear that exposing doubts or insecurities in their reflections can negatively affect portfolio assessment.14,15 Insights of researchers and educators differ whether and how to deal with these tensions.1,5,11,13 The approaches that have been suggested to deal with tensions of multipurpose portfolio use (e.g. the advice to no longer assess portfolios in order for reflection to take place)5 do not acknowledge the complexity of the problem at hand. Complexity theory describes that complex problems are signified by a large number of interconnected elements, that share interdependencies, are dynamic and intransparent.16 A pitfall when dealing with complex problems is the expectation that a single, fit-for-purpose solution can solve the problem.17-19 The previously provided solution regarding multipurpose portfolio use shows that such solutions do not sufficiently address the interdependent and dynamic nature of a complex problem: when portfolios are not assessed, learners can be left with the feeling ‘what am I doing it for?’7,20 In contrast, systems thinking methodologies are considered suitable to deal with complex problems, 19,21 as these methodologies ‘recognize that factors relating to a problem are connected and dynamic, are considerate of diverse perspectives, and are aware of boundaries surrounding issues’.19(p4) Examples are social network analysis (i.e. the collaboration, communication and information flow between a multiplicity of actors are depicted) and causal loop diagrams (i.e. the relations and connections between factors that contribute
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