120 | Chapter 5 Discussion Multipurpose portfolios are implemented in medical education with the aim to support the qualification of competent, lifelong learning professionals. However, in educational practice it appears to be difficult to combine multiple purposes in one portfolio, as different tensions undermine the portfolio’s potential. We identified accountability and learner agency as an important overarching polarity that can explain various tensions related to multipurpose portfolio use. By the use of the polarity thinkingTM framework we charted a polarity map®, in order to clarify the polarity and provide concrete advice on how to manage tensions that result from this polarity. Tensions related to multipurpose portfolio use have been discussed previously, often in concern to the combination of (summative) assessment and reflection.1,5,11-13 Moreover, multiple fears described by our polarity map® have been reported in studies that evaluated multipurpose portfolio use in medical education, thereby indicating imbalances between accountability and learner agency. Fears that indicate a focus on accountability at the cost of learner agency were reported most often: portfolio use as a tick-box exercise, motivational problems and/or stress and anxiety of learners.8,26-30 However, also the opposite situation (learner agency that overshadows accountability) might occur, as studies have discussed reliability and/or validity problems of portfolio assessment due to the disparity of portfolio content.31,32 Given that multipurpose portfolios are an essential component of medical curricula across the world, it is troublesome that the instrument often does not meet its intended purposes. As discussed, previously suggested solutions can add to imbalances between portfolio purposes, as they are usually focused on one of the purposes (e.g. rubrics that are intended to increase the interrater reliability of portfolio assessment33). Instead it is time to consider solutions that fit the criteria of systems thinking methodologies, such as the polarity thinkingTM framework. Systems thinking has been defined as ‘a set of synergistic analytic skills used to improve the capability of identifying and understanding systems, predicting their behavio[u]rs, and devising modifications to them in order to produce desired effects’34(p675) and we believe that this type of an approach is vital in order to reach the full potential of multipurpose portfolio use. Implications for practice Many of the action steps included in our polarity map® are similar to previous recommendations regarding portfolio use. In line with the research literature that emphasises the importance of clear guidelines, the participants of the stakeholder session formulated the action step ‘provide sufficient information on portfolio use’.4,11,35 Furthermore, the literature stresses the importance of faculty development, which could be seen as a prerequisite for another action step ‘faculty actively engage with the portfolio and guide learners during the completion of learning cycles’.4,11,35 Moreover, it is not surprising that
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