121 Polarity map | 5 action steps have been proposed considering the content (i.e. ‘provide portfolio tools that focus on an awareness of learning’), use (i.e. ‘evaluate competencies periodically’) and technical aspects of the portfolio (‘provide learners with the opportunity to deliver content in a personalised way that corresponds with clinical practice’).11,35 In addition to previous recommendations there is one action step unique to our polarity map®: ‘acknowledge and discuss the tensions between accountability and learner agency’. We advocate that it is important that all stakeholders (e.g. learners, faculty, and curriculum coordinators) exchange information on the purposes, expectations and assessment of the portfolio in use, in order to create a shared frame of reference between all involved with the multipurpose portfolio. During this exchange, the focus should not be on isolated aspects (or problems) of the portfolio, but instead a holistic approach is needed, i.e. systems thinking. In these implications, we would like to highlight an important concept related to systems thinking: continuous quality improvement.21 While (most of ) abovementioned actions points will probably be considered during the introduction of a multipurpose portfolio, attention for the functioning of the portfolio often fades when the portfolio has become an established component of the training programme. At that point, imbalances between the different purposes, and therewith tensions, will often arise. Therefore it is important that portfolio use is periodically evaluated. Evaluation should go beyond a strengths and weaknesses assessment, and the use of a comprehensive Plan-Do-CheckAct (PDCA) cycle is advised.36 During this process the action steps and early warnings of our polarity map® can be helpful. Strengths and limitations Although the tensions that can result from the use of multipurpose portfolios have been discussed previously,5-7,13 research literature so far has provided little guidance on how to adequately manage these tensions in educational practice. The polarity thinkingTM framework offered us an approach that aligns with systems thinking and enabled the provision of concrete advice on how to deal with the complex problems related to multipurpose portfolio use. However, the construction of a polarity map® was also complex and possibilities to make alterations were limited due to the trademark agreement. Moreover, the polarity thinkingTM framework underlines the importance of interdependency between the two poles of a polarity. At the same time the polarity map® requires the formulation of values, fears, action steps and early warnings for each pole separately, which can be contradictory to the interdependent nature of the poles addressed. Consequently, it was difficult for the participants of the stakeholder session to formulate action steps and early warnings that applied to only one of the two poles. Therefore, some suggestions were removed after the stakeholder session, as they were not considered distinctively related to one pole (e.g. user-friendliness and accessibility of the portfolio). However, during later discussion of
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