146 | Chapter 7 Consequently, questions can be asked about the transferability of the conclusions to settings with different characteristics regarding supervision and/or portfolio purpose(s). Nevertheless, there is a considerable amount of overlap between the results of the studies that were performed within GP specialty training (Chapter 3 and 4), studies included in the realist review that were performed in various clinical WPL settings (Chapter 2), and studies on portfolio use within secondary schools and universities.57 Thereby, indicating that within and outside the clinical WPL setting, the use of different types of portfolios is associated with similar challenges, such as tensions between portfolio purposes, dilemmas about the preferred degree of standardisation and personalisation, and checking-off behaviour of learners.57 Implications for practice The most influential publications on how to use portfolios during medical education are by Driessen and van Tartwijk, who have underlined amongst others the importance of clear instructions and the presence of a mentor during portfolio use.1,13,58 They also stressed the need to design a portfolio in accordance with its intended purpose(s) by quoting Spandel: ‘one size does not fit all and the best choice depends on purpose’.58(p71) This thesis indicates that prior to the design, it is important to critically appraise which portfolio purpose(s) are valuable and attainable in a specific educational setting. Because choosing portfolio purpose(s) that do not align with the educational setting might result in an ‘one size fits nobody-portfolio’. In order to appraise if the support of SRL can be a valuable purpose of portfolio use, it is important to explore various approaches to the support of SRL within the educational setting. Logically, the most straightforward and reliable approach should be preferred. Given the above discussed complexities related to portfolio use, this might be another approach than portfolio use. In order to appraise if the support of SRL can be an attainable purpose of portfolio use, it is especially the assessment programme that is of interest. In general, when the assessment programme necessitates requirements concerning the quantity and/or quality of portfolio reports, it will be difficult to adequately use the portfolio for the support of SRL. If the support of SRL is considered a valuable and attainable purpose of portfolio use, it is important to realise that deliberate attention for this purpose is required during the design, guidance and evaluation of the portfolio. The following recommendations based on different studies of this thesis might be helpful in this regard: - Create a shared frame of reference between stakeholders Chapter 4 and 5 discussed that it is important to create a shared frame of reference between all stakeholders involved with the portfolio in an educational setting (e.g.
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