14 | Chapter 1 An advantage of my background as psychologist was that I was already familiar with theories of human behaviour and a systems thinking view of complex processes. It was refreshing that some of my attributes that previously had led to frustrations (e.g. meticulous, critical), were of value during the research process. I also consider it valuable that I had no personal experiences with portfolio use (in the context of medical training) and/or ties with the GP specialty training programme, as I was therefore able to approach this research project with an open mind. My PhD trajectory was an intriguing learning process, but at times I was also disappointed in the academic world of which I was now part. For example, when it became clear that it was difficult to publish my studies, not necessarily because of their quality, but because the topic (portfolio use) was no longer of interest to a variety of journals. Furthermore, I found it hard to do justice to the complexity of this topic, as it felt like people (e.g. colleagues, peer-reviewers) seemed to be primarily interested in clear-cut answers and recommendations. Aim and research question of this thesis The aim of this thesis is to gain insight into what extent, in which ways and under what circumstances portfolio use supports SRL during clinical WPL. In order to reach this aim, one central research question was formulated for this thesis: How does portfolio use affect SRL during clinical WPL? Outline of this thesis In order to address the research question three studies based on different research methods were employed to assess current portfolio practices: a realist review, a content analysis and a focus group study. Based on the results of these studies, it was decided to use a systems thinking methodology to propose suggestions for future portfolio use. Lastly, a philosophical discussion of the support of SRL during medical education was written, as multiple complexities concerning the support of SRL were encountered during the different studies of this thesis. This material is presented in the following chapters: - Chapter 2 presents the realist review, which consisted of two phases. During the first phase, a programme theory was formulated. During the second phase an in-depth literature searchwas performed. Through extraction of context-mechanism-outcome configurations a model was proposed that describes how contextual factors and portfolio mechanisms can impact SRL outcomes.
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