21 Realist review | 2 Introduction The use of portfolios to support self-regulated learning (SRL) is common practice in medical education. 1,2 Portfolios are a purposeful aggregation of (digital) items (e.g. evidence, reflections, feedback) that demonstrate learning, experience or professional growth.3,4 SRL refers to ‘the degree to which students are metacognitively, motivationally, and behavio[u]rally active participants in their own learning process’.5(p167) The literature indicates that higher levels of SRL are associated with better academic performance and lifelong learning.5,6 However, effective SRL is not self-evident, especially during clinical workplace learning (WPL), since it is difficult for learners to monitor their individual learning needs in the unpredictable and complex clinical setting.6,7 It is assumed that portfolios can mitigate this difficulty.4,8 Previous reviews have examined portfolio use for a variety of purposes, including competency development and assessment.1,2,4,9 With regard to SRL-related outcomes, the reviews are most informative about reflection. Although portfolio use was associated with an increased incidence of reflection, the quality of reflection did not necessarily improve with portfolio use.1 This might be due to learners’ reluctance to disclose their introspections in a document accessible to faculty members who can influence their study prospects.2,9 Furthermore, some evidence suggests that portfolio use can support self-assessment and identification of learning needs.1,2,4,9 However, it was also shown that the use of a portfolio alone is not sufficient for these processes to occur, as several preconditions for successful portfolio use were mentioned, such as encouragement by a mentor2,4,9 and clear portfolio goals and instructions.9 Given the popularity of portfolios, it is important to gain insight in the extent to which and under what circumstances portfolio usage is effective for supporting SRL. Therefore, we conducted a realist review to better understand when and how portfolio use supports SRL during clinical WPL. We used the following research question: How does portfolio use affect SRL during clinical WPL: What works, for whom, and in what contexts? Methods A realist review is suitable to provide a rich and practice-oriented understanding of complex social interventions, such as portfolio use.10 The aim of realist reviews is ‘to unpack the mechanism of how complex programmes work (or why they fail) in particular contexts and settings’.10(p21) To do so, the first step is to formulate a programme theory, that can explain why the programme under review is expected to work. Subsequently, literature is included to search for context-mechanism-outcome configurations (CMOs). In other words: what works for whom in which circumstances? Finally, a synthesis of these CMOs provides insight into the contexts and mechanisms that can explain different outcomes
RkJQdWJsaXNoZXIy MjY0ODMw