22 | Chapter 2 of the programme. This approach fitted our aim to better understand when and how portfolio use supports SRL during clinical WPL. Review process The review process consisted of two phases, which are described in more detail below (See Appendix A for a visualisation of the review process). Two reviewers (AT, RG) performed the data-collection and -analysis. They discussed their approach and dilemmas that arose during the review process on a regular basis with the other authors. The standards of the RAMESES project were used to guide our decisions.11 Phase 1: The goal was to formulate a programme theory, which describes how portfolio use is expected to support SRL during clinical WPL. Step 1: Stakeholder interviews. We conducted individual interviews to gather ideas and experiences from portfolio users. We included eight stakeholders from different institutes of the Dutch general practitioner specialty training, all of whom had previous experience with portfolio use and/or guidance. RG performed the interviews using a semi-structured interview guide. The interviews were audio recorded and later summarised. (See Appendix B for information on the interviews). Step 2: Exploratory scoping search. Simultaneously with the stakeholder interviews, we performed a scoping search of PubMed and Web of Science in collaboration with a librarian to gather papers that explain how portfolio use supports SRL (July 2018; See Appendix C for search strings). We selected search terms that included portfolios and SRL or Self-Directed Learning (SDL) during WPL. Although, there are intrinsic differences between SRL and SDL we included both, given the interchangeable use of these terms in the literature.12 The search resulted in 53 references; 45 references remained after removing duplicates. We considered 14 papers useful to formulate a programme theory, as these papers theorised about how portfolio use can support SRL.13-26 Step 3: Formulating the programme theory. To establish a first version of the programme theory, RG and AT examined the interview summaries and included papers to extract ideas and theories that explain how portfolio use supports SRL. Subsequently, the theory was clarified and adapted in discussion with the other authors. During these discussions we recognised that interviewees and papers often (implicitly) assumed a relationship between portfolio use and the completion of learning cycles. The stages of the learning cycles explained by interviewees and in the included papers were similar to the experiential learning cycle described in Kolb’s theoretical framework.27 Therefore, we utilised this experiential learning cycle as middle range theory. This resulted in a final version of the programme theory provided in Figure 1.
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