27 Realist review | 2 Portfolio (related) mechanisms The mechanisms of the CMOs were distilled into: • Portfolio mechanisms: primary mechanisms inherent to portfolio use, that seem to affect SRL directly. • Portfolio related mechanism: mechanisms related to portfolio use that seem to affect the primary portfolio mechanisms and thereby also SRL. The first portfolio mechanism affecting SRL concerns documenting as a moment of contemplation.33,35,37,42-45 Documenting was reported to help learners analyse their experiences; writing a portfolio report helped learners to capture the essence of their experiences.35,42,43,45 The second portfolio mechanism is documentation as a reminder of past events.32,33,44 Previously documented information helped learners to remember what happened before, which provided an opportunity to mentally return to these events.33,44 The first two portfolio related mechanisms are controlled by training institutes and their faculty. First, some papers mentioned conditions of portfolio use (e.g. a digital format, the provided instructions or privacy matters) that affected portfolio use and thus the potential for documenting and use of documentation.31,33,36,41,43,44,46 The second portfolio related mechanism controllable by training institutes and/or faculty concerns mentoring during portfolio use.33,36,39,44-46 Some papers describe how portfolio use supported mentoring and, in this way, SRL: feedback was exchanged more easily, since sensitive or otherwise neglected topics were included in the portfolio and therefore discussed.44,45 However, others described that supervisors could only provide valuable feedback when learners provided suitable portfolio reports.36,46 Also WPL (contextual factor) can interfere with the possibility to exchange feedback through the portfolio: learners were hesitant to ask busy supervisors for portfolio contributions, as they did not want to add to the supervisor’s workload.39 The other portfolio related mechanisms concern different aspects of learners’ reactions to portfolio use. Multiple papers described learners’ assumptions about portfolio use.33,36,40,42,44 Two papers showed that positive assumptions about the potential of the portfolio for reflection and feedback were related to the occurrence of these SRL outcomes.36,44 Likewise, Kjaer et al. identified negative assumptions about portfolio use during clinical care that related to doubts about the portfolio’s educational benefit.42 Two other papers reported that learners only considered the portfolio suitable to provide evidence of competence, and not for (extensive) reflection.33,40 Furthermore, two papers referred to learners’ feelings about portfolio use related to SRL.36,39 There were learners that experienced stress and anxiety in reaction to the system of assessment, which potentially limited SRL.36,39 In contrast, Fu et al. also mention positive effects of portfolio use on feelings. They mentioned, for example, how learners experienced a positive self-image when supervisors took the effort to provide them individualised feedback.36
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