29 Realist review | 2 Context Mechanism Outcome Self-assessment (-) - Learners did not have a personal work and/or storage space within the hospital (WPL) - The busy, frenetic pace of the clinical setting (WPL) - Summative assessment; more specifically, requirements regarding the (number of ) portfolio reports (SA) Learners struggled to collect the required portfolio forms, because they usually did not have access to their portfolio at the workplace. And because they were reluctant to add to the workload of colleagues by asking them to observe and provide feedback on routine procedures (M). Consequently, the portfolio requirements induced stress, anxiety, and other negative feelings (F) Learners did not experience the portfolio as help in the identification of strengths and weaknesses in one’s own performance.39 Context Mechanism Outcome Reflection (+) - Time-pressure (WPL) - Upcoming job interviews (WPL/A) Learners documented short, superficial, selective and/or strategic portfolio reports (DC), because of time constraints, the idea that the portfolio was a record of achievement (AP), and privacy concerns (CP). Nevertheless, these short notes helped in remembering the events that had taken place (DR) Although documented reflections were superficial, learners could engage in deep reflection at a later moment when they were reminded of the events that had taken place.33 The busy, frenetic pace of the clinical setting (WPL) Brief dedicated time to write in the portfolio needed to be secured (CP). Reflections could be captured as they happened.41 The busy, frenetic pace of the clinical setting (WPL) Learners experienced limited time for reflection. Yet portfolio writing was considered to take up no additional time, as it was possible to do this in between the regular tasks and responsibilities (AP) Learners engaged in reflection.44 The busy, frenetic pace of the clinical setting made it difficult to synthesize learning experiences (WPL) However, documenting in the portfolio provided an intentional deliberate moment to pause and think about what had happened during the day (DC). Learners engaged in reflection.43 Learners documented frank and open portfolio reports about their deficiencies and how they had tried to remedy them (DC) Learners engaged in reflection.37
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