33 Realist review | 2 Distilling clinical experiences into portfolio reports helped to analyse these experiences (DC) Learners directed future progression, as they charted their own course of professional development.35 The portfolio facilitated that all information was stored in one place (DR) The portfolio helped to set goals for the future.32 Context Mechanism Outcome Learning objectives and plans (-) - 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. But also 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 achievement of learning objectives.39 - Low resource country with scarce human resources (GC). - Learners and supervisors were not aware of and experienced with reflective thinking and writing (ES). Learners thought that they should not reveal any weaknesses, deficiencies, or mistakes in their portfolio and should only include evidence of competency (AP) Learners were reluctant to document learning needs.40 Context Mechanism Outcome Monitoring (+) The busy, frenetic pace of the clinical setting, which can result in the training year passing by without any concrete developments (WPL) The portfolio provided a structure to document information during busy workdays (DC). Subsequently, this documentation reminded learners of what had happened before and thus provided an opportunity to look back (DR) Learners looked back and mapped their development.44 Existing documentation of (learning) events provided the opportunity to reconsider past events (DR). Learners gauged their own progress, as returning to previous reports helped to see what they had learned and how they had progressed.33 a The contextual factors are indicated as follows: characteristics of workplace learning (WPL), system of assessment (SA), geographical/cultural characteristics (GC), prior experience with SRL constructs (ES) b The portfolio (-related) mechanisms are indicated as follows: documenting as a moment of contemplation (DC), documentation as a reminder of past events (DR), conditions of portfolio use (CP), mentoring (M), assumptions about portfolio use (AP), feelings about portfolio use (F) c The CMOs are ordered according to the SRL outcome they were assigned to during synthesis: self-assessment, reflection, feedback, learning objectives and plans, and monitoring. For each SRL outcome the positive outcomes are provided first (+) and the negative outcomes second (-)
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