35 Realist review | 2 SRL outcomes Weassigned theoutcomesof theCMOs to theSRLoutcomes that arepart of theprogramme theory. The outcomes related to self-assessment were mostly encouraging.32,35,37,39,44 Learners identified proficiencies and deficiencies in performance32,35,44 and/or were aware of their own thoughts and feelings35,37 with help of their portfolio. One study described that the system of assessment (contextual factor) interfered with this process, as learners mainly experienced stress and anxiety in concern to portfolio assessment and did not experience any benefit for the identification of individual strengths and weaknesses.39 A majority of the papers mentioned a relationship between portfolio use and learner reflection.31-33,35,37,40-45 While most papers stated that portfolio use promoted reflection, they often did not explain this relationship further.31,32,35,37,42,45 Brown et al. was an exception explaining that short portfolio reports that were jotted down in between tasks of busy workdays, were accompanied by superficial reflection. However, deep reflection could be instigated at a later (quieter) moment, when the portfolio report reminded the learner of the event that took place.33 Different activities concerning feedback were discussed as an outcome of portfolio use.36,44-46 Two papers described that honest and constructive feedback between learner and supervisor was facilitated by portfolio use, as sensitive or otherwise neglected issues were discussedmore easily now that they were part of the portfolio process.44,45 Moreover, the interaction between provided feedback and feedback-seeking of learners was described by Fu et al., who showed that the perceived utility of feedback was positively related to feedback-seeking motivation. Learners perceived individualised feedback to have a high utility, whereas more general feedback was considered less useful.36 The role of portfolio usewas less convincing for learningobjectives andplans.32,35,39,40,43 We found some positive outcomes, e.g., thinking about the application of lessons learned in the future.32,35,43 However, other papers reported difficulties related to portfolio use and learning objectives. Jenkins et al. found that learners were reluctant to document learning needs, as they did not want to show weaknesses.40 In addition, learners described by Hrisos et al. did not experience the portfolio as helping with the achievement of learning objectives, as they struggled to collect the required portfolio reports.39 Lastly, two papers provided results concerning monitoring.33,44 These papers reported a positive outcome related to portfolio use: learners in these studies were able to assess their progress, as they were able to look back on what they had learned because portfolio documentation acted as reminder of past events.33,44
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