65 Content analysis | 3 Results Phase one: Number of Forms Table 2 provides the descriptive statistics of the number of pre-structured forms used within the portfolios. Statistics are split up into the three cohorts, based upon the duration of portfolio use. The table shows high standard deviations, representing a considerable difference in numbers of forms present in individual portfolios. The percentage of portfolios that contained a particular form is also presented for each of the three cohorts. These figures show substantial percentages of non-use, even in the second- and third cohorts, indicating that there are GP trainees in their second- or third-year that miss a number of (mandatory) forms in their portfolio. Phase two: Content analysis The results of the content analysis are displayed in Table 3. It shows that forms aimed at reflection were present in just over half of the portfolios (54.4%). In case an entry was present it could often (83.7%) not be qualified as reflective, because only experiences and events were described. Entries that were reflective did not exceed descriptive reflection (a singular explanation or justification was given for an event). In general, trainees described experiences with a positive focus, and did not discuss reasons, motives and context. For example: “Things are going very well; well on track, tight schedule; meeting commitments” and “I could think more about the patient’s context, although sometimes I’m managing well enough already. I also know the families and their backgrounds and, if necessary, take this into consideration during the consult.” There were no examples of dialogic or critical reflection in our sample; trainees did not document a variety of possible explanations for events, whereby also considering contextual influences. Feedback was in many cases confined to a summary of what went well or needed improvement, often lacking specificity, context and direction for future action. For example: “Nice constructive attitude, friendly. Responds well to feedback.” and “Engages actively in the learning process, open for feedback. You are struggling with doubts about the discipline. Sometimes it is hard to keep one’s distance to the patient and not to take your work home.” Feedback was specific in one quarter to one third of the portfolios (27.8% and 35.6% for teachers and supervisors, respectively). In about 90% of the portfolios, feedback was focused on performance and learning under the trainees’ control. Feedback was aligned with the purpose of the form in about two third of the portfolios (58.9% for teachers and 73.3% for supervisors). In these cases, the feedback concerned topics relevant for the competence at hand. A foundation or reasoning for the provided feedback was present in over half of the portfolios, such a ‘source’ for feedback was formulated in 57.8% of the portfolios. Tips for improvement were present in 13.3% (teachers) and 33.3% (supervisors) of the portfolios. Future-directed comments that were given generally missed specificity, for example: “Now just demonstrate it” and “Keep taking (more) care of yourself here”.
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