72 | Chapter 3 assessment, which needed to be covered sufficiently for accountability reasons. It was expected that the potential of the portfolio for the support and documentation of SRL would surface naturally when the portfolio was adequately used. Consequently, trainees received instructions concerning the use of the portfolio and its programmatic assessment function, but no specific instructions regarding the documentation of SRL. With the choice to only provide information on the technical and assessment aspects of the portfolio we potentially overestimated the knowledge and skills that trainees and their teachers/supervisors have concerning (the documentation of ) SRL. Research shows that support of a teacher/supervisor is important for the development of SRL,67 in addition, teachers/supervisors often do not know how to support SRL effectively.68,69 Thus, trainees, teachers and supervisors not only need to be supported in the technical aspects of a portfolio, but also need training concerning (documentation of ) SRL, e.g. on effective reflection, feedback and goal-setting. Strengths and limitations This is the first study to conduct content analysis on portfolios of medical trainees in order to achieve insights in the documentation of multiple SRL processes. For this purpose, a codebook, based on research literature, was constructed to rate the documentation of different criteria for good SRL practice in portfolio content. To ensure anonymity of trainees, we chose to only include the pre-structured forms, which make up a considerable part of the portfolio. Consequently, it cannot be excluded that material stored in the folder for personal documents does show different patterns concerning SRL than those found in the pre-structured forms. This study focused on self-assessment, via feedback and reflection, goal setting and planning, and monitoring, as these SRL processes are commonly mentioned in the health professions education literature in concern to portfolio use. However, SRL is a comprehensive concept that covers more than the processes that were considered within this research. Implications for future research We focused on the documentation of SRL processes within portfolios, by using portfolio content as data source for quantitative analysis. Qualitative research would be valuable to assess how different factors, such as level of introspection and writing skills, influence the (limited) documentation of SRL processes. Likewise, other questions that still exist concerning the use of portfolios for the support of SRL require combined use of quantitative and qualitative measures. Future studies should, thus, use different data sources – e.g. portfolio content, portfolio users - and methods – e.g. questionnaires,
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