87 Focus group study | 4 Introduction In medical education portfolios are implemented for different purposes, e.g. assessment, guidance and/or competency development.1 Portfolios can be defined as a purposeful aggregation of (digital) items (e.g. evidence, reflections, feedback) that demonstrate learning, experience or professional growth.2,3 One of the purposes for which portfolio use is recommended is the support of reflective-, self-regulated- and/or lifelong learning. While papers recommend and provide guidance on how to implement a portfolio for these purposes,3-22 there are still substantial uncertainties concerning the extent to which and how portfolio use can support learning.23-25 Self-regulated learning (SRL) is one of the learning concepts that is supposedly supported by portfolio use.23,25 SRL refers to ‘the degree to which students are metacognitively, motivationally, and behavio[u]rally active participants in their own learning process’,26(p167) and is considered of eminence during and after medical education.27-29 SRL is considered especially important in workplace learning (WPL), because of its potential to help learners keep track of individual learning needs in the unpredictable and sometimes chaotic clinical workplace.28 Portfolio use is expected to facilitate learning from experiences, by supporting different metacognitive processes (e.g. self-assessment, monitoring) that instigate and sustain the completion of learning cycles.30,31 It is insufficiently clear to what extent these SRL processes actually occur when portfolios are used during WPL. Portfolio research considering SRL processes, predominantly consists of studies that evaluated portfolio implementation with (quantitative) surveys.32-42 While some of these evaluations concluded that portfolio use was experienced to support learning in general,32,37 or more specifically reflection,36,42 others reported no learning benefits of portfolio use.33,34,39 Additionally, some evaluation studies reported mixed results regarding SRL processes.35,38,41 These evaluations have not provided mechanisms that can explain differences between the more and less successful implementations of portfolios for the support of SRL, as surveys present user perceptions, while missing the experiences, sentiments and reasoning on which those perceptions are based. Moreover, these perceptions often did not represent all interests and experiences in play during portfolio use, as most studies involved one stakeholder group (e.g. trainees or mentors). Consequently, there is a need for in-depth explorations of portfolio use that involve different stakeholders, in order to gain insight in the functioning of portfolio use in the context of SRL. Therefore, this study explored experiences with portfolio use among different stakeholders of the Dutch General Practitioner (GP) specialty training, to answer the research question: How does portfolio use support SRL during GP specialty training?
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