88 | Chapter 4 Methods Context The Dutch GP specialty training is provided by eight training institutes across the Netherlands. Three of these participated in the study (Radboudumc, Maastricht University, Leiden University Medical Centre). During the three years of specialty training, GP trainees learn while working in general practice and adjacent fields (emergency-, mental health- and chronic care). Trainees receive one-on-one supervision on a daily basis from physician-supervisors, who work on site with them. In addition, trainees receive education in peer trainee groups during a weekly academic day, which is provided by faculty of the training institutes (GPs and behavioural scientists). Trainees are obligated to document information concerning learning and assessment in a digital portfolio. The portfolio is designed to support SRL and considered an essential component of programmatic assessment. Accordingly, portfolio content is used to inform annual progress decisions. The portfolio contains eleven pre-structured forms that trainees can fill out themselves and/or send to others in order to obtain feedback (e.g. a mini-CEX and a form to formulate learning objectives and plans). Trainees have the ownership to use the various forms at their own discretion. Alongside the pre-structured forms, trainees can add their own (learning) documents to a separate folder of the portfolio (e.g. individual trainings plans and test results). Further information about the design and content of this portfolio can be found in our previous publication.43 Reflexivity We adopted a contextualist world view during this study, thus ‘assuming that context – in historical, cultural and social terms – is integral to understanding how people experience and understand their lives’.44(p7) The identity of the Dutch GP specialty training and its portfolio are defined by various contextual factors. Examples are the Dutch (educational) culture, the GP profession and the fact that the portfolio was developed to suit eight different training institutes that all have their local organisational and educational culture. We expected that these contextual factors affected experiences with and understanding of the portfolio by stakeholders. In order to acknowledge contextual factors, we made sure that all study stages were discussed within the research team. In that way, we could secure consideration of the perspectives and experiences present in the research team. These differed due to our professional backgrounds - psychology (RG, AT), educational science (MS, BT, SH), health science (SH) and medicine (BT, AK, NS) - and our own involvement with portfolios, as developer (MS, BT, AK, SH), user (AT works as faculty member), or researcher (all authors). Moreover, all authors had experience with qualitative research. RG undertook a two-day course concerning focus groups.
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