Of 53 students available at the time of the project, 32 agreed to participate in the focus groups (60%). They represented each year of study other than 5th year: due to the timing of the study, 5th year students had finished their MBChB.
The focus group discussions ranged from 40-60 minutes in length.
Three main themes relevant to the task of effectively introducing a PPD portfolio, emerged. These are set out below.
Information and support needs
The data indicated that most students wanted a clear explanation of the purpose of a portfolio, in a format which incorporated opportunity for questions, such as a lecture or tutorial. Written guidance was also seen as essential to supplement the introduction of a portfolio, and several students said the content should include worked examples and links to further resources: "I think if you had an example of a filled in portfolio, kind of the good, the bad and the ugly..."
Student views on the format of a portfolio were mixed. Some students preferred a traditional paper portfolio that could be viewed in its entirety, while others wanted an online platform which would provide reminders as to completing portfolio tasks (and which would not get lost): "I appreciate something in front of me, rather than online. But then I can see the advantages of having something online so you can go straight to wherever it is you want to go to."
The majority of students were anxious about writing reflectively and wanted support in this, and feedback on early reflective exercises in order to improve their skills, if required, for future exercises.
Students felt that tutor-led small group sessions for portfolio support would be useful if these facilitated honesty and openness about their experiences. However, there were some concerns about competitiveness, group interaction and the potential for inequality in group contributions raised by a minority of students. For example, "We're all in competition with each other for careers, that sounds horrible but that's what it's like so I don't think many people would be willing to contribute much to that kind of group work." "I just annoys me if you look at all the people in my class, who're always late and never bother turning up, why should I sit there and help them?"
Tutor characteristics were consistently reported as important to students: they should be enthusiastic and have experience of using a portfolio themselves.
"Think it would have to be people who wanted to actually be involved."
"Someone who has kept a really good portfolio themselves, who wants to do it."
Use of peer-led (e.g., older students) tutorials was viewed less positively: "I don't know how much experience they would have compared to a doctor...."
There was some concern from many students about the potential workload involved in a portfolio and how this would be integrated with their other commitments. Assessment of a portfolio was also a concern (as yet another method of assessment) but, on the other hand, some form of assessment was seen as motivating.
"I don't think reflection's something you can assess, y'know like an exam, you can assess someone's memory, test their memory but I don't think you can test reflection. Quite a personal thing." "At least that ensures that students will take it seriously."
However, some participants discussed how assessment of portfolio content may encourage students to write socially acceptable or perceived "correct" answers.
"Again with the portfolio thing you are just going to end up saying, become good at writing essays which is exactly what they want to hear it I think."
A pass/fail system where a fail would constitute a poor effort as opposed to a judgement of the content, was the favoured method of assessment from the majority of participants: "But people who've made an absolute shocking or shabby attempt at it..." "Cause as it is all quite personal things, can't say that's wrong, right or wrong."
Students found it difficult to provide a definition of reflective learning. While one or two participants were able to articulate the need to think about learning experiences (Schon's reflection on action [19
]), no one revealed a deep understanding of the process and its potential benefits.
"It's learning from your mistakes. But it's also learning from what you've done well and why."
Indeed, many comments were negative with some asking whether this was a skill that could be taught at all and others suggesting that formalised reflection was inappropriate.
"I think it's something that you do off your own back; it's not really something that you can integrate into a course." "I don't know if you can really teach people how to reflect. Surely you just do that."
For example, several students commented that reflection on an individual task was done almost unconsciously: "...in a real life situation if you make a mistake, if you I don't know prescribe the wrong drug or y'know harm a patient, you're going to reflect on that anyway, if you're a competent doctor and learn from your mistakes so I don't find it particularly useful writing down." Whilst a few students recognised some potential value in reflection, some students felt that they would face difficulties in reflecting, particularly worrying that they may become over-critical of themselves.
"It's not necessarily good though if you're the type of person who's really hard on themselves because like, you're not going to, like, benefit from it, it's just going to make you doubt yourself, even more than you already do." When this was explored further, they discussed how developing such skills as an undergraduate would be of use when they came to work as a foundation doctor.
"I got the impression from the start that portfolios were just for practice of doing portfolios before we actually have to do them for our job."
Benefits of the portfolio
Students were then given an example of portfolio content to illustrate some of the potential benefits. The potential advantages in having skills and material to aid in completing foundation programme application were widely perceived as important.
"I agree if it was emphasised from the beginning, you know this is going to be helpful and you know you will need to answer these type of questions when you're applying for your first post, I think people would spend more time on it and it would be sort of seen that there's a purpose to it."
Other benefits of the portfolio included the view that a portfolio would prepare the students for when they came to use portfolios in future (when working as a doctor) and that they could use the portfolio as a useful record of non-academic achievements such as extra-curricular activities. For example, "It's good to get into the mind-set because we'll have to do this, I assume, all the way through." Overall, benefits were perceived in terms of concrete outcomes such as job applications or making post graduate life easier. Understanding of portfolio based learning as a learning tool and for personal development was lacking.