|LETTER TO THE EDITOR
|Year : 2012 | Volume
| Issue : 1 | Page : 75-76
The Development of a Cardiovascular System Portfolio: Challenges Faced and Lessons Learned
Priyanga Ranasinghe, Yashasvi S Perera, Godwin R Constantine
Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
|Date of Submission||26-Jun-2010|
|Date of Revision||21-Jan-2012|
|Date of Acceptance||11-Apr-2012|
|Date of Web Publication||30-Jul-2012|
Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ranasinghe P, Perera YS, Constantine GR. The Development of a Cardiovascular System Portfolio: Challenges Faced and Lessons Learned. Educ Health 2012;25:75-6
A professional development portfolio is "a collection of material, made by a professional that records and reflects key events and processes in his/her career."  Portfolios were originally used in arts-based subjects as a means for individuals to put together examples of their work for assessment or for prospective employers. Portfolio-based learning has gained increasing popularity in medical curricula. The three main purposes for which medical schools use portfolios are: as an assessment tool; as a record of achievement held by students for their own use; and as evidence for continuous professional development. Portfolio learning has a number of benefits which include: encouraging professional learning; promoting self-development; encouraging reflective practices and self-evaluation; providing a framework for assessment; catering for variations in learning styles; helping to identify relationships between theory and practice; and providing a framework for continuing professional development.  Traditionally medical students have found it difficult to make the links between university and clinical-based skills' learning. The use of portfolios helps students to identify and meet their learning needs and build an educational plan for the future.  Thus, it helps to bridge the gap between university teaching and clinical training. Past work has demonstrated that students using portfolios obtain higher marks in factual knowledge than a control group of students not using portfolios.  Over the past 10 to 15 years, there has been introduction of portfolios into all stages of undergraduate medical education. 
Students graduating from the Faculty of Medicine, University of Colombo, Sri Lanka, complete a 5-year training programme. The curriculum is subdivided into five main streams, initially starting from the Introductory Basic Sciences Stream (IBSS), followed by Applied Sciences Stream, and Clinical Stream. The Community Sciences and Behavioural Sciences Streams are spread throughout the 5 years. The Applied Sciences Stream, which starts immediately after the IBSS, consists of different modules; the cardiovascular systems module is one of the initial modules. Our current work demonstrates how a cardiovascular portfolio was developed for medical undergraduates of our faculty and shares some tips/guidelines for those clinical staff interested in developing self-directed learning programs using portfolios. The cardiovascular system was selected as the theme for this pilot project for a number of reasons: the module teaching commences in the third year, i.e., during the early phase of clinical training; students commonly encounter cardiovascular disease patients, procedures, and emergencies; and it is an area frequently assessed at faculty examinations.
The initial step was to identify the target group, determine their needs, set program goals and objectives, and identify stakeholders in the portfolio development process. Medical students engaged in clinical training (3 rd to 5 th year) were the target group. A needs assessment using a survey approach was conducted in a cohort representative of this group (n = 60, randomly selected students from the cohort). The stakeholders identified were academic staff involved in cardiology training (Department of Clinical Medicine, Faculty of Medicine and Institute of Cardiology, National Hospital of Sri Lanka) and medical educators (Medical Education Development and Research Centre/MEDARC).
After triangulation of data which were collected from the target group and stakeholders, goals, objectives, and outcomes of portfolio development were developed. A working committee of six people consisting of a nominated coordinator from each stakeholder group was involved in the portfolio development process. The final portfolio contained the following sections:
- Goals, objectives and outcomes
- Introduction on how to use the portfolio
- Sections i−v:
- Procedures: measuring blood pressure; measuring jugular venous pressure; venepuncture; venous cannulation; central venous catheterization; and arterial puncture
- Investigations: echocardiogram and electrocardiogram
- Emergencies: cardiopulmonary resuscitation; hypertensive emergency; acute left ventricular failure; acute myocardial infarction; and cardiac arrhythmias
- Cardiovascular long cases: hypertension; heart failure; ischaemic heart disease; and infective endocarditis
- Approaching a cardiovascular short case.
Students were expected to complete three clinical attachments where they were exposed to cardiovascular clinical training with increasing difficulty and complexity of exposure [Table 1].
|Table 1: Clinical Attachments in Cardiovascular Training of Students in Clinical Years at the Faculty of Medicine, Colombo, Sri Lanka|
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The students resume activities of the cardiovascular portfolio at the beginning of the General Medicine-I clinical attachment, and are expected to complete the portfolio by the end of the General Medicine-II clinical attachment. The students' work is closely supervised by the clinical teaching staff. The staff members involved in mentorship include physicians, cardiologists, senior registrars, and registrars. Regular training of mentors on portfolio supervision is provided by the MEDARC and Department of Clinical Medicine. A formative and summative assessment of students is conducted at the completion of the General Medicine-II clinical attachment by academic staff involved in clinical cardiology training from all three partnering stakeholders: Department of Clinical Medicine, Faculty of Medicine, Colombo, Sri Lanka; Institute of Cardiology, National Hospital of Sri Lanka; and medical educators (MEDARC).
In conclusion, portfolio-based learning represents a model of educational development and review that is consistent with current adult learning theory. It is becoming a common practice in many areas of higher education and professional development, including medical education. However, development of a portfolio is not without its challenges. Since introduction into medical education in the early 1990s, portfolios have been the subject of educational research. The evidence to date suggests that they have resulted in mixed success. , Factors associated with the success of portfolios are: goals need to be clearly defined;  portfolio use in the curriculum is integrated with other educational activities; , use of mentoring enhances effectiveness and appears to be crucial for success;  portfolio assessment must be a part of institutional assessment procedures; and a flexible learner-centered approach in portfolio format is preferred over a rigid structure, which can elicit negative reactions from users. 
The cardiovascular portfolio at the Faculty of Medicine, Colombo, Sri Lanka, was developed in line with the above-mentioned success factors. However, evaluation of students' perceptions following implementation of portfolios, still to come, will provide insight into the degree to which this educational tool has aided their learning and development. This will require further evaluation by our clinical educators.
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