Evidence-guided approach to portfolio-guided teaching and assessing communications, ethics and professionalism for medical students and physicians: a systematic scoping review

OBJECTIVES

Guiding the development of longitudinal competencies in communication, ethics and professionalism underlines the role of portfolios to capture and evaluate the multiple multisource appraisals and direct personalised support to clinicians. However, a common approach to these combined portfolios continues to elude medical practice. A systematic scoping review is proposed to map portfolio use in training and assessments of ethics, communication and professionalism competencies particularly in its inculcation of new values, beliefs and principles changes attitudes, thinking and practice while nurturing professional identity formation. It is posited that effective structuring of portfolios can promote self-directed learning, personalised assessment and appropriate support of professional identity formation.

DESIGN

Krishna's Systematic Evidence-Based Approach (SEBA) is employed to guide this systematic scoping review of portfolio use in communication, ethics and professionalism training and assessment.

DATA SOURCES

PubMed, Embase, PsycINFO, ERIC, Scopus and Google Scholar databases.

ELIGIBILITY CRITERIA

Articles published between 1 January 2000 and 31 December 2020 were included.

DATA EXTRACTION AND SYNTHESIS

The included articles are concurrently content and thematically analysed using the split approach. Overlapping categories and themes identified are combined using the jigsaw perspective. The themes/categories are compared with the summaries of the included articles in the funnelling process to ensure their accuracy. The domains identified form the framework for the discussion.

RESULTS

12 300 abstracts were reviewed, 946 full-text articles were evaluated and 82 articles were analysed, and the four domains identified were indications, content, design, and strengths and limitations.

CONCLUSIONS

This review reveals that when using a consistent framework, accepted endpoints and outcome measures, longitudinal multisource, multimodal assessment data fashions professional and personal development and enhances identity construction. Future studies into effective assessment tools and support mechanisms are required if portfolio use is to be maximised.

Portfolio use in postgraduate medical education: a systematic scoping review

BACKGROUND

Portfolios are increasingly commonplace in postgraduate medical education. However, poor understanding of and variations in their content, quality, and structure have hindered their use across different settings, thus dampening their efficacy.

METHODS

This systematic scoping review on portfolios in postgraduate medical education utilized Krishna's Systematic Evidence Based Approach (SEBA). Braun and Clarke's thematic analysis and Hsieh and Shannon's directed content analysis were independently used to evaluate the data.

RESULTS

In total, 12 313 abstracts were obtained, and 76 full-text articles included. Six key themes/categories were identified: (i) portfolio definitions and functions, (ii) platforms, (iii) design, (iv) implementation, (v) use in assessments, and (vi) evaluations of their usage.

CONCLUSIONS

Portfolios allow for better appreciation and assessments of knowledge, skills, and attitudes in time-, learner-, and context-specific competencies through the establishment of smaller micro-competencies and micro-credentialling. Organized into three broad stages-development, implementation, and improvement-a six-step framework for optimizing and instituting portfolios in postgraduate medical education is offered.

Impending spontaneous tracheal rupture due to steroid use

A spontaneous tracheal rupture is rare and life-threatening. We postulate that long-term steroid administration is an under-reported risk factor. We present a case of an impending spontaneous tracheal rupture in a 51-year-old female with a significant medical history of systemic lupus erythematosus and interstitial lung disease, and a drug history of chronic steroid intake for 9 months. An impending tracheal rupture was diagnosed by computed tomography, which prompted surgery. A right thoracotomy, followed by a posterior tracheal repair via an intercostal muscle flap, was done, with venovenous extracorporeal membrane oxygenation support throughout the operation.