Global differences in electronic portfolio utilization - a review of the literature and research implications.

The philosophy and overall structure of medical education and knowledge assessment have undergone dramatic transformations over the last fifteen years, highlighted by the shift from summative-driven assessment methods to competency-based techniques that foster reflective learning and professional growth. Assessment of educational and clinical success in this new paradigm, although crucial, is challenging as historically assessments have been based on summative-driven methods like standardized tests and subjective instructor assessments [1,2]. The days of traditional numerical grades and pass-fail hierarchies which medical students were so accustomed are being replaced by self-assessment, introspection, and appraisal of achievements in core competencies [3-10]. To be successful, competency-based medical education (CBME) necessitates a robust and multifaceted assessment system with assessment processes that are more continuous, frequent, criterion-based, and developmental. We should use tools that meet minimum requirements for quality, and have both quantitative and qualitative measures [4]. Although this transition to competency-based medical education has the obvious potential of engendering more well-roundedness and professional maturity, the optimal methodology for assessing attainment of these competencies is less transparent [2-9]. One technique proven to be successful in reliably assessing student achievement in this new educational paradigm is the electronic portfolio (e-portfolio) [5,10-12]. The e-portfolio is a collection of electronic evidence assembled and managed by an end user usually on the web that has the ability to longitudinally capture and visually display competency attainment data over time, has naturally gained popularity in the competency-based medical education arena. Many countries across the globe have already tapped into the inherent advantages of e-Portfolios, and implemented them into their medical education curriculum [13-15]. Sanchez Gomez et al. describes an e-portfolio initiative for medical students at The University of Seville that provides quantitative feedback that can be chronologically followed over time to monitor student progress. When surveyed, all of the students answered affirmatively that the e-portfolio tracked and guided their learning process, and indicated their outstanding competency deficiencies [13]. A similar report by Vernazza et al. describes a cutting-edge e-portfolio that was developed as a web-based system with access granted to students via laptops connected to a wireless network. The perceived benefits by students was that the e-portfolio allowed for additional quantity, quality, manipulation, and trending of data than previous assessment techniques [14]. Other countries around the world including the Netherlands, United Kingdom, Taiwan, and South Africa have reported implementing similar competency-based e-portfolios [14-17]. Typically, electronic portfolios are online programs with links to Web tools that allow documentation of students’ learning and assessment, while acting as a forum to showcase skills, progress, and reflections. In essence, it acts as a platform to encourage students to manage their own career planning and skill development, while offering instructors the ability to chronologically track progress and competency attainment over time [12,14]. When compared to paper-based portfolios, el-portfolios offer better customization, ease for data manipulation, and increased ability to share and transfer [12,14]. In fact, when compared head-to-head, users unanimously agree that e-portfolios are easier to use as they allow faster retrieval of evidence through hyperlinks, and enable access from a variety of sites at the instructor’s convenience [10-12]. Due to its unique ability to interactively engage students in professional development and the educational process, while simultaneously providing instructors with dynamic tools to track competency assessment, many countries worldwide have started implementing e-portfolios into their curriculum. Chen et al. describes an interactive and digitalized electronic portfolio system in Taiwan used to track emergency medical education competency attainment by allowing students to register, analyze, and reflectively comment on at least ten cases per day. The authors concluded that their e-portfolio enhanced competency analysis and curriculum improvement, due in large part to its innovative competency tracking functionality [15]. Sanchez Gomez et al. describes an e-portfolio, capable of automatically displaying competency feedback and providing numerical visualization of progress, that assesses medical students at The University of Seville. As described, this e-portfolio is web-based, available online via all standard browsers, and accessible via the institution’s web environment by individual username and password. In addition, this system collects and displays evidence of learning from numerous sources such as texts, presentations, images, photographs, and videos, which students can upload using laptops, tablets, smartphones, and other devices. The students that used this e-portfolio were overwhelmingly supportive, with all students reporting an improved understanding of their learning objectives due to the numerical visualization of progress. The authors concluded that their e-portfolio was highly successful in guiding students’ learning process by indicating competency gaps to themselves and teachers [13]. Scheele et al. describes major educational reforms in the Netherlands, featuring an electronic portfolio system used to assess competency attainment. In this system, medical trainees regularly gather evidence of their personal and professional development and store it in an electronic portfolio, which is shared and reviewed with educational supervisors every three months. The result is a clear two-dimensional picture of students’ progress over time that supervisors can use to assess proficiency and competency fulfillment [17]. Finally, Vernazza et al. describes the successful implementation of a web-based e-portfolio system introduced for undergraduate students in the United Kingdom, which is accessed via laptops connected to an institutional wireless network. This robust system generates large volumes of competency data by allowing regular student participation, often several times daily. The consensus among the students and supervisors that utilized this system was that it is user-friendly, provides large quantities of high-quality data, allows for better data manipulation as compared to paper-based systems, and gives accurate assessments of students’ progress toward competency attainment over time [14]. Despite the widespread use of e-portfolios around the globe in evaluating and longitudinally trending student aptitude, the literature review suggests that institutions in the United States may be lagging behind their global counterparts in the use of innovative competency assessment methodologies [2]. For example, Fishleder et al. described a hybrid electronic and paper portfolio system at the Cleveland Clinic Lerner College of Medicine used to assess undergraduate medical students in nine competency areas. The e-portfolio portion of the system, accessed via laptop computers, allows students to log patient encounters and receive competency-specific encounter-based feedback from faculty to refine their clinical skills. However, the electronic system that is described seems to evaluate students at isolated time periods throughout the five-year program, without the ability to trend, longitudinally track, and illustrate competency attainment, like the electronic systems of other countries [7,9]. Furthermore, a literature review by Carracio et al. investigating e-portfolios in the United States uncovered limited evidence regarding the use of e-portfolios in medical education, with only two descriptions of residency programs and no undergraduate medical schools, utilizing electronic portfolios for assessment of competency-based medical education. Moreover, the e-portfolios that are discussed are not described as having the ability to longitudinally display competency attainment like the electronic portfolio systems of other countries [5]. Thus, it appears through review of the e-portfolio literature that e-portfolios are being used less frequently and are less innovative in the United States than in other countries. Across the globe, medical education has undergone dramatic transformations over the last fifteen years, highlighted by transitions in assessment techniques from traditional summative methods to competency-based approaches. One competency-based assessment technique that has gained popularity, with its ability to store large amounts of data and visually depict and track competency attainment over time, is the e-portfolio. Numerous reports show that many countries outside of the United States appear to have tapped into this robust assessment tool, detailing widespread success and satisfaction. On the contrary, similar reports from American medical schools are lacking. The purpose of this article is to inspire future research endeavors that investigate these international dissimilarities by exploring the current-state makeup of e-portfolios in American medical schools to determine whether the research, innovations, and successes of our global counterparts are being implemented.