The development and evaluation of a portfolio of learning in the workplace for postgraduate family medicine education in South Africa

Jenkins, Louis S. (2014-04)

Thesis (PhD)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: A portfolio of learning is one way of showing evidence of performance over a period of time. Worldwide, the need for social accountability and health services reforms has led to an increased interest in competency-based medical education with specific outcomes. Postgraduate training increasingly focuses on life-long adult learning, placing emphasis on close supervision with feedback and workplace-based assessment. South Africa, although better resourced, faces many similar socio-political and health services challenges as the rest of Africa. The democracy is less than 20 years old, with 80% of the previously disadvantaged population now having access to health services. In this new era medical schools have aligned their curricula to focus on patient-centred primary health care. The huge demand for appropriately trained family physicians has become a national priority. Subsequently, the College of Family Physicians of the Colleges of Medicine of South Africa developed a national exit examination for postgraduate family medicine training. One component of the examination is the submission of a satisfactory portfolio of learning. The aim of this thesis was to develop a national portfolio for postgraduate family medicine education in South Africa. It needed to be valid, acceptable, useful for learning, and be assessed in a reliable way. The research process involved a collaboration with registrars, supervisors and programme managers from all eight medical schools in the country over four years and culminated in the first national portfolio for family medicine in the country. The thesis was done by way of publication, which involved four articles being published in international journals, outlining the development, implementation and assessment of our portfolio. Content and construct validity of the draft portfolio was established through a Delphi process. Subsequently, the portfolio was implemented at all eight medical schools. Workshops over two years at all the universities facilitated implementation and provided feedback on the use of the portfolio across the country. After implementation of this initial portfolio, the acceptability, educational impact, and usefulness for assessment were evaluated through a national survey and in-depth interviews. A portfolio assessment tool was developed and its reliability was established for the overall score. The assessment tool has also been implemented nationally. The portfolio’s requirements have made the expectations and challenges of workplace-based learning and assessment more visible, with supervision, safe learning environments and more user-friendly learning and assessment tools needing further research.

AFRIKAANSE OPSOMMING: ‘n Portefeulje met bewyse van opleiding is een manier om bevoegdheid en prestasie oor ‘n periode van tyd te demonstreer. Sosiale verantwoordelikheid en hervormings in gesondheidsdienste wêreldwyd het gelei tot vaardigheids-gebaseerde mediese opvoeding met spesiefieke uitkomste. Nagraadse opleiding fokus toenemend op lewenslange volwasse leermetodes met ‘n groot klem op nabye toesig, terugvoer en werksgebaseerde evaluasies. Alhoewel Suid-Afrika beter toegerus is as meeste lande in Afrika, staar die land baie soortgelyke sosiaal-politiese en gesondheids uitdagings in die gesig. Met die jong demokrasie van 20 jaar het 80% van mense wat voorheen nie toegang gehad het tot goeie gesondheidsdienste nie nou wel toegang. Mediese skole het hul kurrikulums aangepas om te konsentreer op pasient-gefokusde primêre gesondheidsorg. Die Kollege van Huisartse van die Kolleges van Geneeskunde van Suid-Afrika het ‘n nasionale eksamen vir nagraadse opleiding in huisartskunde in die land geimplementeer. Een van die komponente van die eksamen behels die inhandiging van ‘n bevredigende opleidingsportefeulje. Die doel van hierdie tesis was om ‘n nasionale portefeulje vir nagraadse opleiding in huisartskunde in Suid-Afrika te ontwikkel. Die portefeulje moes geldig en aanvaarbaar wees, asook nuttig vir leer en ook op ‘n betroubare manier evalueer kon word. ‘n Proses van samewerking tussen kliniese assistente, toesighouers en programbestuurders van al agt mediese skole in die land oor ‘n periode van vier jaar het die eerste nasionale opleidingsportefeulje vir huisartskunde in Suid-Afrika die lig laat sien. Hierdie is ‘n tesis by wyse van publikasie deur vier artikels wat in internasional journale verskyn het, wat die ontwikkeling, implementering, en evaluering van die portefeulje beskryf. Die geldigheid van die inhoud en samestelling van die portefeulje was ontwikkel deur ‘n Delphi proses. Nadat die portefeulje geimplementeer was, was die aanvaarding, leerimpak en nuttigheid vir evaluering ondersoek deur ‘n nasionale opname en in-diepte onderhoude. Werkswinkels by al die universiteite het die geldigheid en implemetering van die portefeulje verder versterk. ‘n Instrument om die portefeulje te evalueer was ontwikkel en in gebruik geneem landwyd, en betroubaarheid van die totale telling was bewerkstellig. Die behoeftes van die portefeulje het die verwagtinge en uitdagings van werksgebaseerde opleiding en evaluering meer sigbaar gemaak, met toesighouding, veilige leeromgewings en meer gebruiksvriendelike leer- en evalueringsinstrumente as areas identifiseer wat aangaande navorsing benodig.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/86358
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