Models of portfolios

The use of portfolios to assess the clinical

competence of nurses, midwives, health

visitors and other health care profession-

als is now common practice across the

UK.1–4 But does a portfolio provide

educators and employers with real in-

sight into practitioners’ clinical ability or

does it simply show that they are good at

writing about what they do?5–7 We are

carrying out a study for the English

National Board for Nursing, Midwifery

and Health Visiting to evaluate �The use

of portfolios in the assessment of learn-

ing and competence�. Research has indi-

cated that the make-up of portfolios can

be very different and so far we have

identified four different models of port-

folio use in our case studies of nursing

programmes. These are:

• the shopping trolley;

• the toast rack;

• the spinal column;

• the cake mix.

Does a portfolio provide a real

insight into a practitioner’s

clinical ability, or does it simply

show that its author is good at

writing about what he or she does?

We are in the process of developing

the models based on stage two of our

fieldwork, which has involved inter-

views with students, teachers and edu-

cation managers, observation of course

boards, and analysis of curriculum and

quality assurance documents, external

examiners’ reports and a sample of

portfolios.

The key issue is whether portfolios

are valid forms of assessment of

learning and competence

In the shopping trolley model, stu-

dents collect a body of evidence about

their learning during the programme.

The portfolio here seems to be used as a

vehicle to contain anything that has been

used or produced during the learning

process. It may include, for example,

photocopies of journal articles, items of

coursework produced by the student,

policy or guideline documents used in

the specialty being studied, �thank you�letters from patients, reflective logs or

journals, records of meetings with men-

tors, and so forth. The choice is limited

only by what the student considers

appropriate and this form of portfolio is

not usually formally assessed. There is

rarely any overt linking strategy between

the components, other than section

headings, and the student is not expec-

ted to analyse the content against eval-

uative criteria. The function of the

portfolio is formative and its contents

may be confidential to the student, never

being seen by a teacher.

Keeping the portfolio may

amount to little more than ticking

boxes on proformas

The toast rack portfolio has a num-

ber of �slots� that must be filled for each

module ⁄ placement on a preregistration

diploma ⁄ degree programme. There is a

similar �rack� for each module and the

slices of toast to be inserted are speci-

fied in the curriculum document. These

may include action plans for the place-

ment, reflective accounts of critical

incidents occurring during the place-

ment, a list of discrete clinical �skills� in

which students should achieve �compet-

ence�, a checklist measuring attitudes

and behaviour, and a list of overall

outcomes closely paralleling national

guidelines for curricula and compet-

ence. Criteria are laid out so that grades

may be awarded for each kind of item.

These grades are awarded by placement

mentors, who attend a short preparation

session for this. At the start of the

programme, students are usually sup-

plied with a ring binder containing

enough copies of the requisite profor-

mas for all the toast rack slots for the

whole 3 years. As the entire programme

may consist of 36 or more modules, the

accumulated document becomes im-

mense and the portfolio (or collection

of toast racks) cannot be collected to-

gether in one ring binder.

The shopping trolley contains

anything that has been used or

produced during learning

In contrast to the shopping trolley,

the items ⁄ slices of toast are specified

and each one is formally assessed ac-

cording to predetermined criteria. How-

ever, each item remains discrete: there is

no linking between items and thus there

is no overall assessment of learning

and ⁄ or competence.

The toast rack has a number of

slots into which slices of toast are

inserted

With the cake mix, however, there is

integration or blending of the parts – the

separate ingredients – to form a whole

portfolio cake. Students are expected to

provide evidence to demonstrate that

they have achieved their learning outcomes

whilst on placement. To achieve this

�mixing�, they provide reflective com-

mentaries addressing analytical criteria.

In short, whilst there is a collection of

individual ingredients, what emerges as

the �cake� at the end of the process is more

than the sum of the parts.

Correspondence: Christine Webb, University of

Plymouth, Institute of Health Studies, Exeter,

EX2 EAS, UK. E-mail: c1webb@plymouth.

ac.uk

Commentaries

� Blackwell Science Ltd MEDICAL EDUCATION 2002;36:897–898 897

The cake mix involves blending

of parts to form a whole portfolio

cake

In the spinal column model, a series

of competency statements ⁄ vertebrae

form the central column of assessment.

The evidence collected by the students

to demonstrate their achievement can

be compared to the nerve roots entering

the vertebrae. It is likely that each piece

of evidence is used only once against a

certain competency statement. If the

same material is used more than once,

then the student will be required to

reproduce it in the appropriate area of

the spinal column. Thus, while each of

the vertebrae ⁄ competences has its own

unique evidence ⁄ material, collectively

they build up the skeletal framework to

which other parts of the programme can

be, but are not always, attached. This

model is, therefore, particularly appro-

priate for the assessment of clinical

competence by direct observation. With

the other models, clinical competence

assessment may be obtained by student

self-report, with obvious implications

for validity.

These four models are intended as

heuristic devices to identify the distinct

features of portfolios in the four case

studies, and are probably not exhaustive

of the possible range of models. The key

issue is whether they are valid forms of

assessment of learning and competence.

Some of the models, most notably the

toast rack, include no overall reflection

on or critique of the learning that has

occurred – which some educators regard

as the process through which real learn-

ing takes place.8 Without this, keeping

the portfolio may amount to little more

than ticking boxes on proformas. Is this

appropriate to a competency curricu-

lum, which is the most recent type of

preregistration nursing programme? Are

different models suited to different types

of programme, for example pre- and

postqualifying, or those not leading to a

�licence to practise�? Which model

would be most suitable for a problem-

based curriculum? These are questions

to be explored further in the final stage

of the project, which will involve obser-

ving students working with their place-

ment mentors ⁄ assessors in clinical areas

to evaluate how portfolios are used in

practice.

Christine Webb

Exeter, UK

Ruth Endacott

Latrobe, Australia

Morag Gray

Edinburgh, UK

Melanie Jasper

Portsmouth, UK

Carolyn Miller

Brighton, UK

Mirjam McMullan

Plymouth, UK

Julia Scholes

Brighton, UK

References1 English National Board for Nursing

Midwifery & Health Visiting. Professional

Portfolio. London: ENB; 1991.

2 Rane-Szostack D, Robertson J. Issues in

measuring critical thinking: meeting the

challenge. J Nursing Education

1996;35:1,5–10.

3 Sorrell J, Brown H, Silva M, Kohlenberg

E. Use of portfolios for interdisciplinary

assessment of critical thinking outcomes

of nursing students. Nursing Forum

1997;32:4,12–24.

4 Brown R. Portfolio Development and

Profiling for Nurses. Lancaster: Quay;

1992.

5 Finlay I, Maughan T, Webster D. A

randomized controlled study of portfolio

learning in undergraduate cancer edu-

cation. Med Educ 1998;32:2,172–6.

6 Snadden D, Thomas ML, Griffin EM,

Hudson H. Portfolio-based learning and

general practice vocational training. Med

Educ 1996;30:2,148–52.

7 Jasper M. The potential of the profes-

sional portfolio for nursing. J Clin Nur-

sing 1995;4:249–55.

8 Baume D. A Briefing on Assessment of

Portfolios. York: Learning & Teaching

Support Network; 2001.

Models of portfolios • C Webb et al.898

� Blackwell Science Ltd MEDICAL EDUCATION 2002;36:897–898