Physician Trainee Mistrust of the E-Portfolio and Workplace Based Assessment Process

ABSTRACT
Objective: The Electronic-portfolio (ePortfolio) has played a major role in postgraduate medical training in the United Kingdom (UK) for many years, having been created to help facilitate lifelong learning. Its use is multifaceted in supporting development through formative and summative assessment, quality assurance and promotion of self-reflection in order to enhance future performance. A recent high profile medicolegal case in the UK illuminated pre-existing issues with the ePortfolio. This study, contacted at the time when the medico legal case was in the appeals process, aimed to establish trainees’ experiences of the ePortfolio, including their perceptions of the trust they held in the system.

Methods: As part of a larger study into physician trainees’ perceptions of workplace
based assessments value, physician specialty trainees (n=14) attended two focus
groups to discuss their perceptions of the ePortfolio process. Grounded Theory
methods were applied. Data analysis commenced immediately following collection of
the first focus group transcript, in line with Grounded Theory principles (Glaser, 1978).
This supported theoretical sampling; allowing the initial data to be used to inform the
subsequent steps taken. Line by line coding and memo writing was used throughout,
with themes being generated directly out of the data and analysis continuing until
theoretical saturation was achieved.

Results: Participants identified both benefits and limitations of the ePortfolio. Key
concerns related to the permanency of documentation and the potential for negative
training, and subsequent career progression implications. The publicised medicolegal
case challenged participant trust in the system, with individuals reporting concerns
that the ePortfolio suppressed wider organisational issues.

Conclusion: Participants identified several factors which appear to impact upon trust
of the ePortfolio, which may potentially subvert any benefits associated with its use.
Permanency of documentation of suboptimal performance and the identification
of inherent biases existing in the ePortfolio appear to be the major driving concerns
which threaten optimal engagement with the ePortfolio. The introduction of clearer
guidelines for reflective practice and ePortfolio engagement may enhance future trust in the ePortfolio.