By Anthony Donato, MD
I was first introduced to portfolios as assessment tools for internal medicine trainees six years ago at an ABIM conference. Using portfolios as a method to assess learner performance made a lot of sense to me for the arts and social science fields, where quantitative data may fail to capture the richness and uniqueness of a learner’s skills or needs. But it was less clear to me where portfolios could fit into the busy world of internal medicine training. Realizing that considerable effort would be required for both residents and faculty, I knew that I would encounter considerable resistance unless all parties were convinced that portfolios were worth the effort.
When I took a hard look at our mentoring program, I realized we potentially had a great match. Each resident in our program is assigned a full-time faculty mentor, with whom they meet three times a year to talk about progress toward career goals. I serve as one of those mentors; things we’d discuss included: How were they doing on the wards? What research were they pursuing? How were they balancing work and home life? What could I help them with to further their careers? The meetings were completely informal and unstructured.
To make the conversations more productive, I started sending my mentees reflective questions before our meetings, asking them to consider where they were in their careers and where they were trying to go. During the meetings, I would give them informal advice, and I would try to remember to ask them about their progress at the next meeting.
Unfortunately, we rarely got to high-level discussions because the residents had not been able to examine their goals and progress effectively. I thought, if I could get them to review their scholarly activity and research while updating their CVs, to review their ward, clinic and peer evaluations, OSCEs, Mini-CEXs, evidence-based medicine searches, critical incident writings, audits of their care, quality improvement projects, time management grids, and performance improvement plans — and maybe even write down reflections on these activities as well as what they wanted to work on, all in one place, hopefully electronically — and if I could have a look before we met… Perhaps we could get to a truly deep and worthwhile mentoring session, and perhaps I could become an even more effective resident coach.
Six years later, I could not be more pleased with the results. For my struggling residents, I can very easily assess their deficiencies as well as identify their personal insights into those problems; we can then spend our time together crafting mutually agreed-upon remediation plans. For the residents who excel, and who would sometimes coast when they got ahead of their peers, I can identify the milestones they are exceeding and redirect them to educational or research projects for continued growth. In reference letters, I can give rich details about residents’ competence that in the past I could not.
Portfolios are not easy tools to implement. Gradual, step-wise introductions to both faculty and residents are necessary, and even with that, I have found that 10 to 15 percent still will not actively participate. Residents must be convinced of the portfolio’s value to them personally to truly engage.
A robust mentoring program was critical to our success, because the mentor serves the role of champion as well as coach to individual learners.Facultymembers may not be familiar with portfolios, and will need significant training and experience to become comfortable with their use. I, for one, have found them well worth the effort: I have never been more effective as a mentor than I am now.
—Anthony Donato, MD is an academic hospitalist and an associate program director for internal medicine at The Reading Hospital and Medical Center in Reading, PA. He is currently pursuing his masters in Health Professions Education at the University of Illinois at Chicago, and has interests in educational innovation and humanities writing. He can be reached at firstname.lastname@example.org.