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During placements abroad, healthcare students are confronted with different personal and professional challenges, related to participation in practice. This study investigates when and how students respond to such challenges, and which coping and support mechanisms students use to overcome these. Twenty-five international students shared their experiences about physiotherapy placement in The Netherlands. Using a critical incident technique, we asked participants to recall events where participation was affected by an unforeseen situation, in or outside the clinic. Further, we explored students' strategies of seeking support within their social network to overcome individual challenges. Two researchers applied thematic analysis to the interview data, following an iterative approach. Team discussions supported focused direction of data collection and analysis, before conceptualizing results. Participants described a wide range of challenges. The scope and impact level of challenges varied widely, including intercultural differences, language barriers and inappropriate behaviour in the workplace, students' personal context and wellbeing. Mechanisms employed by students to overcome these challenges depended on the type of event (personal or professional), making purposeful use of their available network. Students involve clinical staff, peers, family and friends during placement abroad, to make deliberate use of their support network to overcome challenges in participation, whereas the academic network remains distant. Findings may help reflect on the roles and responsibilities of academic staff and other professionals involved with placements abroad. Healthcare programmes should ensure support before, during and after placement is within students' reach. [ABSTRACT FROM AUTHOR]

Early curricular exposure to interprofessional education (IPE) is intended to acclimatize health professional trainees to shared-care in the practice settings they will ultimately join. However, IPE activities typically reside outside actual organizational and social systems in which interprofessional care is delivered. We aimed to explore how pharmacist trainees experience collaborator and communicator competency roles during team-based workplace-based learning. Participants maintained written diaries reflecting on interprofessional collaboration and communication during an eight-week hospital clerkship. Diary entries and transcripts from semi-structured follow-up interviews were analyzed from the social constructivist perspective using reflective thematic analysis. Participant accounts of on-ward activities represented most collaborator and communicator roles outlined in pharmacy and interprofessional competency frameworks, but were predominantly between the pharmacist trainee and physicians. Pharmacist trainees did not routinely engage with other health professions on a daily basis. Additionally, reported encounters with other team members were typically information exchanges and not episodes of authentic interdependent or shared care. Interactions were almost completely devoid of perceived interpersonal or role conflict. These findings offer insight into how pharmacist trainees perceive and develop competencies for team-based care. Further work is required to understand how such limited scope of interprofessional communication and collaboration might ultimately impair quality patient care. [ABSTRACT FROM AUTHOR]

Clinical supervisors acknowledge that they sometimes allow trainees to fail for educational purposes. What remains unknown is how supervisors decide whether to allow failure in a specific instance. Given the high stakes nature of these decisions, such knowledge is necessary to inform conversations about this educationally powerful and clinically delicate phenomenon. 19 supervisors participated in semi-structured interviews to explore how they view their decision to allow failure in clinical training. Following constructivist grounded theory methodology, the iteratively collected data and analysis were informed by theoretical sampling. Recalling instances when they considered allowing residents to fail for educational purposes, supervisors characterized these as intuitive, in-the-moment decisions. In their post hoc reflections, they could articulate four factors that they believed influenced these decisions: patient, supervisor, trainee, and environmental factors. While patient factors were reported as primary, the factors appear to interact in dynamic and nonlinear ways, such that supervisory decisions about allowing failure may not be predictable from one situation to the next. Clinical supervisors make many decisions in the moment, and allowing resident failure appears to be one of them. Upon reflection, supervisors understand their decisions to be shaped by recurring factors in the clinical training environment. The complex interplay among these factors renders predicting such decisions difficult, if not impossible. However, having a language for these dynamic factors can support clinical educators to have meaningful discussions about this high-stakes educational strategy. [ABSTRACT FROM AUTHOR]

Differences in professional practice might hinder initiation of student participation during international placements, and thereby limit workplace learning. This study explores how healthcare students overcome differences in professional practice during initiation of international placements. Twelve first-year physiotherapy students recorded individual audio diaries during the first month of international clinical placement. Recordings were transcribed, anonymized, and analyzed following a template analysis approach. Team discussions focused on thematic interpretation of results. Students described tackling differences in professional practice via ongoing negotiations of practice between them, local professionals, and peers. Three themes were identified as the focus of students' orientation and adjustment efforts: professional practice, educational context, and individual approaches to learning. Healthcare students' initiation during international placements involved a cyclical process of orientation and adjustment, supported by active participation, professional dialogue, and self-regulated learning strategies. Initiation of student participation during international placements can be supported by establishing a continuous dialogue between student and healthcare professionals. This dialogue helps align mutual expectations regarding scope of practice, and increase understanding of professional and educational practices. Better understanding, in turn, creates trust and favors meaningful students' contribution to practice and patient care. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsInternational Medical Programmes (IMPs) form a distinctive modality in medical education, with diverse student populations, English as a language of instruction and ‘globalized’ curricula. A lack of common understanding of IMPs’ purposes and role in the medical education landscape triggers critiques. This study aims to document the effects of different discourses used to justify the purpose of IMPs.We use a discourse analysis approach to explore the different ways in which the purposes of IMPs are constructed at the regulatory, institutional, and individual level, and how these discourses interact. The research situates in two IMPs, in the Netherlands and in Hungary. Key-informant interviews, policy documents, and scholarly literature form the archive.The purpose of IMPs is constructed discursively around three distinct narratives and associated practices: around serving the institutions that host them, around serving the (global) public interest, and around serving individual students. Co-existence and misalignments of these three discourses cause conflicting practices and confusion among stakeholders.This study illustrates how diverging perspectives on internationalization in medical education create tensions for learners and staff. Articulating a clear and explicit meaning to internationalization may reduce uncertainties, and may reinforce realistic expectations of what constitutes a good outcome. [ABSTRACT FROM AUTHOR]

Workplace-based assessment may be further optimized by drawing upon the perspectives of multiple assessors, including those outside the trainee's discipline. Interprofessional competencies like communication and collaboration are often considered suitable for team input. We sought to characterize multidisciplinary expectations of communicator and collaborator competency roles. We adopted a constructivist grounded theory approach to explore perspectives of multidisciplinary team members on a clinical teaching unit. In semi-structured interviews, participants described expectations for competent collaboration and communication of trainees outside their own discipline. Data were analyzed to identify recurring themes, underlying concepts and their interactions using constant comparison. Three main underlying perspectives influenced interprofessional characterization of competent communication and collaboration: (1) general expectations of best practice; (2) specific expectations of supportive practice; and (3) perceived commitment to teaching practice. However, participants seemingly judged trainees outside their discipline according to how competencies were exercised to advance their own professional patient care decision-making, with minimal attention to the trainee's specific skillset demonstrated. While team members expressed commitment to supporting interprofessional competency development of trainees outside their discipline, service-oriented judgement of performance loomed large. The potential impact on the credibility of multidisciplinary sources for workplace-based assessment requires consideration. [ABSTRACT FROM AUTHOR]

Students perceive reflective writing as difficult. Concept mapping may be an alternative format for reflection, which provides support while allowing students to freely shape their thoughts. We examined (1) the quality of reflection in reflective concept maps created by first-year medical students and (2) students' perceptions about concept mapping as a tool for reflection. Mixed-method study conducted within the medical curriculum of Maastricht University, The Netherlands, consisting of: (1) Analysis of the quality of reflection in 245 reflective concept maps created by 40 first-year students. Reflection quality was analysed by assessing focus of reflection (technical/practical/sensitising) and depth of reflection (description/justification/critique/discussion). (2) Semi-structured interviews with 22 students to explore perceived effectiveness of reflective concept mapping. Depth of reflection reached at least the level of critique in 82% of maps. Three factors appeared to affect the perceived effectiveness of concept mapping for reflection: (1) reflective concept map structure; (2) alertness to meaningful experiences in practice and (3) learning by doing. These results yielded supportive evidence for concept mapping as a useful technique to teach novice learners the basics of effective reflection. Meaningful implementation requires a delicate balance between providing a supportive structure and allowing flexibility for the student. [ABSTRACT FROM AUTHOR]

Construct: The globalization of healthcare has been accentuated by the export of health professional curricula overseas. Yet intact translation of pedagogies and practices devised in one cultural setting may not be possible or necessarily appropriate for alternate environments. Purposeful examination of workplace learning is necessary to understand how the source or "home" program may need adapting in the distributed or "host" setting. Background: Strategies to optimize cross-border medical education partnerships have been largely focused on elements of campus-based learning. Determining how host clinical supervisors approach assessment in experiential settings within a different culture and uphold the standards of home programs is relevant given the influence of context on trainees' demonstrated competencies. In this mixed-methods study, we sought to explore assessor judgments of student workplace-based performance made by preceptors sharing a pharmacy curriculum in Canada and Qatar. Approach: Using modified Delphi consensus technique, we asked clinical supervisors in Canada (n = 18) and in Qatar (n = 14) to categorize trainee performance as described in 16 student vignettes. The proportion of ratings for three levels of expectation (exceeds, meets, or below) was calculated and within-country group consensus achieved if the level of agreement reached 80%. Between-country group comparisons were measured using a chi-square statistic. We then conducted follow-up semi-structured interviews to gain further perspectives and clarify assessor rationale. Transcripts were analyzed using thematic content analysis. Results: The threshold for between-country group differences in assessor impressions was met for only two of the 16 student vignettes. Compared to Canadian clinical supervisors, relatively more preceptors in Qatar judged one described student as meets rather than exceeds expectations and one as meets rather than falls below expectations. Analysis of follow-up interviews exploring how culture may inform variations in assessor judgments identified themes associated with the profession, organization, learner, and supervisor performance theories but not their particular geographic context. Clinical supervisors in both countries were largely aligned in expectations of student knowledge, skills, and behaviors demonstrated in patient care and multidisciplinary team interactions. Conclusions: Our study demonstrated that variation in student assessment was more frequent among clinical supervisors within the same national context than any differences identified between the two countries. In these program settings, national sociocultural norms did not predict global assessor impressions or competency-specific judgments; instead, professional and organizational cultures were more likely to inform student characterizations of performance in workplace-based settings. Further study situated within the specific experiential learning contexts of cross-border health professional curricula is assuredly warranted. [ABSTRACT FROM AUTHOR]

Introduction: A new form of internationalization has been trending upward in the medical education realm: crossborder medical curriculum partnerships established to deliver the same, or adapted, curriculum to groups of geographically separated students. This study aims to investigate crossborder medical curriculum partnerships by exploring the experiences of teachers at the recipient institution who have a key role in delivering the program. Methods: From four pioneering recipient medical schools, 24 teachers participated in a Q-sort study. Each participant rank-ordered 42 statements about teaching in a crossborder medical curriculum on a scale from −5 (indicating strong disagreement) to +5 (indicating strong agreement). The authors conducted a "by-person" factor analysis to uncover distinct patterns in the ranking of statements, using the statistical results and participants' comments about their Q sorts to interpret these patterns and translate them into distinct viewpoints. Results: Three viewpoints emerged, reflecting: (1) a feeling of connectedness with the partner institution, trust in the quality of the curriculum, and appreciation of interinstitutional relationships; (2) the partnership's attractiveness because of the career opportunities it offers; and (3) concerns over the quality of graduates because of doubts about the appropriateness of the didactic model and insufficient attention to local healthcare needs, and over the practical feasibility of such partnerships. Conclusions: The three viewpoints identified revealed a pallet of views on how host teachers might experience their work. It shows the heterogeneous features of this group and seems to counterbalance reports that they are feeling "deprived" from their role as teacher. Two viewpoints featured an appreciation of interinstitutional relationships and of the partnership, especially when perceiving a degree of autonomy. Partners can capitalize on all different viewpoints by deploying procedure and policies to raise the quality of education delivery. [ABSTRACT FROM AUTHOR]

Purpose: National physician validation systems aim to ensure lifelong learning through periodic appraisals of physicians’ competence. Their effectiveness is determined by physicians’ acceptance of and commitment to the system. This study, therefore, sought to explore physicians’ perceptions and self-reported acceptance of validation across three different physician validation systems in Europe. Materials and methods: Using a constructivist grounded-theory approach, we conducted semi-structured interviews with 32 respiratory specialists from three countries with markedly different validation systems: Germany, which has a mandatory, credit-based system oriented to continuing professional development; Denmark, with mandatory annual dialogs and ensuing, non-compulsory activities; and the UK, with a mandatory, portfolio-based revalidation system. We analyzed interview data with a view to identifying factors influencing physicians’ perceptions and acceptance. Results: Factors that influenced acceptance were the assessment’s authenticity and alignment of its requirements with clinical practice, physicians’ beliefs about learning, perceived autonomy, and organizational support. Conclusions: Users’ acceptance levels determine any system’s effectiveness. To support lifelong learning effectively, national physician validation systems must be carefully designed and integrated into daily practice. Involving physicians in their design may render systems more authentic and improve alignment between individual ambitions and the systems’ goals, thereby promoting acceptance. [ABSTRACT FROM AUTHOR]

Crossborder curriculum partnerships are a relatively new and fast-growing form of internationalization in which the curriculum that has been developed by one institution (the home institution) crosses borders and is implemented in another institution (the host institution). These partnerships aim to provide comparable learning experiences to the students in both institutions and are driven by a variety of motives, such as strengthening international networks, increasing financial gains, and stimulating research spinoffs. Although popular, crossborder curriculum partnerships are also criticized for their potentially low educational quality, failing to address fundamental differences in teaching and learning between the home and host institutions, and not addressing the educational needs of the host country’s health care system. Our aim is to provide guidance to those considering or engaged in designing, developing, managing, and reviewing a crossborder curriculum partnership or other forms of international educational partnerships in medical education. Drawing from research, personal, and institutional experiences in this area, we listed twelve tips categorized into four themes, which contribute to the establishment of sustainable partnerships that can withstand the aforementioned criticism. [ABSTRACT FROM AUTHOR]

Introduction: Ward round skills are essential for doctors in hospital settings. Literature shows medical students’ deficiencies in these skills. Simulation has been used to train these skills. However, exposing learners to simulation at an early stage may be associated with a high cognitive load and limited learning. This study aims to determine how students experience this load and its interplay with performance and which factors promote and impair learning.Methods: Fifty-six final year medical students participated in a simulated ward round training exercise. Both students’ performance and cognitive load were measured to determine if there was any correlation and interviews were carried out to understand which factors support and impair learning.Results: Performance scores revealed deficiencies in ward round skills. Students experienced a cognitive load that weakly correlated with performance. Qualitative findings provided important insights into simulated ward-based learning. It is clear that well-designed clinical scenarios, prioritization tasks, teamwork and feedback support students’ learning process whereas distractions impair learning.Conclusions: WRS proved to be a good teaching method to improve clinical skills at this stage as the cognitive load is not too high to impair learning. Hence, including tasks in the simulation design can enhance the learning process. [ABSTRACT FROM AUTHOR]

Background:Portfolios are used as tools to coach and assess students in the workplace. This study sought to evaluate the content validity of portfolios as reflected in their capacity to adequately assess achieved competences of medical students during clerkships. Methods: We reviewed 120 workplace portfolios at three medical universities (Belgium and the Netherlands). To validate their content, we developed a Validity Inventory for Portfolio Assessment (VIPA) based on the CanMEDS roles. Two raters evaluated each portfolio and indicated for each VIPA item whether the portfolio provided sufficient information to enable satisfactory assessment of the item. We ran a descriptive analysis on the validation data and computed Cohen’s Kappa to investigate interrater agreement. Results:The portfolios adequately covered the items pertaining to the communicator (90%) and professional (87%) roles. Coverage of the medical expert, collaborator, scholar and manager roles ranged between 75% and 85%. The health advocate role, covering 59%, was clearly less well represented. This role also exhibited little interrater agreement (Kappa < 0.4). Conclusions:This study lends further credence to the evidence that portfolios can indeed adequately assess the different CanMEDS roles during clerkships, the health advocate role, which was less well represented in the portfolio content, excepted. [ABSTRACT FROM PUBLISHER]

Context: Worldwide, medical schools have entered into crossborder curriculum partnerships (CCPs) to provide equivalent curricula and learning experiences to groups of geographically separated students. Paradoxically, this process also involvesadaptationof curricula to suit local contexts. This study has focused on challenges faced by medical Crossborder curriculum programme directors and strategies they employed to overcome these. Methods: We conducted a qualitative study on six CCPs using document analysis and semi-structured interviews with 13 programme directors from 12 medical schools. Interview transcripts were coded iteratively, followed by cross-case analysis. Results: The challenges faced by CCP programme directors are four-fold, springing from differences in health care systems, legislation and political interference, teaching and learning environments, and partnership. Deliberate strategies, such as intensifying interactions between partners in all academic echelons, can help to overcome these. Partnerships vary in their setup and collaboration strategy. Conclusion: Medical CCPs are challenging though seem feasible. Partnerships with more solid integration of academic operations appear robust in terms of ownership and provide, besides financial, also academic advantages to both institutions. However, more research is needed on the long-term effects on quality of graduates and impact on the host health care system. [ABSTRACT FROM AUTHOR]

Collaborations between groups of professionals often have a long history, which can still influence contemporary practice. If problems in the collaboration occur, the search for effective interventions for these problems may be informed by analysing current practice as well as the historical development of the collaboration. The study focused on the collaboration between obstetricians and midwives in the Netherlands. We performed a secondary analysis of questionnaire data focusing on midwives evaluating the collaborative performance of obstetricians in the Netherlands. Template analysis was used to analyse the questionnaires. The initial template was based on a model for interprofessional collaboration. As a final step, we reflected on the results in light of the historical development of the collaboration. The midwives experienced a power imbalance and a lack of trust and mutual acquaintanceship in their collaboration with obstetricians. They also reported a need for interprofessional governance and formalization. Most of these reported problems in the collaboration have their origin in the historical development of both professions and in the development of the collaboration between both professional groups. Combining an exploration of contemporary interprofessional practice with a historical perspective on interprofessional collaboration is fruitful for understanding problems in collaboration between professional groups, and provides guidance for improving collaboration. [ABSTRACT FROM PUBLISHER]

Background: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. Aim: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. Methods: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. Results: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors' motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. Conclusion: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors' motivation and preparedness to tackle the challenges of health care practice in this region. [ABSTRACT FROM AUTHOR]

Reforms in postgraduate medical education (PGME) exposed a gap between educational theory and clinical practice. Entrustable Professional Activities (EPAs) were introduced to assist clinicians in bridging this gap and to create better consonance between the intended and the enacted curriculum. In this viewpoint paper, we discuss the potential and the pitfalls of using EPAs in PGME. EPAs promise an effective way of teaching abstract competencies in a curriculum based on real-life professional activities that are suitable for clinical assessment. Summative judgement is used to entrust a resident step by step in a certain EPA, resulting in an increase of independent practice. However, we argue that the success of EPAs depends on (1) a balance: brief focussed descriptions against the requirements for detail and (2) a precondition: a mature and flexible workplace for learning. [ABSTRACT FROM AUTHOR]

A tool used in student-centered education is discussion among students in small learning groups. The Western origin of student-centered education, coupled with cross-cultural differences in communication styles, may detract from its cross-cultural applicability. This study investigates how in student-centered education, students' cultural backgrounds are expressed in discussions and shape students' discussion behaviors and skills. A comparative case study using problem-based learning as a student-centered model was conducted in three medical schools located in East Asia, Western Europe and the Middle East. Four cultural factors were found to potentially cause students, especially those in the non-Western schools, to refrain from speaking up, asking questions, and challenging others in discussions. Six contextual factors mediated the influence of the cultural factors. The findings were incorporated in a conceptual model. The conclusion seems justified that student-centered education is feasible in different cultural contexts, but across these contexts, processes and outcomes are likely to differ. [ABSTRACT FROM AUTHOR]

Collaboration between different groups of health care professionals is often rooted in a long and often difficult history. This history can exert a strong influence on how professionals collaborate and historical tensions can contribute to problems in contemporary practice. However, literature about interprofessional collaboration often ignores the historical underpinnings of collaboration. In this paper, the historical development of interprofessional collaboration between obstetricians and midwives within the setting of Dutch obstetrical care is explored using a review of Dutch and English literature for documents explicitly or implicitly describing the historical development of this collaboration. This literature delineates the establishment of professional boundaries and the formalization of the collaboration between the two professions. It also details the history of physician domination over the midwives both in midwifery practice and education and the relatively recent reversal of this situation. Moreover, the shift in collaborative partner from general practitioner to obstetrician and its effect on collaboration is examined. Insight into the historical foundations of Dutch maternity care collaboration may allow us to understand the origins, and thus formulate possible solutions, for contemporary problems within this collaboration. [ABSTRACT FROM AUTHOR]

Background: Despite acknowledgement that the Canadian Medical Educational Directives for Specialists (CanMEDS) framework covers the relevant competencies of physicians, many educators and medical professionals struggle to translate the CanMEDS roles into comprehensive training programmes for specific specialties. Aim: To gain insight into the applicability of the CanMEDS framework to guide the design of educational programmes for specific specialties by exploring stakeholders' perceptions of specialty specific competencies and examining differences between those competencies and the CanMEDS framework. Methods: This case study is a sequel to a study among ObsGyn specialists. It explores the perspectives of patients, midwives, nurses, general practitioners, and hospital boards on gynaecological competencies and compares these with the CanMEDS framework. Results: Clinical expertise, reflective practice, collaboration, a holistic view, and involvement in practice management were perceived to be important competencies for gynaecological practice. Although all the competencies were covered by the CanMEDS framework, there were some mismatches between stakeholders' perceptions of the importance of some competencies and their position in the framework. Conclusion: The CanMEDS framework appears to offer relevant building blocks for specialty specific postgraduate training, which should be combined with the results of an exploration of specialty specific competencies to arrive at a postgraduate curriculum that is in alignment with professional practice. [ABSTRACT FROM AUTHOR]

Background: Earlier studies suggested national culture to be a potential barrier to curriculum reform in medical schools. In particular, Hofstede's cultural dimension 'uncertainty avoidance' had a significant negative relationship with the implementation rate of integrated curricula. Aims: However, some schools succeeded to adopt curriculum changes despite their country's strong uncertainty avoidance. This raised the question: 'How did those schools overcome the barrier of uncertainty avoidance?' Method: Austria offered the combination of a high uncertainty avoidance score and integrated curricula in all its medical schools. Twenty-seven key change agents in four medical universities were interviewed and transcripts analysed using thematic cross-case analysis. Results: Initially, strict national laws and limited autonomy of schools inhibited innovation and fostered an 'excuse culture': ' It's not our fault. It is the ministry's'. A new law increasing university autonomy stimulated reforms. However, just this law would have been insufficient as many faculty still sought to avoid change. A strong need for change, supportive and continuous leadership, and visionary change agents were also deemed essential. Conclusions: In societies with strong uncertainty avoidance strict legislation may enforce resistance to curriculum change. In those countries opposition by faculty can be overcome if national legislation encourages change, provided additional internal factors support the change process. [ABSTRACT FROM AUTHOR]

The differences of learning experiences in the workplace put challenges on the assessment: the assessment programme should be aligned with the general competency framework of the curriculum and also fit to the differences in learning contexts of the workplace. We used van der Vleuten's programmatic assessment model to develop a workplace-based assessment programme for final year clerkships. We aimed to design a programme that stimulates learning, supports assessment decision, is feasible and non-bureaucratic. The first experiences with the programme show that students think that the programme has high learning value and the assessment is sufficiently robust. Many of the commonly reported weaknesses of work-based assessment (not a good fit with the educational context, too complex, too bureaucratic and too much work) were not mentioned by the students. [ABSTRACT FROM AUTHOR]

In 1990, Miller wrote that no tools were available for assessment of what a learner does when functioning independently at the clinical workplace (Miller 1990). Since then portfolios have filled this gap and found their way into medical education, not only as tools for assessment of performance in the workplace, but also as tools to stimulate learning from experience. We give an overview of the content and structure of various types of portfolios, describe the potential of electronic portfolios, present techniques and strategies for using portfolios as tools for stimulating learning and for assessment, and discuss factors that influence the success of the introduction. We conclude that portfolios have a lot of potential but that their introduction also often leads to disappointment, because they require a new perspective on education from mentors and learners and a significant investment of time and energy. [ABSTRACT FROM AUTHOR]

The ability to reflect on one's own action is seen as an important skill for a doctor. A thorough introduction of the portfolio planned in the early stages of theft studies seems to be the way to train medical students in reflection. This article describes the use of portfolios in early undergraduate medical training. The literature on portfolios suggests three aspects that are crucial for the effectiveness of portfolios: structure, coaching and assessment. The portfolio systern was designed by transposing the experience with portfolio systems outside and inside medical training to a situation of firstyear medical students. During the academic year 2001-02 242 first-year medical students compiled a portfolio. Student experience was collected by semi-structured interviews. The majority of students were of the opinion that analysing one's competences in a portfolio was instructive and meaningful. With regard to learning how to reflect and recognize learning needs, however, mentor coaching proved to be necessary. The results thus far show that the portfolio is a worthwhile addition to existing assessment and learning tools. [ABSTRACT FROM AUTHOR]

A wealth of evidence for the effectiveness of progress testing in problem-based learning curricula has been collected in the Western academic world, but whether the progress testing can be equally effective in problem-based medical schools in resource-poor countries is a question that remains to be answered. In order to provide an initial answer to this question, we describe our experiences with progress testing in a medical school in Mozambique since its establishment in 2001, specifically focusing on test acceptability, formative educational impact, test validity and test reliability. After 7 years of experience, we think that the conclusion is justified that the progress testing can be a feasible and effective assessment instrument even in a resource poor setting. Institutional collaboration is important to guarantee test quality and sustainability. [ABSTRACT FROM AUTHOR]

Background: Clinical workplaces are hectic and dynamic learning environments, which require students to take charge of their own learning. Competency development during clinical internships is a continuous process that is facilitated and guided by feedback. Limited feedback, lack of supervision and problematic assessment of clinical competencies make the development of learning instruments to support self-directed learning necessary. Aims: To explore students’ perceptions about a newly introduced integrated feedback and assessment instrument to support self-directed learning in clinical practice. Students collected feedback from clinical supervisors and wrote it on a competency-based format. This feedback was used for self-assessment, which had to be completed before the final assessment. Methods: Four focus group discussions were conducted with second and last year Midwifery students. Focus groups were audiotaped, transcribed verbatim and analysed in a thematic way using ATLAS.ti for qualitative data analysis. Results: The analysis of the transcripts suggested that integrating feedback and assessment supports participation and active involvement in learning by collecting, writing, asking, reading and rereading feedback. Under the condition of training and dedicated time, these learning activities stimulate reflection and facilitate the development of strategies for improvement. The integration supports self-assessment and formative assessment but the value for summative assessment is contested. The quality of feedback and empowerment by motivated supervisors are essential to maximise the learning effects. Conclusions: The integrated Midwifery Assessment and Feedback Instrument is a valuable tool for supporting formative learning and assessment in clinical practice, but its effect on students’ self-directed learning depends on the feedback and support from supervisors. [ABSTRACT FROM AUTHOR]