Home > Information for doctors >Tutorials > Portfolio based learning. (PBL)

Author    Francisco Machado

Date        April 1999

The basis of much adult learning theory revolves around Experiential learning i.e. that we learn from what we experience in our daily work and play. The essential component of experiential learning is reflection.

Two ways of encouraging reflection are:

Debriefing

Keeping a log/diary

PBL allows for both and therefore is a useful method for experiential learning.

A portfolio is a collection of a learner’s experiences and achievements during a period of educational activity.

Most of our experiences are spontaneous and sudden but we need to record them and then reflect on them, otherwise the experience may be lost forever.

A portfolio can contain almost anything:

Projects

Audits/research

Papers that you have read

A log diary

Formal training programs

Video tapes of consultations

Case descriptions

Is a process that the learner undertakes.

The portfolio allows learning to be centred on the individual’s learning needs

Encourages self directed learning

Empowers the learner

You need to have a mentor who:

Facilitates the learning process by offering the learner a combination of support and challenge

Helps the learner to identify his/her own learning needs

Encourages the learner to develop their own learning strategies and to discover their own solutions to problems

Helps the learner reflect critically on the experience and explore different perspectives

Offers the learner unconditional positive regard

Facilitate reflection

Development of self awareness

Help in the development of a learning plan

Help in the development of a learning contract

Help debrief the mentee

Structured debrief in reflection on an experience.

Different stages.

Why choose PBL in GP?

Enables the GP to focus on experience both at home and at work

It allows the learner to tailor to their own learning needs and learning style rather than have to cope with "off the peg" education

It is a learner centred approach

The learner is encouraged to celebrate strengths.

The learner identifies his own agenda.

Usually performed with the help of a mentor.

Define the educational period the portfolio reflects

Identify your learning needs

Identify how you are going to meet these needs

Identify how you are going to assess whether you have met those needs, i.e. what outcomes are you going to look for?

Reflect on your portfolio and plan for the next educational period.

Define the time limit of your portfolio.

It is important to set a time limit for the portfolio. This means that you have an end to the current portfolio to assess whether you have managed to cover what you wanted. If you leave it open ended there is a tendancy not to do this. However it does not mean that unfinished topics cannot be carried into the next portfolio.

Identify your learning needs

This can be performed in a number of ways.

Keep a log diary over a period of a week

This diary is a way of recording what you actually do! It is therefore the first step in the experiential learning cycle. By concentrating on what you actually do you will make your learning more relevant to your actual needs rather than your wants.

It is important to write down everything that you do not just the clinical side of GP. You may limit the entrees to so called critical incidents. These are times when you may think:

"why did I do that"

"I don’t know what to do"

" Is there another way of managing this situation"

Remember that your role as a GP is not just about seeing patients. Include all the non clinical things that you come across e.g. paperwork, meetings e.t.c.

At the end of the week you will probably have an exhaustive list of topics to work with.

An example of a log diary is shown here.

Critical incidents or Significant event auditing.

This revolves around an event which stimulates discussion.

Examples include:

A patient is diagnosed as having carcinoma of the colon. One year ago he presented with rectal bleeding but was not investigated. This patient’s case could be audited and the results used to formulate a protocol for future use.
A patient rings to speak to the doctor but the message is not relayed onto you. The patient later complains.

Audit

Audit can highlight gaps in knowledge and performance.

Examples Compare referral letters to eventual diagnosis and management plans by consultant.

Audit using standard guidelines

Discussion with peers

Forming a learning set and discussing certain topics will allow an individual to identify learning needs.

It is a useful way to discuss the management of practice issues.

Looking at confidence rating scales and checklists similar to one’s used in vocational training may act as a guide.

    Ask yourself

What do I enjoy?

What don’t I enjoy?

What do I feel confident in?

What do I kack confidence in?

What is required to be a good GP?

How do I compare to this ideal?

How can I improve towards this ideal?

Although very subjective it may compliment your other methods. This is particularly useful if a "buzz" group brainstorms these issues.

You will now possibly have an exhaustive list of learning needs.

It is important to classify these into different types.

E.g.

clinical needs, knowledge, skills

management needs, personal, team or practice

personal development needs e.g. self care, IT

Then you need to prioritise the needs.

It is important to remember that you cannot deal with everything at the same time.

Also try an choose a mixture of topics, some that you have a special interest some that you know that you tend to avoid!! Also try and choose topics that will require a number of different learning methods to improve your knowledge and skills.

Then you will need to plan which learning methods you are going to use.

You might:

perform an audit

discuss topic with your learning set

perform a literature search or have some one perform this for you

read textbooks

discuss with local specialists

go on a course

take part in a distance learning course

do an MSc!!!

watch a video of yourself

Remember that there are many different types of opportunities to learn in GP and that there are many different resources.

E.g.

learning within your own practice

learning with a mentor

co-mentoring

learning within a learning set

Attending skills training courses

Your local CME tutor, PG Centre should be able to help you.

OK so you know what you want. You know how you are going to get there. But how will you recognise that you have achieved what you set out to do? This is often the hardest part of PBL and is often neglected.

Here you will need the help from a mentor to discuss ways of demonstrating that you have met your learning needs.

Simply turning up to a course might increase your knowledge but may not necessarily improve performance, this is a major criticism of the PGEA system.

So how can you demonstrate improved performance:

Reflect on your own performance

Re audit your performance

Write up case histories using your new protocols

Reviewing practice data both external and internal e.g. PACT data

Filling in questionaires before and after

Watching videos of your consultations, presentations

Gaining diplomas

Writing papers

Developing and implementing protocols and auditing them

This is by no means an exhaustive list.

OK so you have finished. What now?

You can review:

what went well?

Which methods of learning did you enjoy

Which methods of learning were most successful at meeting your learning outcomes

What did you cover and feel that you can now leave?

What topics do you need to continue to learn about?

What’s next

PBL is continuous. So when you come to the end of your educational time period you will need to move onto the next one.

It is important to make it relevant to you in your situation and above all make it FUN!

Resources

Professional development in General practice. Oxford GP series 37. Pendleton and Hasler

Wisdom website http://www.shef.ac.uk/uni/projects/wrp/index.html
This site contains alot of useful information about adult learning. Well worth a visit.

Francisco Machado March 1999