Portfolios in continuing medical education--effective and efficient?

INTRODUCTION: A cross over comparison between 'traditional' continuing medical education (CME) activities and portfolio-based learning in general practice is described. METHOD: Thirty-two volunteer general practitioners (GPs) were divided into two cohorts; each cohort spent six months following a 'traditional' route to postgraduate educational accreditation (PGEA) and six months following a portfolio-based learning route supported by three CME tutors. OUTCOME MEASURES: These were the submission of a completed portfolio with evidence of the completion of learning cycles and participants reflections on the educational process. Qualitative and quantitative evaluation data were collected by questionnaire, semi-structured interview, participant observation and review of completed portfolios. RESULTS: The themes identified by GPs as hopes for the portfolios were largely fulfilled and the anxieties generally confounded. The flexibility of the portfolio learning process was particularly important to the participants. The breadth of topics covered by the portfolios was extremely wide and comparison with the submissions for 'traditional' PGEA showed a much smaller spread of learning activities and fewer subjects of study. EFFECTIVENESS: The use of the portfolios of critical incidents and the completion of learning cycles with application to practice provided evidence of the effectiveness of such learning. EFFICIENCY: The mean number of hours spent by GPs preparing the portfolios was 24.5 +/- 12 (SD) which was significantly more than the 15 hours of PGEA awarded. CONCLUSIONS: This study demonstrates that a portfolio-based learning scheme can meet the needs of GPs relevant to their professional practice; it can give learners control over how, what and when they learn and encourage active and peer-supported learning; it can build personal and professional confidence and be thought both valid and reliable by participants. Learning outcomes can also be reliably assessed by PGEA within the context of an individually created learning plan.

Portfolio-based learning: continuing medical education for general practitioners--a mid-point evaluation.

In October 1994 a project was initiated by the General Practice Continuing Medical Education Tutors in the Department of General Practice at Sheffield University. The project sought to evaluate the efficiency (effort expended) and effectiveness (distance travelled) of a model of continuing professional development for general practitioners through individual portfolio-based learning in co-mentoring groups. Learning demonstrated through the portfolio was accredited for the postgraduate education allowance of participants. This paper addresses the process of portfolio development at the mid-point of a year-long trial to ascertain the strengths, weaknesses and possible future development of such a process within the context of continuing medical education.

Association between risk factors for coronary heart disease in schoolboys and adult mortality rates in the same localities.

Risk factors for coronary heart disease were compared in fifth year boys (15-16 years old) from two schools that were chosen from localities with a fourfold difference in adult mortality from coronary heart disease. One school was in an underprivileged urban locality in the area of increased incidence of heart disease ('high risk') and the other in a semi-rural affluent locality with an incidence of heart disease similar to the national average ('low risk'). Smoking, hypertension, hypercholesterolaemia, obesity, physical fitness, and inactivity were evaluated as risk factors for coronary heart disease. Smoking, increased body fat, poor diet, and physical inactivity were found increased among pupils from the school in the high risk area compared with those in the low risk area. Lipids, maximum oxygen uptake, and hypertension were similar in both schools. The risk of coronary heart disease seems to reflect the adult mortality rates in the area. To reduce the overall incidence of coronary heart disease, health education should be directed towards prevention of smoking, improving diets, and increasing amounts of activity among school children, with special attention directed toward children in regions where there is a high mortality from coronary heart disease among adults.