Thursday, 7 August 2008


I hate them, I hate them, I HATE THEM!

Right, now I’ve got that out of my system, allow me to try and explain. Within the first few weeks of entering medical school, we were introduced to a rather innocuous blue folder. ‘Ooh what’s this little bundle of fun then?’ Well I’m still not really sure…

Everyone has one of these blue folders, called a portfolio, and it’s divided into a number of sections such as ‘Relationships with colleagues’, ‘Good medical practice’ and ‘Probity’. The general idea, so we are told, is to keep a log of our personal and professional development throughout the course and obtain evidence and write reflective pieces to show that we are progressing. In theory it’s commendable, of course we should all reflect on notable experiences and think about our strengths and weaknesses – but it has degenerated into an exercise in jumping through hoops and ticking boxes! At the end of both academic years we have our portfolios checked and assessed to ensure we are following the guidelines and to give an opportunity to raise any questions. Most people I know spent the week before their review frantically finding things to pad it out, trying to remember patient encounters from months earlier and knocking up wishy washy SWOT analyses and Phase Two goals… Clearly not what the medical school Portfolio coordinators had in mind.

However, the vast majority of these folk blagged the interview and passed - the system is believed to be sound. Do I think keeping a portfolio is necessary in the first 2 years of medical school? Perhaps. Do I think it achieves what it sets out to i.e. improving us as individuals by making us reflect, keep records and fill in endless forms? No. What I think it comes down to is the infamous “white box” questions on the Foundation Year application forms, reducing much of our 5 years of hard graft into a bullshitting contest! If you have a well kept portfolio, with plenty of exaggerated tales of moments you showed leadership or teamwork or reflective qualities, then you’re sorted. If you focused more on actually studying, learning and practising clinical skills, but neglected your portfolio and creative writing proficiency, then screw you. I just happen to think that jobs should be allocated on a far more objective basis, through our written and practical examinations – communication skills are already assessed in OSCEs and creative writing skills should be kept out of the process altogether.

1 comment:

The Shrink said...

You've got the essence of it right here, ". . . neglected your portfolio and creative writing proficiency . . ."

If a portfolio is a presentation of how amazingly amazing you are, it's useless. No, it's worse than useless as it's detracting from folk who have clinical acumen but don't bullshit.

Portfolios in postgraduate medicine are representative samples of objective evidence. As such, there can't be bullshit.

I'd quiver if portfolios are used as exercises in creative literature in undergraduate medicine. That's a pressure that can't be avoided (as it'll help/hinder career progression) but this pressure exerts a steer away from clinical expertise and towards creative writing.

Do we want cohorts of medics who can do good medicine, or cohorts of medics who can win the Booker prize?