Developing professional skills

An electronic learning portfolio for reective continuing professional development

Tim Dornan,1 Carmen Carroll1 & John Parboosingh2

Objectives These were to measure the uptake and use of an electronic learning portfolio to support reective continuing professional development, and to characterize attitudes towards its use and obstacles to its adoption. Design Uncontrolled, longitudinal intervention study with quantitative and qualitative evaluation. Participants Physicians with a specialty interest in endocrinology and diabetes mellitus, registered for continuing professional development with the Royal College of Physicians, London. Intervention All registered consultants were offered a 1-year free trial of PC Diary. Those who accepted were offered a training workshop. Main outcome measures Quantitative and qualitative responses to a simple questionnaire. Two researchers independently used a template approach to analyse free-text responses and jointly agreed a nal system of coding. Results 22% of registered consultants applied to participate; 14% attended training workshops. Of registered

participants, 94% returned the questionnaire. PC Diary was used by 34%, but only 10% used it regularly. Among the registrants, 54% asked to continue their subscription for a second year, and 40% asked for further training. There were emotive expressions of both like and dislike, often coupled with statements about the individuals learning style. Time pressures and lack of computer access, literacy and support were dominant obstacles to adoption. Conclusions There was considerable support for reective learning using an electronic portfolio. Acceptability and use were inuenced by individual learning style, resources, training and technical support, and these were often inadequate. The balance for consultants between workload demands and support provided did not favour a reective type of learning. Keywords Attitudes; diabetes mellitus, methods; education, continuing, *methods; endocrinology, methods; London; professional competence, standards; questionnaires. Medical Education 2002;36:767769

Introduction
The aim of this study was to measure the uptake and use of an electronic learning portfolio developed to support reective continuing professional development (CPD), and characterize attitudes towards its use and obstacles to its adoption.

Methods
The Royal College of Physicians and Surgeons of Canada (RCPSC) has developed an electronic learning portfolio named PC Diary.1 Entries are made as questions, together with the zone of expertise to which each question relates (focusing learning on the users practice), the stimulus for the question (e.g. care of an individual patient, audit, reading), the time spent answering it, and the sources consulted. The user has to make a commitment to change practice, to seek further information, or not to change practice. Notes, references, and an evaluation of the strength of evidence on which the commitment was based can be recorded. The diary also records group CPD attend767

Department of Diabetes/Endocrinology, Hope Hospital, Salford, Manchester, UK 2 The Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada Correspondence: T. Dornan, Hope Hospital, Stott Lane, Salford, Manchester M6 8HD, UK

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Electronic portfolio for reective continuing professional development

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Key learning points

Nearly a quarter of consultants registered for continuing professional development in diabetes/ endocrinology applied to use PC Diary. Uptake and use of the system was considerably lower than that. There was a wide variety of reactions, depending at least in part on the individuals learning style. Training, support, and a work climate conducive to learning are needed for successful electronic portfolio use.

twice per month or more and 3 (3%) used it once per week or more on average. Among the participants, 47 (54%) wished to continue their subscription for another year and 35 (40%) wished to receive further training.
Acceptability

There were positive and negative reactions. Some people who had not started using the Diary remained committed to do so, even in the face of initial failure. Some participants liked it because it enhanced or helped them manage their learning, or tted with their learning style. Others expressed strong dislike.
Time

ance, and provides a to-do list to note events in daily clinical life which are worthy of study at a later time. PC Diary functions as a personal learning planner, targets behaviour rather than abstract learning, allows users to survey whether they have followed through their commitments to change and intentions to seek further information, and can lter contents by any parameter. Thus it supports reection in framing questions, seeking answers, deciding what action to take, and reviewing performance against self-determined goals. All 439 consultants in diabetes/endocrinology who were registered for CPD with the London Royal College of Physicians were offered 1 years free use of the PC Diary. Every applicant was accepted, invited to attend a training workshop, and sent email updates and tips on diary use. The RCPSC provided on-line support. After a year, all participants were sent an anonymous single-page questionnaire asking about their current use, whether they would like to continue, whether they wanted further training, and their reactions to PC Diary. Freehand responses were transcribed verbatim. C.C. and T.D. coded them independently, using a template method,2 discussed their interpretations, and ascribed an agreed nal code to each.

This was a dominant theme. Even participants who strongly approved and started using the Diary did not persevere, because of a workload that gave them no time for learning, self-confessed poor time management, or difculty changing the way they used time. Even when use of the Diary had been adopted, availability of time and the need to change work habits remained problems. Some questionnaire responses described it as time well spent, others as time wasted. Some participants were pleased to nd how much time they were already spending on CPD and to receive credit for it.
Computer use

Inexperience, technical problems, difculty connecting to the internet, lack of a suitably located computer and various shades of personal reaction to computer use made up another dominant theme. Lack of information technology (IT) support in the hospital and incompatibility with locally provided software, hardware and networks created problems. It was common practice to carry out CPD during evenings and weekends because of lack of time during working hours or inadequate IT access in the workplace or both. Those who lacked self-condence in IT skills could be disheartened by failure. Keyboard data entry was a problem for some.
Programme attributes

Results
Of the 439 consultants, 95 (22%) applied and were registered, and 60 (14%) attended a training workshop. Of the registered participants, 89 (94%) returned the questionnaire and 87 ticked a box describing their use 1 & PC diary. Of the 87, 10 (11%) decided not to use it, 18 (21%) planned to use it but never set it up on their computer, 29 (33%) set it up but did not use it, 21 (24%) set it up but used it infrequently, 6 (7%) used it The self-directed learning portfolio attracted favourable comment, although some found making entries a chore. It was suggested that the system could be improved by electronic logging of time spent, integration with an electronic reference manager, and a summary format which was more compatible with UK reporting requirements.

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Learning processes

Respondents commented on the compatibility of PC Diary with their own learning processes, for example: It does stimulate reective learning and this is rewarding.
Emotional reactions

common experience. Many people struggled against heavy schedules and workloads to nd time for their learning. These observations suggest that training, support, and a work climate conducive to learning are needed for successful electronic portfolio use.

Acknowledgements
We thank Catherine Crossley for administration of the project, Marcia Gowenlock for her help in arranging training workshops, Thekla Piga and staff of the RCPSC for support, and Novo Nordisk for generous nancial support.

Learning, the concept of PC Diary and the use of IT elicited positive emotions, particularly from people who 2 were conversant with IT. There were negative emotions about the same factors, particularly concerning technical difculty in using the programme. Other major reasons for negative emotion were time pressure, workload, and lack of sympathy from the trusts which employed the consultants.

Contributors
TD planned the study, trained participants, analysed the data and wrote the paper. CC second-coded the qualitative data and commented on the manuscript. JP devised PC Diary, trained participants and commented on the manuscript.

Discussion
Regarding our rst objective, more than one-fth of consultants were receptive to IT-supported reective CPD. The training we provided, whilst resourceintensive, was unequal to the needs of some participants. We did not have the resources to provide continuing support, an important component of portfolio learning,3 and this may help to explain the poor subsequent use of PC Diary. Concerning the second objective of the study, questionnaire responses demonstrated both positive and negative attitudes, which were inuenced by training and technical factors, but which also showed the importance of individual learning style. As described elsewhere,4 some people valued a portfolio approach to managing their learning, and the electronic presentation was attractive to those who liked IT. Others disliked the whole concept, or found it more trouble than it was worth. With regard to obstacles to adoption of the Diary, the questionnaire showed many consultants to be wholly self-taught or unskilled in IT use, using their own computers at home because they had no equipment, or equipment of very poor quality, at work. Poor or nonexistent support by hospital IT departments was a

Funding
Financial support was provided by Novo Nordisk. 3 There was no other external funding for the project.

References
1 Parboosingh J. Learning portfolios: potential to assist health professionals with self-directed learning. J Cont Educ Health Prof 1996;16:7581. 2 King N. Template analysis. In: G Symon, C Cassell, eds. Qualitative Methods and Analysis in Organisational Research: a 4 Practical Guide. London: Sage; 1998; pp. 11834. 3 Grant A, Dornan TL. What is a learning portfolio? Diabet Med 2001;18 (Suppl. 1):14. 4 Campbell CM, Parboosingh JT, Gondocz ST, Babitskaya G, Lindsay E, De Guzman RC, et al. Study of physicians use of a software program to create a portfolio of their self-directed learning. Acad Med 1996;71 (Suppl. 10):S49S51. Received 19 September 2001; editorial comments to authors 23 November 2001; accepted for publication 22 January 2002

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