Professional Pedagogies and Research Practices: Teaching and Researching Reflective Inquiry Through a Medical Portfolio Process

Reflection and portfolios are relatively novel terms in medical education. However, both have been embraced with gusto. Reflection is widely advocated as a fundamental skill for doctors at all stages of their career. The rationale for the introduction of reflective portfolios has been the need to ensure practitioner engagement in life-long learning. The drive for such practices has originated primarily from the external scrutiny of the fiduciary relationship that forms the basis of medical practice. A portfolio approach seems to offer many advantages: it is learner centered yet provides an externally visible, longitudinal and authentic record of a learner’s engagement with daily problems. However, there are many practical constraints involved with portfolio use as they are resource intense, particularly concerning the time required from both students and mentor. In particular, reflection and portfolio use are based on adult learning theory, which assumes that both students and staff actively engage in a learning relationship that is based on mutual trust and respect. Medicine, like law, however, is a conservative profession, based on a positivist tradition with an inherent hierarchy and little tolerance for error. In a sense, the adoption of reflection and portfolios is a gauntlet thrown at traditional medical education.