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Autor corresponsal:, Asociación de Educación Médica Hondureña, Tegucigalpa, Honduras
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Electronic medical portfolio as a tool in formative assessment: a
literature review
Portafolio médico electrónico como una herramienta en la evaluación formativa: revisión de la literatura
Iving E. Alvarado-Carías
, José Gabriel Milla Mejía
, Nubia Hadanary Molina Baide
, Elena M. Gonzales
, Ginalizia Murillo Castro
, Wendy Carolina Mejía
, José M. Madrid
, Cristina M. Thiebaud
Juan Fernando Suazo
, Jhiamluka Solano
Asociación de Educación Médica Hondureña, AEMH, Tegucigalpa, Honduras
Hospital Zafiro, Tegucigalpa, Honduras
Facultad de Ciencias de la Salud, Universidad Tecnológica Centroamericana, UNITEC, Tegucigalpa, Honduras
Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, UNAH, Tegucigalpa, Honduras
Departamento de Ortopedia, Chelsea and Westminster NHS Foundation Trust, Londres, Reino Unido
Departamento de Medicina Interna, Salford Royal Hospital, Manchester, Reino Unido
Article history:
Received: 1 August 2022
Revised: 3 August 2022
Accepted: 15 August 2022
Published: 31 August 2022
Clinical competencies
Electronic medical portfolio
Medical education
Palabras clave
Competencias clínicas
Portafolio médico electrónico
Educación médica
ABSTRACT. Introduction. The electronic medical portfolio is part of the formative evaluation that allows the
educator to adapt their didactic process to the needs of their students. It also promotes effective formative feedback
that helps create horizontal relationships between educators and students. The aim of this review was to describe the
use of medical portfolios and their impact on medical training. Methods. A review of the literature in PubMed and
Scielo was carried out, including articles and studies on the topic, published in English and Spanish, ranging from 2012
to 2022. Discussion. Medical Education in Latin America, especially in Honduras, relies heavily on summative
assessment as a prevalent evaluation method. In countries like the United States and some in Europe where the student
portfolio is used, it has thrived and been accepted by both educators and students, generating a positive impact on their
learning. Conclusion. The implementation of the medical portfolio in Honduras is a viable and an appropriate process
that will allow the pre-existing traditional academic culture to be innovated. Its multiple advantages such as
encouraging a complete evaluation through feedback from superiors and peers, in addition to ongoing training and
improvement of the student's practical skills, place it as an essential tool for medical education.
RESUMEN. Introducción. El portafolio médico electrónico forma parte de la evaluación formativa. Permite al
docente adaptar su proceso didáctico a las necesidades de sus estudiantes. También, promueve la retroalimentación
formativa efectiva. Esto ayuda a crear relaciones horizontales entre docentes y estudiantes. El objetivo de la revisión
fue describir el uso de los portafolios médicos y su impacto en la formación médica. Métodos. Se llea cabo una
revisión de la literatura en PubMed y Scielo. Se incluyeron artículos y estudios publicados sobre el tema en inglés y
español, desde el año 2012 hasta el 2022. Desarrollo. La Educación Médica en Latinoamérica, especialmente en
Honduras, depende en gran medida de la evaluación sumativa como método de evaluación prevalente. En países como
Estados Unidos y algunos de Europa, donde se utiliza el portafolio estudiantil ha prosperado y ha sido aceptado por
ambos docentes y estudiantes; generando una repercusión positiva en el aprendizaje de los mismos. Conclusión. La
implementación del portafolio médico en Honduras es un proceso viable y apropiado. Permitirá innovar la cultura
académica tradicional preexistente. Sus múltiples ventajas, tales como fomentar una evaluación completa a través de
la retroalimentación por parte de superiores y pares, además de la formación permanente y mejoría de habilidades
prácticas del estudiante, lo colocan como una herramienta esencial para la educación médica.
1. Introduction
Medical education has evolved rapidly during the last
two decades, due to new scientific evidence supporting
innovative teaching and evaluation methodologies. This
leaves behind traditional teaching that has been losing
effectiveness or has become obsolete because of
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globalization (Talanquer, 2015). There are multiple
definitions for the term electronic medical portfolio. The
most outstanding elements include an instrument that
stores evidence of skills that students develop and shows
how they acquire skills throughout their training
(Agostini, 2015; Celis-Aguilar & Ruiz-Xicoténcatl,
2018). Medical portfolios play an important role for
formative assessment. Their purpose is for students to
obtain feedback on their learning process and to be able to
recognize aspects to improve through self-regulated
learning (Wood, 2018).
With the feedback obtained, the interaction between
students and academic tutors improves, being a constant
and more accessible monitoring process. This encourages
horizontal communication, nurturing a favorable
environment for the student's academic development and
the educator´s pedagogical development (Yoo et al.,
2020). The portfolio allows the monitoring and recording
of the clinical and non-clinical skills developed, serving
as evidence to verify them. It enables the development of
ethical competencies at different stages, as well as the
construction of professionalism of future doctors (Joshi et
al., 2015; Heeneman & Driessen, 2017).
In Honduras, the Faculty of Medical Sciences (FCM)
of Universidad Nacional Autónoma de Honduras
(UNAH) was founded on February 14, 1882, by lawyer
Marco Aurelio Soto. Since February 26, 1882, up until
now, the FCM is the only public institution that offers
education and certification of Doctor in Medicine and
Surgery and Bachelor of Nursing to the population
(Aguilar Paz, 2004). In 1999, Universidad Católica de
Honduras (UNICAH) began offering the Medicine and
Surgery Career and Universidad Tecnológica
Centroamericana (UNITEC) in 2012, both private
institutions (Bermúdez-Madriz et al., 2011).
The medical education in the different university
faculties has followed a traditional model focused on
summative evaluation. Currently, according to our
research, no university in the country that trains doctors
use fully structured formative assessment methodologies,
much less a medical portfolio in physical or electronic
format. This may be because they are unfamiliar with it or
lack the resources for its implementation (Haldane, 2014).
A review of the literature was done to analyze aspects
that may be included in the construction of an electronic
medical portfolio and the impact this methodology may
have on the medical training process in Honduras. This
review will provide elements that can be used by the
different universities as part of a national effort to improve
medical training, directly impacting the quality of care
received by the Honduran population and, in turn,
enriching the academic and professional profile of the
Honduran population that graduates from the Medicine
and Surgery educational program.
2. Methods
The literature review was carried out in PubMed and
Scielo, including articles and studies published in English
and Spanish on the use of medical portfolios and their
impact on medical training from 2012 to 2022. Except for
the publications by Snadden Mary Thomas (1998), Miller
(1990), Aguilar Paz (2004), Atkin et al. (2005) and
Bermúdez-Madriz et al. (2011), for their historical
relevance. Articles were also consulted that serve as a
practical guide for implementing the electronic medical
portfolio in Honduras. Opinion articles and letters to the
editor were excluded. Key terms such as ''medical
portfolio'', ''formative assessment'', ''feedback'', ''medical
education'' and ''clinical competencies'' were used.
3. Discussion
In 1990, Miller described in his book The Assessment
of Clinical Skills/Competence/Performance" means to
assess the skills, competencies, and knowledge during
undergraduate and postgraduate training in medical
education. However, he concluded that these are not
legitimate predictors of how well medical doctors would
perform when faced with real-life situations (Miller,
1990). Portfolios commonly used in arts and architecture
offer a space to collect non-standardized information that
helps assess students' performance in an individualised
manner, when it cannot be reached by summative
assessment (Agostini, 2015; Alcaraz Salarirche, 2016). To
fill this gap, higher education started adapting and
transforming portfolios as assessment tools (Driessen &
Tartwijk, 2014), later joining medical education.
Despite these efforts, the traditional approach prevails
in Latin America, where summative models take
precedence (Acosta Silva & Cruz Galvis, 2015). The
principal methodology consists of measuring the
achievements of a course's previously established learning
objectives. However, the student’s feedback is null,
avoiding guidance for the enrichment of their current and
future performance (Cilliers et al., 2012). Formative
assessment refers to a cyclical process in which educators
analyze their students and collect information to
implement changes that meet their needs. This process
promotes creating horizontal relationships between
students and educators, overcoming the traditional
teacher-centered model, and moving to a more student-
centered one. The above supports the use of
methodologies such as problem-based or team-based
learning (Dole et al., 2016).
For formative assessment to be successful, educators
must implement efficient strategies that allow them to get
to know and motivate their students and provide them
with all necessary tools to regulate their learning
autonomously (Mendes dos Santos & Fischer da Silveira
Kroeff, 2018). This evaluation is not intended to give
students a passing or failing grade or to measure their
knowledge or memory, even though a score may be
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INNOVARE Revista de Ciencia y Tecnología Vol. 11, No. 2, 2022
awarded. Formative evaluation provides elements to
determine whether the students have developed new skills
or competencies that will allow them to become better
professionals. These elements are mainly developed
through feedback, the central axis of formative assessment
(Kornegay et al., 2017). Effective feedback offers an ideal
space for critical thinking that leads to clinical reflection,
which is necessary to develop and strengthen their self-
directed learning processes (Agostini, 2015). Self-
directed learning is vital for professional development. It
offers students a starting point to know their limitations
and errors and enables them to plan how to improve their
performance with the support of their educator (Yoo et al.,
Some studies suggest that educator exposed to
portfolios as tools for self-assessment and reflection
consider that they represent a fundamental role in
generating awareness of educators' impact and promoting
personal growth. Additionally, portfolios allow educators
to identify their deficiencies and generate methods that
help improve pedagogical strategies (Arbesú García &
Gutiérrez Martínez, 2014; Patel & Shah, 2021). Regarding
the challenges that educators encounter when using
formative evaluation, the following can be stated: 1) the
demand for solid knowledge in the discipline that they
teach, 2) the constant attention to the perceptions of their
students, 3) the recognition of common learning
challenges faced by students and 4) knowing different
teaching and evaluation methodologies that respond to
different student needs (Atkin et al. 2005). To understand
and identify these needs, educators must be able to ask the
right questions that will assess the student's understanding
and limitations and, in turn, make decisions to promote
effective learning.
Student's perception and acceptance to introduction of
new assessment processes through portfolios have been
documented, demonstrating that there is a considerable
commitment, and the success of its application is
following the importance given to their perspectives and
expectations (Chertoff et al., 2016; Oudkerk Pool et al.,
2020). In the medical field, the portfolio assesses clinical
and academic skills in real-time, therefore providing
stimulus for personal growth (Snadden Mary Thomas,
1998; Kanfi et al., 2021). However, it is essential to
emphasise that some types of portfolios may have
disadvantages compared to others, either because they do
not allow development in a linear visualisation or because
their use is too complex for students or educators.
3.1. Types of portfolios
Portfolios may vary in content or purpose; some of
their goals may be reflection, evaluation, and professional
development (Table 1) (Babaee, 2020). Reflective
portfolios allow the user to keep a diary, leading to self-
assessment and the setting of academic and personal
goals, which in turn, leads them to educate themselves as
introspective and self-critical professionals; at the same
time, they offer a space to receive feedback from peers
and record meetings with academic tutors (Pereira Stelet
et al., 2016).
Evaluation portfolios keep a record of learning goals
with essential evidence of the user's practice; they include
forms for medical procedures, clinical case discussions
and performance patient physical examinations
(Rodríguez Cardenas et al., 2020).
Professional development portfolios focus on
recording personal goals and accomplishments, including
academic presentations, publications, facilitated classes,
attended courses, or other similar projects. They all need
an environment that provides learning opportunities
(access to patients or procedure simulations) and, at the
same time, that offers supervision and feedback from
trained personnel (Driessen & Tartwijk, 2014; Chertoff et
al., 2016).
A portfolio can be oriented towards personal growth,
where it is suggested to apply a checking and motivational
system for its users, in which a series of questions are
answered (Figure 1) (Driessen & Tartwijk, 2014). As the
students develop their portfolios, progress can be
observed through evidence that supports the strengths and
achievements obtained in a certain time period and the
resolution of difficulties encountered (Sidhu, 2015).
Depending on the content and structure, portfolios are
classified as open or free and closed or structured (Table
Table 1
Classification of portfolios according to their purpose.
Professional Development
Diary-style format
Allows self-assessment and goal
Allows record-keeping of feedback
from peers and tutors
Fill-in format
Stores evidence of clinical practice
using various forms
Records personal goals and
accomplishment throughout time
Requires access to patients,
simulations and other learning
c, d
*Feedback and supervisión from experienced personnel are essential in every type.
Stelet et al. (2016),
Rodriguez et al. (2020),
& Tartwijk (2014),
Chertoff et al. (2016).