2
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