A HYBRID TEACHING MODEL FOR MEDICAL EDUCATION: REFLECTIVE E-PORTFOLIOS, FACE TO FACE CONTACT AND STUDENT CENTERED INTERACTIVE GROUP LEARNING

Background:
Demands on faculty time, changes in the health care industry, financial constraints, increased student numbers and dwindling numbers of motivated community preceptors urged faculty to seek ways of student support and mentoring other than daily one on one face to face contact. Could online mentoring serve as alternative allowing faculty to be “present” during student-patient encounters in “remote control mode”? Different definitions and perceptions of portfolios exist. Following a literature search we defined the portfolio purpose as 1)personal development; 2)evidence of learning and 3)assessment of learning. We aimed to test attitude and perception of students and faculty in an Arab medical school towards a defined portfolio and develop a conceptual framework. A hybrid teaching model combining face to face teaching and workplace experience with an on-line reflective portfolio emerged as framework.

Method:
An action research study was conducted 2009 to 2012.
Cycle I (September 2009 - September 2010) comprised of a situational analysis. Definitions and concept clarification based on literature review, SWOT analysis, departmental meetings and 2 Focus group interviews (FGI) resulted in questionnaires and a moderator’s guide. During cycle 2 (September 2010 - April 2011) 5 audiotaped FGIs were conducted and questionnaire completed for triangulation. Web based portfolios were implemented and assessment rubrics refined. Students and tutors attended lectures in reflective writing. Questionnaire results and FGIs were analysed and the e-portfolio revised. A faculty workshop was conducted and a criterion based assessments rubric finalized for implementation in Cycle 3 (June 2011 – April 2012) during which 5 FGI were conducted and analysed. The current e-portfolio focus on clinical reasoning, teaching and evaluating professionalism, ethics and the hidden curriculum.

Results:
The different cycles were evaluated and reported.
Cycle 1:
Tutors Themes:
1) Mentoring
2) on-line interaction and support
3) preference of paper format and face to face interaction
4) complexity of assessment criteria
5) interpretation of terminology and
6) labour intensity.

Students Themes:
1) Tutor support
2) computer technology support
3) repetition and duplication
4) lack of literature search skills
5) time commitment
6) peer interaction.

Cycle 2:
35/39 students participated in 5 FGIs (2 male and 3 female) 37/39 questionnaires were completed and 7 tutors documented written feedback.
Tutors Themes:
1) Time commitment and workload
2) training on on-line technology
3) uncertainty about portfolio grading
4) supervision and feedback
5) commitment
6) confidentiality and access to portfolio entries

Student Themes:
1) Willingness to conduct and develop learning plans,
2) reluctance to share self assessment results
3) uncertainty about self assessment criteria
4) attitudes, expectations and response to feedback
5) inexperience, excitement and caution about documented and shared reflection
6) frustration with technology
7) willingness to interact and share knowledge and resources with peers.

Cycle 3:
In cycle 3 the impact of culture and religion on reflection and interactive learning was explored.

Conclusions:
E -portfolios fostering independent and team learning is a solution to changing demands in medical education and addresses the hidden curriculum.