The daily grind ± use of log books and portfoliosfor documenting undergraduate activities

How many of you have used logbooks

in one form or another for documenting

the activities of your undergraduate

students? The two articles in this issue

may give you ideas of how logs can be

used in traditional, and not so tradi-

tional ways.1,2 As we move towards

community teaching and decentralized

clerkships, logbooks can be used to

track the activities of students as they

learn in different environments, provi-

ding feedback for programme planning.

Logbooks are also extremely

useful in focusing students on

important objectives that must be

achieved within speci®c time

frames

Logbooks are also extremely useful

in focusing students on important

objectives that must be achieved within

speci®c time frames. Murray et al.¢spaper1 highlights that students per-

ceived supervised interaction with

patients and teaching by doctors as the

most educational activity in both

community and hospital environments,

but they found it even more educational

and enjoyable in the former.

Individual students have very

different experiences even with

apparently similar timetables

What are the strengths of learning in

the community? Murray's results con-

®rm what students tell us: they say that,

on the whole, it is that the preceptor

takes time and effort to sit down with

them to teach and to provide ongoing

feedback during their experience.

There is often more one±to±one inter-

action with a single preceptor and even

if a number of teachers are involved,

there are more links among the group

to discuss the students' learning. In the

teaching hospital setting there are many

more teachers, often sicker patients,

and many other con¯icting needs so

that students lose the personal

mentorship. This is particularly the

case in tertiary centres as supported by

the amount of unsupervised time

recorded by students in this study.

The interaction with the patient

is one of the most valuable

experiences for any student

Murray also points out that the

heterogeneity of the data they obtained

suggests that individual students have

very different experiences even with

apparently similar timetables. It is

important for both students and faculty to

recognize that although their learning

experiences may be very different, core

objectives can still be attained. Log-

books can be used to `check off' these

objectives, and to inform the students

whether they need to ®nd experiences

or opportunities that have not been

achieved in a particular rotation. The

students' logs can then be reviewed by

the rotation coordinators to see if the

objectives they have set have been

attained, so completing the education

cycle. With computer technology taking

over, the paper held logbook will evolve

into one stored on a hand held device

such as the Palm V. These are appear-

ing in every student's hand in North

America and if you do not wish to fall

behind the times I would suggest that

you put a request for one in your

upcoming Chanukah or Christmas list.

However appealing the technology, the

interaction with the patient is one of the

most valuable experiences for any stu-

dent and entering or looking up infor-

mation should not diminish this. Hand

held computer logs are in their early

days and are not without problems.

The effort to put information on these

devices is signi®cant and although the

Liaison Committee on Medical

Education (LCME) requires that stu-

dents document patient encounters

during their clerkship, paper docu-

mentation remains more convenient.3

One of the realities of the

teacher's life is that we must

enlist the students to help in

collecting material to document

their experiences

I like the idea, from La Palio, of mul-

tiple strategies to document a student's

learning process.4 Ideally, to really

understand students' experience, we

would need to follow them more closely,

minute by minute, or even participate in

part of the clerkship as a student. If we

had the time this would be most

enlightening. However, one of the reali-

ties of the teacher's life is that we must

enlist the students to help in collecting

material to document their experiences.

Many of us would have

bene®tted from the experience of

keeping a learning portfolio in

our undergraduate and

postgraduate years

Lonka et al.2 describe a portfolio-

based system to support the personal

and professional development of the

medical student, which may help in this

regard. There are several reports of

Commentaries

Correspondence: Kim Blake, Department of

Paediatrics, IWK Grace Health Centre,

5850/5980 University Avenue, PO Box

3070, Halifax, Nova Scotia B3J 3G9,

Canada. Tel.: 00 902 420 8226; Fax: 00 902

428 3216; E-mail: kblake@is.dal.ca

Ó Blackwell Science Ltd MEDICAL EDUCATION 2001;35:1097±1098 1097

portfolio use that support them as a

learning tool. For instance, the Inter-

net-based, multiuser, multicentre

learning portfolio has been shown to

have a signi®cant effect on residents'

perception of their self-directed learn-

ing abilities;5 this study also involved

obstetrics and gynaecology residents.

Where CME is concerned, a portfolio-

based learning scheme can meet the

needs of GPs relevant to their profes-

sional practice; it can give learners

control over how, what and when they

learn and encourage active and peer-

supported learning.6,7 In Finlay's study

students recorded triggers to learning

and key items in a personal learning

portfolio. Students' performances in

the clinical examination correlated

positively with the contents of their

portfolio; the more information in the

portfolio the better they did in the ®nal

examination.8 However, the usefulness

of the portfolios in summative assess-

ments have been more controversial.

Perhaps we should all undertake

logging or portfolio keeping

ourselves

In recent years, teaching portfolios

have been developed as a way for

faculty to document teaching scholar-

ship, accomplishments, skills, and

strategies. Teaching portfolios provide

a means for teachers to demonstrate

their teaching achievements and display

their best work. I believe that many of

us would have bene®ted from the

experience of keeping a learning port-

folio in our undergraduate and post-

graduate years, both as a means of

developing the habit of maintaining one

and also as a means of examining our

experiences and using the information

as a basis for ongoing learning and

improvement. Perhaps we should all

undertake logging or portfolio keeping

ourselves.

Kim Blake

Halifax, Canada

Acknowledgement

I would like to thank Dr Karen Mann

for her helpful comments.

References1. Murray E, Alderman P, Coppola W,

Grol R, Bouhuijs P, van der Vleuten C.

What do students actually do on an

internal medicine clerkship: A log diary

study. Med Educ 2001; 35:1101±7.

2 Lonka K, Slotte V, Halttunen M,

Kurki T, Tiitinen A, Vaara L, Paavo-

nen J. Portfolios as a learning tool in

obstetrics and gynaecology undergra-

duate training. Med Educ 2001;35:

1125±1130.

3 Marshall M, Sumner W. Family prac-

tice clerkship encounters documented

with structured phrases on paper and

hand-held computer logs. Med Educ

2002;36: in press.

4 La Palio L, Filling C, Engel J, Ways P.

Multiple Strategies for Studying Med-

ical Clerkship Experiences: a Case

Study. J Med Education 1983;58:328±

34.

5 Fung M, Walker M, Fung K, Temple

L, Lajoie F, Bellemare G, Bryson S. An

internet-based learning portfolio in

resident education: the KOALA

multicentre programme. Med Educ

2000;34:474±9.

6 Mathers N, Challis M, Howe A, Field

N. Portfolios in continuing medical

education. effective and ef®cient? Med

Educ 1999;33:521±30.

7. Lim J, Chan N, Cheong P. Experience

with portfolio-based learning in family

medicine for master of medicine

degree. Singapore Medical Journal 1998;

39:543±546.

8 Finlay I, Maughan T, Webster D. A

randomized controlled study of port-

folio learning in undergraduate cancer

education. Med Educ 1998;32:172±6.

Use of logbooks and portfolios · K Blake1098

Ó Blackwell Science Ltd MEDICAL EDUCATION 2001;35:1097±1098