"Learning-by-doing": social representations of healthcare
          students regarding reflective portfolio as a teaching, learning and assessment
          method

In the current context of the need for changes in the training of healthcare professionals, portfolios can be highlighted as an innovative method for teaching, learning and assessment. The aim of the present study was to identify the social representations of students in the process of constructing portfolios. This was a qualitative study that used a combination of the following techniques: participant observation, interviews and focus groups. In total, 114 students on healthcare courses participated. Through using content analysis, the following core meanings for portfolios as a teaching and learning method were found: easy-to-understand content; autonomy; liberty; and a critical-reflective stance. The following meanings were found for portfolios as an assessment method: error as an opportunity; interaction with the professor; and a differentiated assessment environment. Convergence and conflict points were also found: time taken to perform the activities; reflection process; and innovative method in the context of traditional teaching.

Social representations; Health education; Reflective portfolio

Authorship

Glauce Dias da Costa

Departamento de Nutrição e Saúde, Universidade Federal de Viçosa. Avenida Peter Henry Rolfs, s/n, campus universitário. Viçosa, MG, Brasil. 36570-900. glauce.costa@ufv.brUniversidade Federal de ViçosaBrasilViçosa, MG, BrasilDepartamento de Nutrição e Saúde, Universidade Federal de Viçosa. Avenida Peter Henry Rolfs, s/n, campus universitário. Viçosa, MG, Brasil. 36570-900. glauce.costa@ufv.br

Rosângela Minardi Mitre Cotta

Departamento de Nutrição e Saúde, Universidade Federal de Viçosa. Avenida Peter Henry Rolfs, s/n, campus universitário. Viçosa, MG, Brasil. 36570-900. rmmitre@ufv.brUniversidade Federal de ViçosaBrasilViçosa, MG, BrasilDepartamento de Nutrição e Saúde, Universidade Federal de Viçosa. Avenida Peter Henry Rolfs, s/n, campus universitário. Viçosa, MG, Brasil. 36570-900. rmmitre@ufv.br

Collaborators

Glauce Dias da Costa was responsible for conceiving the theme, collecting and analyzing the data, and for writing the paper. Rosângela Minardi Mitre Cotta was responsible for constructing the collective portfolio method, supervising data collection and analysis and reviewing the written text.

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Figures | Tables

Figures (1)
Tables (5)

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Figure 1
Undergraduate health students’ social representation of the learning process enabled by the construction of the portfolio, in the perspective of changes in the students’ scenario and context at a federal university.

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Chart 1
Script with the 20 questions that guided the interviews conducted with students from the health programs of a federal university.

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Chart 2
Students' perception of the teaching and learning process experienced in the university context, according to testimonies in focus groups conducted at the end of the school year in 2011, 2012 and 2013.

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Chart 3
Students' representations of the LEARNING process enabled by the portfolio.

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Chart 4
Encouraging and/or hindering points presented by the students in the process of construction of the portfolio.

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Chart 5
Students' social representations of the EVALUATION process enabled by the portfolio.

Figure 1 Undergraduate health students’ social representation of the learning process enabled by the construction of the portfolio, in the perspective of changes in the students’ scenario and context at a federal university.

Chart 1 Script with the 20 questions that guided the interviews conducted with students from the health programs of a federal university.

Script for the interviews with undergraduate students from health programs

1) What is the portfolio for you?

2) At the beginning of the construction of the portfolio, were the learning objectives clear to you? (That is, what should be done and/or what you would achieve with the portfolio were clear?) Explain your answer.

3) How were the contents and evidences chosen for the construction of the portfolio?

4) Has the portfolio helped you to understand the contents of Health Policies and of the SUS? If it has, in what way? If it hasn’t, why?

5) Is there anything that you verified in the construction of the portfolio that transcends (goes beyond) the contents of the discipline of Health Policies? If there is, what is it?

6) Has the portfolio helped you to realize your strong points and your weak points in the professional education process and for life? If it has, please explain it.

7) Before, were you able to relate your previous knowledge (knowledge from other disciplines or what you had already learned) to the knowledge acquired in the discipline of Health Policies?

8) Has the construction of the portfolio helped in the nutritionist’s or nurse’s education to work in the SUS? In what way?

9) Report one or more episodes or situations that have marked you and have made you reflect during the process of construction of the collective portfolio.

10) Has the process of construction of the portfolio contributed to the interaction with your colleagues (student-student)? If it has, in what way? If it hasn’t, why?

11) Has the process of construction of the portfolio contributed to the interaction with the teachers (teacher-student)? If it has, in what way? If it hasn’t, why?

12) What are the strong points and the weak points of teamwork in the process of construction of the portfolio?

13) Please cite some characteristics related to group work that were enabled by the process of construction of the collective portfolio.

14) When you started the construction of the collective portfolio, what were the feelings, perceptions and emotions that you experienced?

15) At the end of the construction of the portfolio, what were the feelings, perceptions and emotions that you experienced?

16) Which stage of the portfolio did you most enjoy doing? Why?

17) To you, are there any differences between the portfolio and a traditional group work?

18) What is the difference between the portfolio and the test as evaluation methods?

19) To you, what is learning?

20) How do you learn best?

Chart 2 Students' perception of the teaching and learning process experienced in the university context, according to testimonies in focus groups conducted at the end of the school year in 2011, 2012 and 2013.

“I think that, in the majority of the disciplines, you have to know a lot of things by heart. Sometimes we can assimilate them, sometimes we can’t. It’s a very mechanic approach and we don’t have space to say anything.” “We’re forced to memorize contents but we don’t have time. There are too many things to learn in little time; there’s too much content.”

“We’re forced to memorize contents but we don’t have time. There are too many things to learn in little time; there’s too much content.”

Guys, it has always been like this and I think it’ll never change, because changing takes a lot of effort. The portfolio is laborious and we’re not used to laborious things.&rdquo

“This is the way it goes here: you study, you get your grades and then you forget everything. The system is based on grades for efficiency coefficients; if you have a good coefficient, you have chances of earning a scholarship and you can get better internships. You are the grade you get.” “

“It’s true: I had a very hard time at the beginning of the construction of the portfolio. I couldn’t understand how to do it, how to use my creativity; the university doesn’t teach us how to do it...”

“But I don’t think the blame is only of the teachers or the system. We can’t be left out of it. We’re here to think, we have to question more.”

“I think the test has its place, as it sees the individual potential and forces us to study... but it can’t be just tests.”

“Our learning reality is very theoretical; the internship takes place only at the end. I learn with practice, that’s why I miss creative methods like the portfolio.”

Chart 3 Students' representations of the LEARNING process enabled by the portfolio.

Understanding of the content (Health policies – SUS)

“The search for news reports, texts, songs, cartoons helped us to relate theory to practice. Sometimes I read a news report about the health sector and I thought, “This is what the teacher meant.” (I15)

“What’s cool about the portfolio is that I learned with the searches I made. I formed my knowledge about the SUS. Today I have a different idea of the SUS: it’s not only for poor people, and I myself discovered this. The teacher said it in the classroom, I read the articles that she recommended, but in the portfolio I searched by myself. I saw and learned that the SUS is our policy, and it’s not just for poor people; it’s for everybody.” (I09)

“The portfolio helped me to link things. At the beginning I thought that the texts were very difficult and I had to read a lot to be able to reflect on the themes. I thought: “Oh, my God, I won’t be able to do it!” But this helped me understand the health paradigms and that a biological and fragmented view of the human being is rooted in us. In the portfolio, I had the chance not to memorize this; I made drawings and used my creativity to express what I was learning and feeling.” (I10)

Autonomy and Freedom

“We can put in the portfolio what we find interesting, although the teacher instructs us in the steps we must follow. It’s not something closed; we can exercise our creativity, we can color, paint, draw, synthesize, make schemata relating it to what we’re learning in the classroom.” (I55)

“The interesting part is what we do in the portfolio. We research; there’s a little of ourselves in the portfolio. Although the teacher evaluates it and tells us her opinion, we can do it by ourselves. For example, there was one part that we called “Look what we’ve found”. We ourselves made the searches, we did it and we found things, it wasn’t the teacher who told us about it, we discovered things. I think that we learn better this way.” (I43)

“If there was something I learned with the portfolio was how to search for things, to reflect on them and to argue in the group that what I had found was important. I’ve always received everything ready and I demanded this from the teacher. I had a hard time in the portfolio because of it; I had to make searches, look for things by myself and defend my idea.” (I67)

“I don’t learn under pressure. I retreat when something imprisons me, it’s like I block myself. I noticed it during this semester: I did better in the discipline that was well guided but gave me freedom to do and construct things. I think that things must have lightness so that we can enjoy doing them.” (I27)

Criticism-Reflection

“One thing I learned with the portfolio was not to accept everything people say as truths. For example, I’ve always thought that the SUS was for poor people, that the SUS was bad. The media only shows the dark side of the SUS. So, I’ve learned to have critical thinking – is this true? And to search for the reason for things.” (I24)

“In the portfolio we were forced to think and reflect. The teacher always asked us to mention other points of view and discuss with the authors. I found it very hard, I’m not used to doing it, but then I saw how much I’ve grown. Today I watch a news program and I don’t accept everything they say as the absolute truth.” (I41)

“It’s funny to say that we need to reflect. It seems so obvious: we think all the time. But when we really thought about it, we realized that we’re alienated, and the portfolio made me see the extent of my alienation. We put in the portfolio many things about the protests against corruption in Brazil and I thought that all of this has impacted me a lot, and that I was far from the things that happen in the world.” (I33)

Chart 4 Encouraging and/or hindering points presented by the students in the process of construction of the portfolio.

Time

“The portfolio is interesting but very laborious. It’s necessary to dedicate a lot of time to it. Taking tests is easier due to the available time we have.” (I83)

“We created a group on Facebook and this helped us a lot. We didn’t have time to meet every week because in the group there were people from different classes and different programs, but in the Facebook group we talked almost every day and discussed the news reports, articles and cartoons we’d found.” (I101)

“Everybody complains about lack of time, but what can we do? We have to do it and we have to find a way to do it well. In fact, we have to organize ourselves better – Time Management. Everybody does everything at the last minute. I think we don’t know how to study.” (I72)

Reflection

“I don’t know, I used to find it weird to evaluate what I think and reflect; it’s private stuff. I have difficulties in separating what the authors think from what I think. Sometimes I think I’m not mature enough to discuss with the authors, and the portfolio helped me exercise the reflection process.” (I75)

“I think that reflecting means giving my opinion. It’s hard, I’d never thought about it. Sometimes, I think that what is important is to mention the opinion of other authors; not mine. I really must exercise reflection and the university doesn’t give us a chance to do it. (I56)

“In the university, we don’t have spaces to reflect and think. We learn to memorize and repeat what the teacher transmits. I can read slides at home. The portfolio gave me the opportunity to really think and exercise reflection.” (I51)

The portfolio as an innovative method in a traditional teaching context

We’re not used to performing a task like this, it’s hard for us. Only in the middle of the semester did we understand what a portfolio was. We don’t know how to reflect and be creative; we used to do it only in primary school.” (I29)

“Constructing the portfolio is very good, but what’s bad is that I’m enrolled in 33 credits this semester – it’s what must be done, according to the curriculum framework. The portfolio demands dedication, but I don’t have the time I’d like to have.” (I13)

“We started constructing the portfolio as if it were a file. In the first evaluation we put the pieces of information in it and there it was. Then the teacher said it was important to include what the group thought about what we had read. I had to change my way of thinking. In the university we learn to present the information of others, to memorize what they say and stand by their opinion, and not to form ours. It was hard for me; the portfolio really impacts us.” (I31)

Teamwork

“At the end of the construction of the portfolio, we had to write a text. What was good about it is that we had to build this; we had to reach a consensus. The five of us were working on this task and at the beginning nothing came out of it; we thought, we wrote a sentence, we erased it, and all of a sudden, we began to brainstorm, everybody started talking at the same time. The result was nice, the text became so beautiful that we couldn’t believe we had been capable of writing it. It seemed a very scientific piece of writing. Then we realized that we only did it because each one of us proposed an idea, each one of us put something of herself in it, and then I said ‘in fact, none of us is as good as all of us together’, and it was really beautiful, you know? This work of cooperation with the other, and it was only possible because we had the freedom to construct in the portfolio and we exercised it.” (I05)

Working as a team is hard for me. In the portfolio we could not distribute the activities like in the other tasks, and we had to reach conclusions and decide everything together. I think it’s easier to do it myself, take my part and do it; people are complicated, some of them do not take it seriously. On the other hand, this is what I’m going to experience out there, and I have to learn how to deal with it, right?” (I76)

Chart 5 Students' social representations of the EVALUATION process enabled by the portfolio.

The Mistake as an Opportunity

“I think that the portfolio is a fairer evaluation method, because many times the test is a copy; you memorize contents to take the test and some hours later you don’t remember anything. Besides, you can’t make mistakes and you can’t correct them. Sometimes, I don’t know why I made the mistake and I spend the rest of the course without knowing it and repeating the same mistake. In the portfolio, you really construct learning and don’t forget it anymore.” (I16)

“The portfolio allows going back to what you don’t know and changing it. Then I understand why I was wrong and where the problem is. I think this is good for us; in the university, sometimes we don’t have time to reflect on what we do. Sometimes, the teachers give us tests and we don’t even know what we did wrong or why; they don’t show us the corrected test and we don’t ask them to do it, either.” (I13)

“I remember that, on the evaluation day, the teacher told us that we were not mentioning our opinion, our reflections, and that we had put the news in it and that was it. Then I realized that we were making a file and not a portfolio. With this, the group noticed that we were doing it wrongly and we had the chance to fix it: in the next evaluation, there was more of us in the portfolio. We’re not used to it, to think about our mistakes.” (I07)

“I’ve never liked evaluating myself. I blame myself, so much so that I’ve never asked a teacher to show me my grades. I let it go. In the evaluations, I get anxious and I’m scared of the teacher. In the evaluations of the portfolio, I saw that it wasn’t so bad, as it helped me to see flaws and I could fix them.” (I10)

The interaction process

“The work of construction of the portfolio made me get to know the members of the group better. Our interaction and integration surprised me. At the beginning, I didn’t know my colleagues, I didn’t have contact with the girls, and then we created friendship bonds due to the group work that I’ll take with me forever.” (I35)

“Do you know what teamwork means? We had a great interaction. All the group members got involved and each one did what she was best at. Some had artistic talents and creativity skills, others wrote well, others had spirit of leadership, so one thing added to the other and it worked.” (I99)

“The interaction with the teacher happened especially in the evaluation moments. It was important because then we got to know what she wanted exactly; she always gave tips to the next evaluations. So we grew a lot with this. I was very scared of the portfolio at the beginning, but after I understood it… now I don’t want to hand it in; it’s mine.” (I81)

Welcoming environment: transparency of evaluation criteria, non-punishment and appreciative evaluation.

“What I liked most in the portfolio was knowing what was going to be asked; we never know what is expected from us. The teacher handed a material for us to make the group’s self-evaluation, then she evaluated the group and handed her evaluation to us. This was very good because we saw what we needed to change.” (I18)

“It was different from a test, in which we get tense. The atmosphere was different, and as we could fix it, we became calmer. It was possible to improve it later and this was good.” (I01)

“It was good to show what we had done. It was a lot of work, so we wanted to show it to the teacher, we were proud of our portfolio. It was good to show what we had learned and we weren’t tense, we didn’t do it under pressure.” (I44)

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"Learning-by-doing": social representations of healthcare students regarding reflective portfolio as a teaching, learning and assessment method

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[1] Collaborators

Glauce Dias da Costa was responsible for conceiving the theme, collecting and analyzing the data, and for writing the paper. Rosângela Minardi Mitre Cotta was responsible for constructing the collective portfolio method, supervising data collection and analysis and reviewing the written text.