This article is concerned with the development of portfolio based education for Health Visitors. The portfolio structure that is being used within the new RSCPHN at Leeds Metropolitan University has its origins in an FTDL funded project to determine the value of portfolio based learning. At Leeds Metropolitan University this project initially focused on the creation of a suitably structured portfolio for the assessment of competency in Non-Medical Prescribing course. However, the final product of this project exercise was the development of a portfolio format that could be adapted to meet the assessment needs of a variety of courses provided by the faculty of health at Leeds Metropolitan University. For the sake of simplicity we have chosen in this article to focus on the use of portfolio learning in only one of the courses, that being the Registered Specialist Community Health Nurse (RSCPHN)
Context of development.
The portfolio was initially used with non medical prescribing students at the university and continued to be developed and evaluated by staff and students until we accomplished the current format.
It is notable that as the structure of the portfolio has evolved to meet the constantly advancing process of non-medical prescribing, the standard and quality of the work submitted through it, has represented progressively higher levels of professional excellence. Over a period of almost four years the portfolio assessment document has moved from a simple, but effective, method of determining the achievement of the required practical competencies, specific to non-medical prescribing, to a tightly structured and systematic, yet highly flexible, tool that can be used to evaluate the individual practical competency of students embarking on a range of health-based professional qualification courses.
The core structure of the portfolio, originally developed to meet the specific needs of the Non-Medical Prescribing course, had to evolve very rapidly for two key reasons. The first being the unexpectedly wide range of practitioners in highly specific, specialised areas of practice that began to apply to the course from 2002-2003 (perhaps as a result of the advent of supplementary prescribing). The second element was the linked necessity to find a means of ensuring equity and parity in the assessment of practitioners from a wide range of functional backgrounds. The resulting current portfolio format has proved to be sufficiently robust to not only meet the burgeoning assessment range requirements of the Non-Medical Prescribing course but has now become an integral element, and, in two instances, the sole element, of assessment in a number of health professional courses at the university. Given the inherent flexibility of the portfolio structure, there is no reason why this approach could not be used more widely in the fields of health and social care.
The principle components of the current format are relatively simple. Prior to the commencement of the teaching of the core curriculum the students attend an intensive day long workshop on portfolio learning. Initially the students, as a group, are introduced (often re-introduced) to the central concept of personal and professional reflection, through a series of exercises designed to indicate the quality of academic presentation required. The students then explore the specific learning outcomes and/or practical competencies required for the course, with reference to their own specific area of professional expertise. They are then offered a standardised learning contract template, the central building block of the portfolio, that allows them to lay out a pathway of practice orientated, aims and objective based, learning contracts, each in conjunction with a specific self-determined action plan of activities and an indication of the evidence that they will aim to provide to indicate success. A summary reflection for each learning contract is the academic vehicle used to display their developed expertise. The strength of the portfolio is that it is the
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direct link between theory and practice. The mentor in practice would first have to sign off the competencies as achieved to a minimum safety standard, whilst the overall mark for the portfolio is determined by the academic quality of the portfolio content.
A key advantage for the student is that the finished portfolio is often an invaluable resource in their specialist field of practice containing case studies, research material, relevant data and active routes to post-qualification continuing professional development.
Prior to the new Health Visiting Programme (NMC, 2004) a portfolio of practice based competencies had been a required element of the overall assessment strategy; but this did not attract a mark that reflected it’s importance as both a measure of the value of practice and as a substantial piece of academic work in its own right.
With the advent of the new course this anomaly was rectified and by attaching four course modules to the portfolio it became worth half of the total academic marks for the course.
The standards of Proficiency for Specialist Community Public Health Nursing NMC (2004) informed the content of the course for those nurses accessing part 3 of the register. By the summer of 2005 Leeds Metropolitan University had been formally validated by the professional body, the NMC and the University to run the SCPHN course. Subsequently the newly structured course including the new portfolio model ran for the first time in September 2005.
The new course is offered at both undergraduate and post graduate level. The course consists of eight modules which are a mixture of generic and specialist focus. Four modules are assessed through traditional academic means and four are assessed through the portfolio; one module incorporating a one hour examination.
What does the course look like?
The course incorporates 50 per cent theory and 50 per cent practice with 15 alternative practice days. There are 112.5 practice days including ten weeks consolidation at the end of year one and year two for part time students and 15 days alternative practice placement. Incorporated into the course is inter-professional learning in the form of the Children and Young Peoples Workshop. Tutorial support is available and offered in a manner that meets the individual needs of the student. In addition each student is on placement with their individual practice teacher.
Structure of the portfolio.
The modules that are now integral to the portfolio are:
- Children and Young People.
- Health Promotion
- Professional Development
- Vision for Practice.
The students complete a series of learning contracts, including one specific to each of the named modules. Each learning contract forms the basis of a learning plan; which enables the student to set personal and professional objectives, which are, as a consequence, student centred. The objectives will reflect self assessment and identified learning needs, in relation to the development of confidence and competence to become a SCPHN (SCPHN, Health Visiting Course, Portfolio Handbook, Leeds Metropolitan University, 2006).
Learning contracts provide a foundation on which to develop a structured programme that is specific and unique to each individual student, they promote the concepts of self-awareness and self-development and they form the basis of their future learning needs. This process is necessarily student centred and encourages the student to adopt a problem solving approach which they explore within unidiciplinary groups in the university. This actively encourages partnership learning and bridges the gap between the central theoretical concepts and policy of health visiting and the reality of health visiting practice. The student, practice teacher and the university tutor all have their individual responsibilities with regard to the portfolio.
The students’ responsibility is to carry out the required practice activities and to supply the necessary supporting evidence to satisfy both the practice and academic elements of the portfolio. The role of the practice teacher includes the provision of counselling, support and supervision to aid the development of individual learning contracts for their practice content which culminates in the students learning contracts being confirmed by the practice teacher as having attained at least the minimum NMC standard for safe practice. The university tutor actively supports the practice teacher and the student through tripartite visits and individual tutorials for academic guidance (adapted from SCPHN Portfolio Handbook, Leeds Metropolitan University, 2006).
The ultimate measure of success in portfolio learning is that the student successfully indicates that they are proficient in the required competencies and that they can express their knowledge, skills and personal development consistent with the required academic criteria. This includes both the facility to critically reflect and analyse the supporting evidence that they have provided within the portfolio. This is further evidenced through the use of four synoptic statements; each one applied specifically to one of the four named modules associated with the portfolio. The structure of each synoptic statement comprises of a 1000 word summary indicating where the evidence can be found to demonstrate that the set learning outcomes for each of the discreet specialist focus modules have been achieved.
Conclusion
The creative process required to develop and implement this form of portfolio assessment has been both interesting and academically stimulating. For the first time this professional scheme can claim to fully recognise and value the practice element of a course which is 50 per cent theory and 50 per cent practice. It also provides a vehicle for assessing the academic validity of the practice component.
References
NMC (2004) Standards of proficiency for Specialist Community Public Health Nurses. London, NMC.
SCPHN (SCPHN, Health Visiting Course, Portfolio Handbook, Leeds Metropolitan University), 2006.
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