Portfolios as a Method of Assessment for UK Student Paramedics - Assignment Example

Portfolios as a Method of Assessment for UK Student Paramedics Abstract Proper training is important for paramedics because in their work, paramedics must confront situations that will overwhelm many and they must make the right decisions for patients in emergencies before transporting them to hospitals. Thus, like many other healthcare workers, paramedics must present a capability for handling the real world and it is not possible to develop such capabilities by merely reading theory. To connect theory with practice, student paramedics must reflect and learn without having to make decisions in real time. Thus, for healthcare workers and paramedics, written examinations and tutorial assessment are unstructured, variable and inaccurate. A paramedic must demonstrate ability to combine a broad range of skills to cope with reality. Thus, examiners thought it necessary to add coursework, modular assessment, logbooks and portfolios to assessment to provide greater effectiveness and accuracy in assessment of paramedics. In the United Kingdom, the use of portfolios for assessment of health and social care students, including paramedics, is an accepted fact for some time. This literature review attempts to explore the use of portfolios as a method of assessment for student paramedics in the United Kingdom in the light of what is available from literature related to this topic. Contents Introduction 1 Literature Review for the Use of Portfolios as a Method of Assessment for UK Student Paramedics 3 Conclusion 21 Bibliography / References 24 (This page intentionally left blank) Introduction The number of students in the United Kingdom wanting to undertake university based training for entering the health professions has increased substantially over the last three decades (Jones, 2010, Pp. 2). Paramedics, which used to be an undergraduate health profession has now entered higher education and it is important to ensure that the increasing number of students with an interest in becoming paramedics not only receive the best training, but that they complete their training to attain proficiency. Saving lives in emergencies requires quick action and reflecting about what was the best approach to situations helps with learning (Tangherlini, 1998, Chapter 1). It is important to ensure that students do not feel overwhelmed when they confront real-life situations after studying theory and attempting to learn practice (Driessen, 2003, Pp. 18 – 19). Portfolio learning is a method for encouraging adult and reflective learning for professionals (Snadden, 1998, Pp. 192). It is possible to describe a portfolio as a collection of traditional and non-traditional work that represents a students learning, progress and achievement over a period (Scholes, 2004, Pp. 596). Reflections and conclusions reached by students on matters related to their training are included in portfolios and for paramedics the portfolio may represent a record of observations and reflections related to emergencies or aspects of training in dealing with emergencies. Portfolios for encouraging summative and formative learning and assessment in medical and healthcare training are in frequent use and students often prefer the use of portfolios for assessment compared to the traditional (Sturmberg, 2009, Pp. e85) and (Goran, 2006, Pp. e171). After all, teachers in the health sciences must focus on trying to help students to become capable health professionals despite a tendency for students to focus on passing their examinations (Sturmberg, 2009, Pp. e85 – e86). The portfolio as a record that depicts reflections and reasoning presented by a student paramedic is likely to help students to arrive at the right conclusions when their teachers examine this record and it is possible to use such a record for assessment to decide about the proficiency attained by a student. This literature review examines available literature related to training in the health sciences in an attempt to try to decide about the utility of portfolios as a means of assessment for paramedic students from the United Kingdom. Literature Review for the Use of Portfolios as a Method of Assessment for UK Student Paramedics Medical and healthcare education must produce trained people who can perform in the real world by applying the real learning that has resulted in an understanding and a grasp of the real world applications instead of those who can only remember facts (Sturmberg, 2009, Pp. e85 – e86). A paramedic responding to real world emergencies must successfully handle complex situations that require consideration of a variety of perspectives and issues within a short span of time. The cycle of reflective learning involves an experience, reflection, challenging past learning and improvement in thinking and it is not possible for many to indulge in well-considered action that caters to complex situations without exposure to similar events (The University of Leicester, 2008, Pp. 10). According to Sturmberg (2009, Pp. e85 – e86), it is not possible to cover everything in any evolving field, including medicine for paramedics and this means that students should be able to find and deliver answers by filling gaps in their education. Thus, student paramedics should be able to research, reflect and present the correct answers for a plethora of issues not adequately covered in the classroom. Portfolios present student paramedics with opportunities for research and self-learning together with presenting an opportunity for assessors to decide if a student has a capacity for arriving at the right answers after logical reasoning and use of all available sources of knowledge. Because professional education is a continuous process, it is correct to expect that professional health workers will be in a position to use their basic training to present correct answers for a plethora of issues that will confront them. The use of portfolios for assessment provides training and stimulation for students in real world problem solving and enables assessors to decide about their ability and capacity for the real world challenge. According to the previously mentioned author, assessment for health workers needs to be capability based and this means that the use of portfolios needs to be an important part of the overall assessment for paramedics. The portfolio based assessment approach highlights the ability of assessors to decide about self-direction, critical thinking, ethical and professional behaviour, capacity for dealing with uncertainties, leadership and capacity for using knowledge creatively for a candidate. Thus, the use of portfolios for assessment of paramedics highlights recognition of capabilities rather than rote knowledge. Tochel (2009, Pp. 320 – 321) suggests that a danger exists that the use of portfolio may encourage support from mentors and peers to skew the assessment. However, it is important to understand that even if mentors and peers do support a paramedic in preparing a portfolio for assessment learning does take place when a portfolio is prepared. Thus, it is not possible to overemphasise the value of portfolios as an important component of the overall assessment for paramedics. According to Tochel (2009, Pp. 320), an extensive base of evidence exists for supporting the use of portfolios for assessment for student healthcare workers despite the fact that high quality studies are lacking. The previously mentioned author states that although reports about the reliability for use of portfolios as an assessment tool with a mix of examiners remain uncertain, portfolios are effective for enhancing personal responsibility for learning and professional development. In addition, a recommendation exists for combining portfolio-based approaches with other traditional methods for assessment, keeping in mind the added requirements for time to prepare portfolios. Tochel (2009, Pp. 321) goes further to state that electronic portfolios offer more flexibility for access, feedback and mentoring support compared to paper portfolios. Burch (2008, Pp. 896) describes the structured interviews to assess portfolio-based learning involving patient case selection. For paramedics, a similar approach that exposes them to situations in emergency medicine will help with reflective learning and present an opportunity for assessors to decide if student paramedics can identify problems confronting a patient in need of emergency care, formulate a diagnosis and decide about a plan of action that will best assist the patient. According to the previously mentioned author, structured interviews based on selected portfolio cases can assist students to learn if an examiner asks questions while steering the student towards a satisfactory solution for diagnosis and a plan of action that will best assist the patient. It is unlikely that a steering approach will prevent examiners from arriving at reasonable conclusions about capabilities. Spickard (2008, Pp. 979 – 980) goes further to suggest that in addition to presenting opportunities for student learning, reflection and assessment of their practical capabilities, portfolios present opportunities for helping students to improve their abilities in communications, especially clinical communications. It is important to understand that the communications presented by a paramedic about a patient do influence subsequent treatment and the clinical strategy employed by doctors who will provide post-emergency care. Spickard (2008, Pp. 981 – 982) presents a teacher and a student survey. The survey by the previously mentioned author suggests that electronic portfolios, or e-portfolios, made it easier for teachers to present feedback and for students to benefit from the feedback presented by their teachers. Lombardi (2008, Pp. 8 – 10) states that the use of portfolios for teaching and assessment is not limited to the teaching of medicine and healthcare professionals. Now, the use of portfolios is well entrenched in higher education institutions around the world and this by itself points towards the utility of portfolios in teaching and learning. Portfolios reflect on the growth of a learner over time and present opportunities for assessing learning that has taken place. The previously mentioned author states that some of the world’s most prestigious universities, including MIT, have championed the use of ePortfolio as an important learning and assessment tool for students. In addition, the use of the ePortfolio is a part of the standards requirements of the National Council for Accreditation of Teacher Education in the United States of America. In the United Kingdom, the use of portfolios for assessment of health and social care students by leading universities, including the University of Leicester, the University of Northampton and De Montfort University, is already a fact (The University of Leicester, 2008, Pp. 5 – 19). Thus, it is possible to say that it makes sense to use portfolios for assisting with teaching, learning and critical reflection as well as development of communication skills for paramedics. Experience gained in undergraduate health education at other European universities, such as those from Sweden, suggests that it is possible to consider the portfolio as a central tool in teaching and learning about practical aspects of medicine (Thome, 2006, Pp. e171 – e176). However, a need for having trained teachers with a capacity for evaluating portfolios and a requirement for including other types of tests in addition to the portfolios is emphasised in the previously mentioned study. In addition, the previously mentioned study suggests that students may feel threatened with the discussion between them and their teachers if the purpose of such a discussion is only assessment. Thus, it makes sense to use the portfolio interviews for teaching and guiding students prior to using portfolios for assessment. Portfolios are not just assessment tools and portfolios are useful for guiding the way in which student paramedics think. Thus, although portfolios are useful for both summative and formative assessment, formative assessment encourages students to be more open and daring by trying to include material, which they may consider as having some weakness in the hope of learning from the feedback. However, such risks are not common with portfolios meant for summative assessment and it is possible to conclude that if the portfolio approach is judiciously used, it promotes deep learning while reducing assessment stress. According to Burch (2005, Pp. 1169), the use of portfolios as a means for assessing capabilities for healthcare workers had gained widespread acceptance even in the past decade. However, portfolios can turn out to be resource intensive with a requirement for spending substantial time and effort in assessing students. Patient encounters, structured questions during interviews and training of examiners prior to the use of portfolios will add to the burden of assessment. However, the previously mentioned researchers observed that single examiner portfolio interviews with standardised questions and a global rating scale for paramedics has the capacity for delivering a high level of internal consistency with a capacity for accomplishing a broader spectrum in assessment. The previously mentioned techniques for using portfolios for assessment reduce examination time for candidates and the requirement for resources, while adding consistency. However, for formative assessment, it may be useful to try a broader range of portfolios and more questions. Regener (2005, Pp. 234 – 235) presents a discussion about student assessment in paramedic education and emphasises that it is important to try to identify the strengths, unused opportunities, faults and threats in an existing system of assessment to try to bring about improvements. The previously mentioned author goes further to suggest that assessment for paramedic students must include assessment for knowledge relevant to a paramedic, communication skills, decision making, technical skills, professionalism, ability for self-reflection, creativity and enthusiasm. It is better if the methods used for assessment can permit triangulation to decide about the capabilities of a paramedic student. Assessment for paramedics must take into account the fact that paramedics are subordinate to the directives of doctors and that these emergency healthcare workers must often act independently to provide care in the first instance while a patient is awaiting contact with a physician. A paramedic student must demonstrate that they have the knowledge and the capability of applying their knowledge to support their independent acts related to rescue techniques and preclinical medical treatment of patients. Thus, according to the previously mentioned authors, a paramedic must be able to demonstrate a capability in the following five interdependent functions (Regener, 2005, Pp. 234): A paramedic must demonstrate leadership, a capacity for organisation and a capacity for documenting facts that will help others at a later stage. Paramedics should be able to quickly seize up a situation and deploy resources to manage an emergency involving people who are hurt. A paramedic must demonstrate proficiency in technical procedures related to preclinical care, delegation of preclinical care to those who can adequately handle matters and an ability to function adequately when constrained by time. Paramedics must be able to get involved with aspects of infrastructure, techniques and logistics for handling emergencies. Paramedics should maintain a desire for bringing about quality improvements in all things, a desire for continuous professional development and for advancing knowledge through research. Regener (2005, Pp. 235) suggests that it is important that the formative and summative assessment for paramedics includes guidance from the capabilities that paramedics must demonstrate to work effectively. The traditional methods for assessment encourage superficial learning and rote cramming, especially for the health sciences that require practitioners to retain possession of facts. However, application of factual knowledge in practice requires learned strategies for application that are difficult to master in real time emergencies and this means that the portfolio approach used to slow down action taking place in real time to arrive at well thought out conclusions helps with the development of capabilities. In-depth knowledge emerges from reflection and deciding about action after thinking slowly and gradually arriving at the correct answers. Thus, the portfolio approach trains the paramedic to deal with real emergencies. According to the previously mentioned author, the portfolio approach to assessment highlights decisions for self-reflection and creativity in paramedics. However, other aspects of the whole of capabilities that a paramedic student must demonstrate for testing include expert knowledge, problem solving, communication skills and performance related to competencies, skills and tasks. Decision-making skills and professional attitudes are also important for the paramedic and these aspects of the capabilities of a paramedic need testing in addition to the previously mentioned. Regener (2005, Pp. 235) states that having a narrow assessment scheme that leads students to memorise and failing to take into account individual achievements are amongst the faults that are found in assessment schemes for student paramedics. Deep learning is not possible if assessment schemes encourage students to memorise to pass examinations without attempts at application of their knowledge and successful combination of knowledge from various areas to approach a whole. Scoring instruments for assessment of paramedics should not present too much room for interpretation and examiners should be able to conclude with a high degree of agreement about the capabilities of a paramedic. Assessment methods should present reliable and valid evidence about a candidate so that those who complete their course can be trusted to perform with confidence in the real world. The portfolio approach helps students to demonstrate their best without undue stress and it is possible to say that the portfolio is likely to present a reasonably reliable evidence for capabilities despite possibilities of help from peers and friends. It is important to ensure that assessment methods match the learning modality for a course. According to Regener (2005, Pp. 236 – 238), the portfolio method for assessment must be used together with objective structured clinical examinations, written essays, interviews on individual learning, structured observations, case simulations, peer assessments, structured oral examinations and multiple choice questions. The previously mentioned author mentions nine different methods for assessment of paramedics and suggests that although it is better to use a combination of assessment methods, it is important to consider capabilities that need assessment when deciding about the assessment methodology. Clearly, multiple-choice questions may be more efficient for testing knowledge of anatomy, but it is better to use portfolios for testing a capacity for applying paramedic knowledge to real world situations. However, components of the totality of knowledge possessed by a paramedic should build up to enable them to demonstrate their capabilities in the real world and this means that knowledge components are important and need assessing. Satisfactory holistic assessment is only possible when various methods for assessment triangulate to provide a reliable judgement about knowledge and capabilities attained by student paramedics. According to the previously mentioned author, using the maximum possible methods for assessment often helps student learning and the reliability of assessment about capabilities. Thus, it is better to try to incorporate different approaches to assessment for training competent paramedics. Shaffer (2004, Pp. 171 – 175) emphasises a need for global or holistic performance assessment in medical education and by extension education for paramedics and other health workers. The previously mentioned author goes further to suggest that political and structural considerations may have an impact on assessment methods used for health workers during their education, but an emphasis on testing individual skills and abilities needs emphasising in an age when even medicine and health sciences are experiencing rapid changes. The issues involved in developing a system of assessment for healthcare education and education for paramedics should emphasise testing with a wide scope, assessment of actual performance capabilities, reliability and repeatability in assessment. In addition, an emphasis on attempting to assess the present capabilities rather than considerations for what may have been the case for individual capabilities in the past is emphasised. The authors go further to state that portfolios of work are important for systems of assessment that emphasise global or holistic performance assessment. Shaffer (2004, Pp. 167 – 170) states that in the last century, medicine and allied professions, including paramedics, have been able to present a well-developed sequence of training activities for producing technically competent and compassionate health workers. However, it is not certain if the systems for educating medical and healthcare workers are the best possible ones that could have evolved. The previously mentioned author goes further to state that funding constraints and demand do burden the educational systems and this means that a need exists to make all possible and sustainable improvements within training programmes for paramedics and health workers that can improve the products of training. Assessment in educational and training programmes that focus only on a small set of tasks while ignoring the broader requirements for capability often ignore important aspects of capability. Thus, assessment that focuses only on wound management will only produce skilled technicians that do not relate well to patients and it is important to ensure that the assessment of paramedics should help them to make progress in all areas of expertise that combine to decide about their capabilities. In addition, it is important to try to make efforts to include observation and observable behaviour in assessment and perhaps the use of portfolios can help with this. Performance matrices for paramedics must enable assessment to take place relatively quickly in a few days or weeks rather than in months or even years. Performance is the only useful measure on which it is possible to judge the training of paramedics. According to Shaffer (2004, Pp. 174), portfolios are useful for assessing paramedics because a capable paramedic must possess a broad range of skills and abilities that are developed after extended study and practical work. Thus, when paramedics present their logbooks and casework, they present a record of their experiences that presents insights to assessors about what they have handled. It is unlikely that a paramedic can be assessed based on a single performance of expertise because the tasks that the paramedic may be called upon to perform are many and varied. Thus, reliable assessment for paramedics must include portfolios of work on a variety of different tasks on which the paramedic has worked over time. A need exists to enhance the collaboration that exists between a teacher and a learner in healthcare education and portfolios, especially portfolios in the electronic format, may help with this. Carraccio (2004, Pp. 381 – 382) supports the previously mentioned observations by suggesting that the emphasis in medical education has shifted towards one that is outcome based and this shift in emphasis requires that those that receive training must develop competencies in a broad range of domains. Portfolios help with the testing of capability requiring competencies in a broad range of domains. Carraccio (2004, Pp. 381 – 382) proceeds further to suggest that portfolio assessment offers the best possibilities for assessing capability that depends on acquisition of competencies in multiple domains. Portfolios permit learners to document their learning, helps them to reflect about complex matters and permit assessors to look into the reasoning and cognitive attitudes of learners to present feedback that will assist them to move in the right direction. Carraccio (2004, Pp. 383) suggests that for optimal benefits, a portfolio used for educating health workers, including paramedics, must have a creative component to it. This means that students must be able to solve mysteries using their knowledge and competencies in multiple dimensions after putting in the mental effort rather than by resorting to rote cramming, which is a bit like solving a paramedic’s mathematical problem. The exercise of the brain cells in delayed time demonstrates real world capabilities in real time and presents new learning. Like other authors and researchers mentioned earlier, Carraccio (2004, Pp. 381 – 382) emphasises the need for balancing the creative component of a portfolio with quantitative assessment. Web based electronic interactions with teachers, discussion boards and self-assessment quizzes are examples of what supplements the portfolio. It is possible for the additional activities mentioned previously to add to the learning potential of paramedics and this will help them with their portfolio related activities. Thus, a combination of a number of approaches for teaching, learning and assessment works best for training a health worker or a paramedic. Educators can help paramedics to develop individualised learning plans and portfolios supplement and build on the learning planned by a learning plan. Portfolios for assessment may be required to support an individualised learning plan and an instructor may want to prescribe a portfolio that will best support a learning plan. In addition, it is possible to use different types of portfolios for evaluating different competencies for a paramedic. However, the previously mentioned author emphasises a need for validity and reliability in assessment when using portfolios along with a need for educators to try to maximise the size and breadth of assessment of competencies. Scholes (2003, Pp. 595 – 597) states that the use of portfolios to assess practice in health education had commenced prior to 1996. However, since then, the elements of a portfolio have expanded and their use in assessment, teaching and learning has become more complex. Thus, according to the previously mentioned author, it can be time consuming to make sense of portfolios and this suggests a judicious use for portfolios because sometimes it is more convenient to evaluate practice by observing. Portfolios are time consuming to produce and assess, requiring much effort and time. Thus, the amount of time and effort that students and assessors can devote to portfolios is a consideration in the use of portfolios. However, the previously mentioned author suggests that it is important to teach all students about portfolios even if reliable and rigorous assessment using portfolios is proving to be difficult, because it is only by emphasising the importance of portfolios to students will it possible to have students prepare great portfolios. By emphasising the importance of portfolios, educators encourage students to put in the effort to prepare great works, otherwise the motivation will be lacking. In addition to emphasising the value of preparing good portfolios to student paramedics, it is likely to help if educators explain to student paramedics how portfolios can link theory and practice (Scholes, 2003, Pp. 600). Encouraging students to try to achieve literary refinement in their portfolios will improve both learning and communication skills. Thus, if taken seriously by students who value learning, portfolios help them to develop literary and analytical skills relevant for paramedics. However, other students who are struggling will find that they cannot make the right connections between theory and practice in their portfolios, they will not be able to present decent portfolios and this will become apparent to assessors. By completing the portfolio, the student paramedic presents evidence that they have the capacity for linking theory with practice and a need exists for this evidence prior to permitting students to proceed into the practical and real world to create their own theories of practice. Duque (2003, Pp. 510 – 513) states that for assessment of healthcare workers, the classical assessment model involving written examinations and tutorial assessment have been demonstrated to be unstructured, variable and inaccurate. Thus, examiners thought it necessary to add coursework, modular assessment, logbooks and portfolios to assessment to provide greater effectiveness and accuracy in the assessment of student knowledge. Thus, the use of portfolios is necessary for bringing about effectiveness in student assessment for healthcare workers and this extends to assessment for paramedics. According to the previously mentioned author, portfolios demonstrate the personal and professional development of students. Well thought out portfolio exercises help students to monitor progress in learning goals, but the paperwork associated with portfolios can present a burden for the assessors. The amount of time required for portfolios has resulted in some negative comments about portfolios from students and educators. Thus, the use of technology for portfolio work and assessment is a welcome development that not only presents benefits for presenting feedback, but also makes it possible for students to access web-based interactive lectures, assessments, multiple-choice tests and problem-based learning exercises. According to Duque (2003, Pp. 511 – 512), good practice in undergraduate education for healthcare workers requires encouragement of student-faculty contact, cooperation amongst students for information exchange and discussions, encouragement of active learning, prompt feedback from educators about work or any questions, time on tasks and a requirement for students to access from educators what is expected from their work. In addition, healthcare education should promote development of diverse talents and new ways of learning together with refinement of skills. Implementation of web – based electronic portfolio facilities promotes the previously mentioned good practices that are desirable in healthcare education. Thus, portfolios are useful for assessing student paramedics, enabling these student paramedics to gain more from their education and electronic portfolios present added advantages that are beneficial for both students and educators. The previously mentioned author goes further to suggest that one of the many web-based instructional platforms now commercially available, such as webCT, can be used for implementing systems for electronic portfolios that present far more benefits compared to paper based portfolio systems. Electronic portfolios are very storable and instantly transferable to remote locations, making it possible for multidisciplinary teams with members that are remote to assess these portfolios. Electronic portfolio systems permit permanent contact between students, peers and teachers to encourage student self-assessment. Thus, web-based electronic portfolio and systems for education are probably the way to go in the future for educating paramedics and such systems offer opportunities to educators to introduce innovations in education for paramedics. Driessen (2003, Pp. 20 – 21) emphasises the fact that healthcare students and paramedics must be made to complete portfolios but completing portfolios without presenting credits for the work done is unlikely to encourage interest by students. Thus, making students complete portfolio work is beneficial for students but it is important to assess portfolios and students must have credit for assessment because without credit students will not take portfolios seriously. However, having portfolios assessed is likely to motivate students not to take risks or to show their weaknesses to assessors. Thus, assessed portfolios are likely to invite pressure to present excellence without any efforts at reflection or inviting criticism for enhancing learning. The previously mentioned corruption of the portfolio for testing purposes can compromise the most important reason for introducing portfolios in healthcare education, to encourage reflection in students. A capacity for reflection and application of theoretical knowledge is essential for lifelong learning. Thus, perhaps a strategy that will maintain student interest in portfolios while trying to maintain demonstration of reflective reasoning in portfolios presented to educators can help further the cause of learning. Asking paramedic students to present a number of portfolios leading to a final assessable portfolio may help because students will try to learn from portfolios that are for their learning and guidance in the hope of doing well in their final portfolio for assessment. However, the burden presented to educators with such an approach is likely to increase and it may be necessary to have portfolios not meant for assessment assigned to tutors who are well experienced, but not senior assessors. Conclusion It is possible to conclude from the literature review that a vast majority of researchers in the field of medical education and education for healthcare endorse the use of portfolios for assessment. Thus, it is right to conclude that assessment of student paramedics in the United Kingdom should include use of portfolios. Portfolios encourage reflection, present practice of application of theory to practical real-world situations and enhance deep learning if taken seriously by students. However, for assessors and mentors the burden of scrutinising portfolios in detail for presenting feedback, shifting student mindsets and presenting assessment can be substantial. Electronic portfolio and web systems for teaching student paramedics present a promise for reducing the burden associated with the portfolio and for adding to the potential for enhancing learning in student paramedics. Web based systems for healthcare education not only permit quick feedback for portfolios and the use of teams for dealing with portfolios presented by students, but such systems encourage interactions between students, peers and educators, allow students to test their knowledge, access learning material and receive learning plans from educators. Portfolios in healthcare courses, including courses for paramedics, encourage students to reflect and to learn from feedback and reflection. Making portfolios assessable is an important consideration in maintaining student interest in portfolios, but it is equally important to try to make students open up and to present their work so that it can be improved after examination by educators. Thus, perhaps a series of electronic portfolios presented on a web system with a final assessable portfolio may help with maintaining student interest, enhancement of learning and reliable assessment to present the best in the use of portfolios for training of paramedics. (This page intentionally left blank) Bibliography/ References Blaber, Amanda Y. 2008. Foundations for Paramedic Practice: A Theoretical Perspective. McGraw Hill / Open University Press. Burch, Vanessa C. & Seggie, Janet L. 2008. Use of a structured interview to assess portfolio-based learning. Medical Education, 2008, 42, Pp. 894 – 900. Retrieved: June 16, 2010, from: EBSCO. Burch, Vanessa Celeste and Seggie, Janet. 2005. Portfolio Assessment Using a Structured Interview. Medical Education, 2005, 39, Pp. 1143 – 1172. Retrieved: June 16, 2010, from: EBSCO. Carraccio, Carol and Englander, Robert. 2004. Evaluating Competence Using a Portfolio: A Literature Review and Web-Based Application to the ACGME Competencies. Teaching and Learning in Medicine, /6(4), 2004, Pp. 381-387. Retrieved: June 16, 2010, from: EBSCO. Driessen, Erik W. Et al. 2003. Use of Portfolios in Early Undergraduate Medical Training. Medical Teacher, Vol. 25, No. 1, 2003, Pp. 18 - 23. Retrieved: June 16, 2010, from: EBSCO. Duque, Gustavo. 2003. Web-Based Evaluation of Medical Clerkships: A New Approach to Immediacy and Efficacy of Feedback and Assessment. Medical Teacher, Vol. 25, No. 5, 2003, Pp. 510 - 514. Retrieved: June 16, 2010, from: EBSCO. East of England Ambulance Service. 2010. Certificate in Emergency Medical Care – Student Pack. East of England Ambulance Service. Retrieved: June 16, 2010, from: http://www.eastamb.nhs.uk/work-for-us/student-ambulance-paramedic/Cert%20EMC%20student%20pack.pdf/at_download/file Jones, Aled. Slater, Julie and Griffiths, Pauline. 2010. The First Year Experiences of Paramedic Students in Higher Education. The Higher Education Academy. Retrieved: June 16, 2010, from: EBSCO. Lombardi, Judy. 2008. To Portfolio or Not to Portfolio: Helpful or Hyped? College Teaching, Winter 2008, Pp. 7 – 10. Retrieved: June 16, 2010, from: EBSCO. Mannon, James M. 1992. Emergency Encounters: EMTs and their Work. Jones and Bartlett Publishers. Pitts, John. Coles. Colin and Thomas, Peter. 2001. Enhancing reliability in portfolio assessment: `shaping’ the portfolio. Medical Teacher, Vol. 23, No. 4, 2001, Pp. 351 - 356. Retrieved: June 16, 2010, from: EBSCO. Regener, Helge. 2005. A Proposal for Student Assessment in Paramedic Education. Medical Teacher, Vol. 27, No. 3, 2005, Pp. 234–241. Retrieved: June 16, 2010, from: EBSCO. Scholes, J et al. 2004. Issues and Innovations in Nursing Education: Making Portfolios Work in Practice. Journal of Advanced Nursing, 46(6), 595–603. Retrieved: June 16, 2010, from: EBSCO. Shaffer, Williamson David. Gordon, James A. & Bennett, Nancy L. 2004. Learning, Testing, and the Evaluation of Learning Environments in Medicine: Global Performance Assessment in Medical Education. Interactive Learning Environments 2004, Vol. 12, No. 3, Pp. 167-178. Retrieved: June 16, 2010, from: EBSCO. Snadden, David and Thomas, Mary. 1998. The Use of Portfolio Learning in Medical Education. Medical Teacher, Vol. 20, No. 3, 1998, Pp. 192 - 199. Retrieved: June 16, 2010, from: EBSCO. Song, Holim and Kidd, Terry (Editors). 2010. Handbook of Research on Human Performance and Instructional Technology. Information Science Reference. Spickard, Anderson et al. 2008. Automatic Capture of Student Notes to Augment Mentor Feedback and Student Performance on Patient Write-Ups. Journal of General Internal Medicine, 2008 Jul; 23(7):979-84. Retrieved: June 16, 2010, from: EBSCO. Spratt, Christine and Lajbcygier, Paul (Editors). 2009. E-Learning Approaches and Evidence-Based Assessment Approaches. Information Science Reference. Sturmberg, J. P. & Farmer L. 2009. Educating Capable Doctors—A Portfolio Approach. Linking Learning and Assessment. Medical Teacher, 2009; 31: e85–e89. Retrieved: June 16, 2010, from: EBSCO. Swanwick, Tim. Williams, Nicki and Evans, Alison. 2006. Workplace assessment for the licensing of general practitioners: qualitative pilot study of a competency based trainer’s report. Education for Primary Care (2006) 17: 453–64. Retrieved: June 16, 2010, from: EBSCO. Tangherlini, Timithy R. 1998. Talking Trauma: Paramedics and their Stories. University Press of Mississippi Jackson. The University of Leicester, DeMontfort University and The University of Northampton. 2008. Portfolio for the Assessment of Interprofessional Competencies for Health and Social Care Students. The University of Leicester, DeMontfort University and The University of Northampton. Retrieved: June 16, 2010, from: http://www.med.monash.edu.au/srh/mudrih/document_links/hsin/ipl-competencies.pdf Thome, Goran. Hovenberg, Hans and Edgren, Gudrun. 2006. Portfolio as a Method for Continuous Assessment in an Undergraduate Health Education Programme. Medical Teacher, Vol. 28, No. 6, 2006, pp. e171–e176. Retrieved: June 16, 2010, from: EBSCO. Tochel, Claire et al. 2009. The effectiveness of portfolios for post-graduate assessment and education: BEME Guide No 12. Medical Teacher, 2009; 31: 320–339. Retrieved: June 16, 2010, from: EBSCO. Wyatt, J. P. Et al (Editors). 2005. Oxford Handbook of Accident and Emergency Medicine, Second Edition. Oxford University Press. Read More