Cultivating the potential of the ePortfolio

As digital innovation continues to advance, the growth of electronic portfolios (ePortfolios) has established another horizon for learning.  Medical educators are looking to assimilate the rewards of this relatively new mode of learning into our practice.

An ePortfolio can be described as a purposeful collection of information and digital artefacts that demonstrates development or evidences learning outcomes, skills or competencies (Cotterill, 2007).  So how does an ePortfolio or digital portfolio differ from a traditional portfolio?  In other words, what aspects of this instrument are altered by digitalization?  Undoubtedly, data and learning experience can be portrayed in richer detail and complexity through the use of multimedia.  (For a learner taking a patient’s history, compare video footage to a written account of that same event).  But more importantly, the reflective ePortfolio enhances the opportunity for prompt information sharing with a supervisor and/or peers.  Subsequently, from a social constructivist perspective, many experts suggest deeper reflective learning occurs (Hall, Byszewski, & Sutherland, 2012; JISC, 2008; Lorenzo & Ittelson, 2005).  Although, this argument is not always borne out in practice with one study determining no benefit in aiding reflection (Vernazza et al., 2011).

The ability to share learning with colleagues in an ePortfolio is highly desirable.  Both individual and group learning can be achieved.  This is drawn out in a case study reflection of a senior faculty member in emergency medicine who describes a medical error (Chisholm & Croskerry, 2004).  This portfolio entry is shared with the faculty.  Not only was a learning experience created for the physician and the faculty, but, by publication, many more in the global medical community have benefited from the story.  The element of sharing and feedback in ePortfolios is essential.

Portfolios, in general, are learner-centred and engender self-regulation with the capacity for personal development planning (Kardos, Cook, Butson, & Kardos, 2009) as part of life-long learning.  Beyond this, they also serve as evidence of achieving goals (competencies or skills) which may be set by the learner, the supervisor or the faculty.

However, the implementation and maintenance of an ePortfolio system has its hurdles.  There are the initial costs of developing a tailored system and the ongoing technical maintenance.  Learners have found it to be time-consuming (Gardner & Aleksejuniene, 2008; Vernazza et al., 2011) and additional effort may be required to become familiar with the chosen technology.  There are security and intellectual property issues.  Questions are likely to arise around evaluation parameters when it is used as a component of assessment.

Currently, the Australasian College of Emergency Medicine (ACEM) employs a paper-based Professional Development Portfolio for trainees.  It includes a general log sheet where reflections may be recorded.  The actual trainee participation rate is not known.  Currently, “no party (employer, ACEM or DEMT/Supervisor) has the right to requisition it” (ACEM, 2013) but, hopefully, with regard to supervisors, this approach will be revised in the near future.  A staged roll-out of an online learning portfolio is expected to be introduced later this year with completion by 2016.

Within the Emergency Medicine Certificate (also administered by ACEM for non-trainees), an ePortfolio already exists with the ability to invite colleagues including one’s supervisor to view and make comment on entries.  As a supervisor, I have found this insightful and a useful barometer of the learner’s skills in clinical reasoning.

In the future, after years of accumulated experience is logged by and for our trainees, we will have a rich seam of knowledge describing the details of the learning journey whereby our basic trainees become advanced trainees and finally emergency medicine specialists.  This database of knowledge constructions and attitudinal transformations, in itself, has the potential to be a powerful resource for ACEM educators in optimizing our training program and continuing to create competent specialist care in emergency medicine.


ACEM. (2013). Using the Professional development Portfolio.   Retrieved 20th April, 2013, from

Chisholm, C. D., & Croskerry, P. (2004). A case study in medical error: the use of the portfolio entry. Academic Emergency Medicine, 11(4), 388-392.

Cotterill, S. J. (2007). What is an ePortfolio?   Retrieved 20th April, 2013, from

Gardner, K. M., & Aleksejuniene, J. (2008). Quantitative and qualitative analysis of student feedback on ePortfolio learning. Journal of Dental Education, 72(11), 1324-1332.

Hall, P., Byszewski, A., & Sutherland, S. (2012). Developing a sustainable electronic portfolio (ePortfolio) program that fosters reflective practice and incorporates CanMEDS competencies into the undergraduate medical curriculum. Academic Medicine, 87(6), 744-750.

JISC. (2008). Effective Practice with e-Portfolios.   Retrieved 20th April, 2013, from

Kardos, R. L., Cook, J. M., Butson, R. J., & Kardos, T. B. (2009). The development of an ePortfolio for life-long reflective learning and auditable professional certification. European Journal of Dental Education, 13, 135-141.

Lorenzo, G., & Ittelson, J. (2005). An overview of e-portfolios.   Retrieved 20th April, 2013, from

Vernazza, C., Durham, J., Ellis, J., Teasdale, D., Cotterill, S., Scott, L., . . . Drummond, P. (2011). Introduction of an e-portfolio in clinical dentistry: staff and student views. European Journal of Dental Education, 15, 36-41.


Educational podcasting: where are we going?

Access to medical education occurs through a wide range of internet-based media in the form of educational websites, medical blogs, online video, social media and podcasts.  Podcasting involves the uploading of recorded media to the web where it can be accessed anytime by any number of people.  Recently, my personal use of podcasts has grown at a seemingly exponential rate.  Some of these podcasts are themed in critical care medicine and education.  But what is the utility of these podcasts as learning tools?  (When the term ‘podcast’ is used in the following discussion, it specifically refers to podcasts designed for health professionals).

Podcasts are available in a range of formats.  They may be

  • complete recordings of lectures,
  • readings of pre-written text,
  • recorded discussions, or
  • a combination of these in the same podcast

The podcast may occur as a component of an established instructional design or it may be a freelance podcast unencumbered by curricular imperatives or learning objectives (and, in essence, an audio blog).  Many podcasts are free in the spirit of the Free Open Access Medical education (FOAM) concept (“FOAM,” 2012) elucidated by Cadogan at a recent international medical conference. (“Mike Cadogan on FOAM at ICEM2012,” 2012)  

Perhaps surprisingly, most under-graduates use a personal computer to listen to podcasts rather than a mobile device. (Kazlauskas & Robinson, 2012)  Motivation for podcast use is quite diverse.  Reasons for listening (Jalali et al., 2011) include

  • To “slow down” the lecture
  • Topic review
  • Learning subjects not covered by an associated teaching program
  • Preparation for exams
  • Enhancing inclusivity of the distance learner

Podcasts are convenient and can be listened to over and over (Jalali et al., 2011; Scutter, Stupans, Sawyer, & King, 2010; Van Zanten, Somogyi, & Curro, 2012).  Learner experiences of podcasts is further enhanced when combined with visual media for example PowerPoint slides (Jalali et al., 2011; Scutter et al., 2010).  Impediments to use are time constraints, lack of perceived need and a non-auditory learning style (Jalali et al., 2011).

As one would expect with a relatively new technology, the evidence base describing our educational experiences is only beginning to develop.  Podcasting has been studied predominantly in the higher education setting.  Learning groups included have been medical students studying anatomy (Jalali et al., 2011) and histology (Beylefeld, Hugo, & Geyer, 2008), nursing students (Kazlauskas & Robinson, 2012) and medical radiation students (Scutter et al., 2010).

Little is known of the educational value of podcasts for post-graduate education or continuing professional development in health.  One may speculate that the patterns of use may be quite different to the undergraduate experiences.  Discussions with my own colleagues suggests that the majority of podcast use occurs whilst driving or walking and only occasionally on a personal computer.  Of course this is mere speculation.  However, if there is indeed a significantly altered usage pattern then the pedagogic implications are equally significant.

Listening to a podcast in isolation may be perceived as passive learning.  Many podcast producers link their own website to the podcast.  These educational websites often include a range of additional educational material including blogs where the learner can ask questions and provide comment.  In doing so, engagement and interactivity are promoted with the podcast acting as the catalyst.  The proportion of podcast users who subsequently take advantage of the associated online interaction is not known.

Through peer discussion, concern has emerged in some that podcasting (and social media in general) lacks the formalised and robust peer review of evidence-based medicine occurring through journal publications.  Proponents of the opposing view (Weingart, 2013) argue that rapid crowdsourcing (leveraging the collective experience and intelligence of a large group) through social media also brings its own high levels of rigorous analysis and debate.  This phenomenon has intrinsic merit in fostering active learning approaches.

Podcast producers can enhance the pedagogic nature of their podcasts by understanding the usage patterns and the associated learning needs of their listeners.  Therefore, the content can be aligned and their podcast methodology chosen accordingly.  The ability of podcasts to produce transformation and improvement in clinical performance in the areas of critical care and emergency medicine is yet to be elucidated through research.  However, early anecdotal experience appears promising and it is clear that podcasting allows rapid and widespread dissemination of novel opinions, approaches and techniques.  Research focussing on freelance podcast use would be particularly illuminating as, through my own observations, it is this construct of podcast education that post-graduate health professionals are adopting at an increasing rate.

Beylefeld, A., Hugo, A., & Geyer, H. (2008). More learning and less teaching? Students perceptions of a histology podcast. South African Journal of Higher Education, 22(5), 948-956.

FOAM. (2012). Life in the Fast Lane.  Retrieved 10th April, 2013, from

Jalali, A., Leddy, J., Gauthier, M., Sun, R., Hincke, M., & Carnegie, J. (2011). Use of Podcasting as an Innovative Asynchronous E-Learning Tool for Students. US-China Education Review, 741-748.

Kazlauskas, A., & Robinson, K. (2012). Podcasts are not for everyone. British Journal of Educational Technology, 43(2), 321-330. doi: 10.1111/j.1467-8535.2010.01164.x

Mike Cadogan on FOAM at ICEM2012. (2012).   Retrieved 10th April, 2013, from

Scutter, S., Stupans, I., Sawyer, T., & King, S. (2010). How Do Students Use Podcasts to Support Learning? Australasian Journal of Educational Technology, 26(2), 180-191.

Van Zanten, R., Somogyi, S., & Curro, G. (2012). Purpose and preference in educational podcasting. British Journal of Educational Technology, 43(1), 130-138. doi: 10.1111/j.1467-8535.2010.01153.x

Weingart, S. (2013). EMCrit Wee – Tacit Knowledge and Medical Podcasting.   Retrieved 12th April, 2013, from


Can neuroimaging studies on cognitive load influence the way we teach?

When we think, a myriad of complex processes and interactions within our brain occur simultaneously.  Almost instantaneously, we become conscious of a thought.   Whelan (2007) has discussed the neurobiological evidence associated with the components of cognitive load.  As we discover more about the mysterious intersection where neuroanatomy and brain imaging meet educational psychology, is it conceivable that, one day, our choice of teaching methods (particularly those involving multimedia) will have a neurobiological basis?   Whelan (2007) describes in some detail a range of changes shown on functional MRI (fMRI) as a result of varying types of cognitive stimuli.  These investigations may begin to influence educational methods associated with multimedia and the internet.  Whelan (2007) suggests further research should focus on measuring the components of cognitive load rather than attempting to measure cognitive load as a whole. 

First elaborated by Sweller (1988), cognitive load has three components:

  • Intrinsic load: refers to the innate brain work necessary to process the content
  • Extraneous load: refers to those factors which distract from the seamlessness of a learning process as reflected by the way it is taught or the methods used
  • Germane load: refers to learner characteristics and their influence on the learning activity e.g. their motivation driven by curiosity or by an external factor such as the learning activity being a high-stakes assessment

Clark and Mayer (2008) include generative load (integrating and organising the content) as a part of intrinsic load.  Cognitive load theory implies learning is optimal when the instructional design is aligned with the learner’s cognitive architecture.  It works on the premise of a limited short-term working memory and the assimilation of schemas (chunks of prior learning) (Sweller et al. 1998).  Based on this theory, optimal instruction moderates intrinsic load, minimises extraneous load and harnesses germane load.

If I review my own learning in order to write this blog, the components were as follows.  The intrinsic load was high given the topic’s complex underpinnings and the blend of neuroanatomy, functional radio-imaging and educational psychology.  The generative load in organising the concepts offered by different sources was also significant.  Extraneous load was minimal however as the literature sources were well-written and logical.  My curiosity for the topic and the assessment component for my studies established a positive germane load.

Research using fMRI indicates that each component is associated with its own relatively unique pattern (Whelan 2007) with respect to its neuroanatomical location and associated neurophysiological activity.  Further, he refers to existing evidence suggesting augmented responses can be found on fMRI for neuronal pathways that are receptive to multiple types of sensory stimuli.  The implication is that if higher activity on fMRI correlates with deeper thinking then, it is conceivable that, a deeper level of learning is occurring when the content is presented by the teacher using methods that effectively engage multiple senses (i.e. auditory and visual).  Could this explain why some learners prefer instruction utilising multimedia? 

One must be wary as Whelan (2007) points out that the evidence he refers to involves “distinct and isolated learning tasks” unlike the complex multimodal learning environments currently available in education.  This caution is supported by Clark and Mayer (2008) who assert the importance of psychological activity over behavioural, even as far as stating that “high-engagement environments such as multimedia simulations are not inherently effective”.  To become effective, these learning environments require expert facilitation and appropriate context aligned to learning objectives.  In addition, learner readiness for computer-mediated learning has been identified as a significant contributor to extraneous load in online learning. (Chen et al 2011)  This emphasizes the need for instructors to ensure the inclusion of technology in their teaching methods does not undermine the quality of the education they deliver.

Technological development continues to accelerate and, as educators, we are repeatedly challenged to effectively adapt our methods to this technology and strive for optimal teaching.  Maybe, further understanding of neurobiological learning pathways and their innate characteristics may provide us with some guidance but I think practical application would lie in the distant future.  For the moment, however, the questions arising from research in this area leaves me pondering what discoveries and new themes of inquiry lie ahead.


Chen, C., Pederson, S., Murphy, K.L. (2011). Learners’ perceived information overload in online learning via computer-mediated communication. Research in Learning Technology 19(2):101-116

Clark, R.C., Mayer, R.E. Learning by viewing versus learning by doing: Evidence-based guidelines for principled learning environments. Performance Improvement. 47(9):5-13

Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science 12(2):257-285

Sweller, J., Van Merrenboer, J., Paas, F. (1998). Cognitive architecture and instructional design. Educational Psychology Review 10(3):251-296

Whelan, R. (2007). Neuroimaging of cognitive load in instructional multimedia. Educational Research Review 2(1):1-12

How can the quality of feedback be improved by technology?

As educators and health professionals, we regularly deliver feedback for colleagues and receive feedback on our own performance.  This may be part of a structured performance appraisal process or it may be ad hoc in the workplace.  A recent literature review (Hepplestone, Holden, Irwin, Parkin, & Thorpe, 2011) refers to descriptions of negative student experiences in terms of adequacy, timing and usefulness.  The suggestion is made that feedback in its present form is generally of poor quality because of time pressures, burgeoning student numbers as well as learners being more focused on the grade than the message.  Further, reference is made to at least two studies where written feedback was reported as ineffective as it was indecipherable.

Their review outlines a range of methods of technological intervention including:

  • Publishing written or audio feedback via virtual learning environments
  • Sending text or audio files via email
  • Standardised qualitative feedback from pre-populated comment banks based on grade

Written feedback may constitute annotations on the actual coursework or associated passages of text.  The authors also support the adaptive release process whereby the grade is released only after the learner submits an action plan addressing the feedback received.

A small UK study (Merry & Orsmond, 2008) examined interview responses of 15 biology undergraduates who had received both audio and written feedback.  The students overwhelmingly favoured the audio (13 out of 15) describing it as easier to understand, having greater depth, more personal and most annotated their work as they listened. 

The tutors felt they were able to provide examples with their comments which resulted in a more personalised and meaningful commentary for the students.  However, the large file size (up to 11 Mb) was not compatible with some email systems.  Also, the authors concede there may have been a positive “novelty factor”.  The investigators were also the tutors and this may have influenced the findings as well. 

An interesting insight was found on analysis of responses from the transcribed interviews. It was discovered that the students did not refer to the audio feedback in terms of its bearing on their achieving the learning outcomes of the presented work.  This may suggest that students can derive greater benefit still if the feedback is interpreted in light of the curriculum aims and not just the associated grade.

Lunt and Curran (Lunt & Curran, 2009) analysed the online survey responses of 60 university students. Each student received both written and audio feedback delivered either via a virtual learning environment or via email.  17 of the 26 respondents found audio more helpful than written but three students encountered access issues.  Twenty-three requested audio feedback for the future.  Tutors found that, on average, thirty minutes was required for written feedback and just five minutes for audio feedback.  The authors note that consideration is needed for the hearing-impaired but audio is ideal for the vision-impaired.

Perhaps audio, more so than written, allows one to convey more emotive elements of the teacher’s feedback such as an encouraging or perplexed tone.  Further, the feedback is richer in that more information can be provided in a given time with the spoken word as compared with the written word. 

Audio feedback is particularly encouraging and the technology is widely available.  Other benefits include

  • More detail
  • Legibility no longer an issue
  • Creates a record which can be stored and reviewed again
  • After initial acclimatisation to audio recording, it is more efficient allowing more timely feedback

Currently, for my own trainees, I email a written summary of a mid-term discussion and summative feedback is entered on the Australasian College of Emergency Medicine (ACEM) learning management system at the end of term.  It will be interesting to trial the use of audio feedback in my setting in the near future.  It would also be interesting to hear of others’ experiences in this area.


Hepplestone, S., Holden, G., Irwin, B., Parkin, H. J., & Thorpe, L. (2011). Using Technology to Encourage Student Engagement with Feedback: A Literature Review (Vol. 19, pp. 117-127): Co-Action Publishing. Ripvagen 7, SE-175 64 Jarfalla, Sweden. Tel: +46-18-4951138; e-mail:; Web site:

Lunt, T., & Curran, J. (2009). ‘Are you listening please?’ The advantages of electronic audio feedback compared to written feedback. Assessment & Evaluation in Higher Education, 35(7), 759-769. doi: 10.1080/02602930902977772

Merry, S., & Orsmond, P. (2008). Students’ Attitudes to and Usage of Academic Feedback Provided via Audio Files. Bioscience Education e-Journal, 11, 11-11.


Introduction and Purpose: My Background and the Background to this Blog

First of all, this is my first ever blog!  So, apologies in advance for the inevitable hitches about to occur…  Having a professional blog is such a good way of maintaining a learning portfolio and really, I probably should have commenced this sort of thing a long time ago.  This blog has been initiated through my studies for Masters of Education (Health Professional Education) and maybe I will continue with it indefinitely as part of my life-long learning.  The initial blogs will be centred on topics related to the Masters but I hope to extend on these beyond this task with reflections on my work as an emergency doctor, as an educator and as an education student.

Here is a brief description of my current work and student life.  It may provide some perspective for you as I begin to build this blog.  Hopefully, you’ll be interested in following me and sharing your experiences too.

So my background is as follows:

I’m in the final year of a Masters of Education (Health Professional Education) at Sydney University.  My current Unit of Study is Teaching, Learning and the Internet.  As part of this unit, my classmates and I need to create a blog and give comment on four different topics related to teaching/learning and the internet.  I think there’s more than 20 of us so hopefully there will be good discussion as we comment on each other’s blogs.  Of course, any comments and thoughts from people outside our student group would be invaluable in providing another perspective.  These blogs are to be professional and guided by evidence.  I am also in the early stages of tinkering in education research.

I’m an emergency physician in Australia.  I’m the Director of Emergency Medicine Training at my hospital.  I enjoy teaching of course.  As part of my work, I am an educator primarily for doctors, nurses and medical students.  I’m a long way from being an expert educator.  I’m eager to develop my teaching skills so that I can simultaneously share my dual interest in emergency medicine and emergency medicine education.

The first blog is scheduled for next week.  I’ll tweet the post from my twitter account @deep_green_sea

Be back soon,