The recent fitness to practice case in the UK of Hadiza Bawa-Garba, whose reflections documented in her e-portfolio were used as evidence against her during the case, has called into question the role of portfolios in UK postgraduate medical training (Dyer and Cohen, 2018). As a psychiatry trainee, I have reflected on how I use my portfolio in my training. Should I be using it as a formative tool for personal development and reflect openly within it, or should I be viewing it as a summative tool which could also be used in a future fitness to practice case?

Schuwirth and van der Vleuten asserted that ‘if you do not know what you are assessing it also becomes very difficult to know how you can best assess.’ (Schuwirth and Van der Vleuten, 2011) What is the aim of portfolios? Is it to measure competence within a framework of clearly defined outcomes or is it to assess professionalism more broadly, facilitating feedback and reflection? Some have argued that explicit performance criteria are necessary to ensure robust and transparent professional regulation (Crossley, Humphris and Jolly, 2002). However, this approach assumes that performance criteria can be defined and has been described as ‘reductionism’ by those who argue for a more holistic approach beyond the testing of individual curricular components (Schuwirth and Ash, 2013). Moreover, there is evidence that feedback is best received within a formative context (Gosling, 2002) and that this facilitates critical reflection (Mann, Gordon and MacLeod, 2009). 

Thus perhaps one of the many learning points from Bawa-Garba’s case is that it has highlighted the need for further evaluation of the role of portfolios in facilitating the development of trainees. I would argue that critical reflection and honest feedback is likely best achieved via formative assessment, whereas attainment of a common standard is likely best evidenced within a summative assessment. However, there is an urgent need to provide trainees with clarity on their intended purpose in order to best engage us in their use as part of our training.