Making Practice Transparent Through ePortfolio

7/30/2019 Making Practice Transparent Through ePortfolio

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Discussion

Making practice transparent through e-portfolio

Sarah M. Stewart *

Professional Development Officer, Australian College of Midwives, PO Box 87 Deakin West ACT 2600, Australia

1. Introduction

To meet statutory requirements for registration midwives are

expected to provide evidence of their competency, and make

professional development plans for the future.1 In some countries,

midwives use professional portfolios as a vehicle for their ongoing

professional development.2 Reflection is an integral part of

portfolio development, and is a statutory requirement for mid-wives in countries such as New Zealand.2 E-portfolio using open,

social networking tools is portable andflexible in where, when and

how it can be accessed; tracks and records reflections and learning

processes; and facilitates sharing, feedback and dialogue with

others.3,4 However, there are questions that must be answered

before e-portfolio is likely to be taken up by regulatory and

professional bodies, such as how appropriate is social networking

for professional e-portfolio?5How is reflective learning influenced

when carried out in open digital and collaborative spaces? Can

midwives reflect and learn in a safe way, and provide authentic

evidence of their learning? In this paper I will share my experience

as a midwife, educator and student who uses social networking

tools to maintain a professional e-portfolio. I describe how Iemploy social networking tools and processes for reflective

practice and professional development. Finally, I discuss how I

manage statutory obligations with e-portfolio using online public

spaces and tools.

2. Literature review

2.1. Midwifery and professional portfolios

Since the early 1990s midwives have been using professional

portfolio as a way to provide evidence of competency, and to show

Women and Birth xxx (2013) xxxxxx

A R T I C L E I N F O

Article history:

Received 10 March 2012

Received in revised form 11 February 2013

Accepted 19 February 2013

Keywords:

E-portfolio

Midwifery

Social networking

Learning

Blogging

Reflection

A B S T R A C T

Background: Midwives are required to maintain a professional portfolio as part of their statutory

requirements. Some midwives are using open social networking tools and processes to develop an e-

portfolio. However, confidentiality of patient and client data and professional reputation have to be

taken into consideration when using online public spaces for reflection.

Question: There is little evidence about howmidwives use social networking tools for ongoing learning.

It is uncertain how reflecting in an e-portfolio with an audience impacts on learning outcomes. This

paper investigates ways in which reflective midwifery practice be carried out using e-portfolio in open,

social networking platforms using collaborative processes.

Methods: Using an auto-ethnographic approach I explored my e-portfolio and selected posts that had

attracted six or more comments. I used thematic analysis to identify themes within the textual

conversations in the posts and responses posted by readers.

Findings: The analysis identified that my collaborative e-portfolio had four themes: to provide

commentary and discuss issues; to reflect and process learning; to seek advice, brainstorm and process

ideas for practice, projects and research, and provide evidence of professional development.

Conclusions: E-portfolio using open socialnetworkingtoolsandprocesses isa viableoptionformidwives

because it facilitates collaborative reflection and shared learning. However, my experience shows that

concerns aboutwhatpeople think, andclientconfidentiality does impacton thenature ofopen reflection

and learning outcomes. I conclude this paper with a framework for managing midwifery statutory

obligations using online public spaces and social networking tools. 2013Australian Collegeof Midwives. Published by Elsevier Australia (a division of Reed International

Books Australia Pty Ltd). All rights reserved.

* Correspondence address: Professional Development Officer, Australian College

of Midwives, 115 Canberra Avenue, Canberra, PO Box 87, Deakin West, ACT 2600,

Australia. Tel.: +61 420714031.

E-mail address: [email protected]

G Model

WOMBI-280; No. of Pages 5

Please cite this article in press as: Stewart SM. Making practice transparent through e-portfolio. Women Birth (2013), http://dx.doi.org/

10.1016/j.wombi.2013.02.005

Contents lists available at SciVerse ScienceDirect

Women and Birth

journal homepa ge : www.elsev ier .c om/loc ate /womb i

1871-5192/$ see front matter 2013 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights

reserved.
http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005mailto:[email protected]://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005http://www.sciencedirect.com/science/journal/18715192http://www.sciencedirect.com/science/journal/18715192http://www.sciencedirect.com/science/journal/18715192http://www.sciencedirect.com/science/journal/18715192http://dx.doi.org/10.1016/j.wombi.2013.02.005http://dx.doi.org/10.1016/j.wombi.2013.02.005mailto:[email protected]://dx.doi.org/10.1016/j.wombi.2013.02.005


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how they have acquired skills, learned from experience, and grown

as practitioners.6 In some countries such as the United Kingdom,

Ireland, and New Zealand, professional portfolio is a statutory

requirement.2,7,8 In other countries including Australia, it is a

professional activity that is encouraged, but not yet legislated.9

Standard practice favors the use of paper-based portfolios, usually

in the form of a commercial, or home made folder.7

2.2. What is an e-portfolio?

The web-based e-portfolio is a digital container that allows

practitioners to record professional and educational activities, and

attach accompanying evidence in the form of text, audio, video and

images.3 The move from paper-based to electronic portfolio in the

midwifery context has been led by education, especially at

undergraduate level.9 In part, this has been a pedagogical

development to encourage reflective practice, and support

work-based learning.4 But it has also been a response to the

increase in blended and online delivery of midwifery programs,

which has caused logistical issues when working with students

who live at a distance from campus. The result has been a need to

simplify administration and collation of artifacts and evidence

about competency, in readiness for registration.10 Some institu-

tions and organizations are using proprietary (commercial) e-portfolio platforms or developing their own.11However, questions

remain about how students can take their e-portfolio with them

once they leave the educational institution, and start work as

registered midwives. This problem is solved by using open social

networking tools such asblog, wiki, Youtube, Slideshare and Flickr,

which are for themostpart free and have wide spread availability.5

However, how to integrate such an e-portfolio with statutory and

professional registration processes and systems has not been

addressed.5 Nor is there consensus on how appropriate it is to use

social networking for professional development.11

2.3. Personal reflection and e-portfolio

Reflection is a key element of a portfolio, be it in a paper orelectronic format.12 Reflection is the process of thinking about

practice and making meaning of experience.13 Deep learning

occurs when practitioners describe or explain practice, and then

critically examines specific aspects.12 Ideally these reflections and

insights lead to decisions for action..achievement of goals and

changes to immediate and future practice.14 However, studies

have shown that some e-portfolio users do not progress past the

descriptive stage, and thus do not acquire deep learning.15

2.4. Collaborative reflection and e-portfolio

One way to support practitioners to move from description into

deeper thinking and learning is through collaborative reflection.16

Such

reflection

draws

on

multiple

views

and

perspectives

whichallow practitioners to learn with and from each other. Reflecting

with peers enhances collaboration and collegiality, and increases

problem-solving and goal-setting capability.17 Sharing questions,

information and resources support practitioners to clarify, confirm

and re-frame knowledge which can add to the depth of learning.18

However, collaborative reflection can be challenging when

irresolvable conflict emerges and issues of confidentiality, trust

and respect are not carefully managed.19 Collaborative reflection

can take place in online environments as well as face-to-face

conversations. E-portfolio facilitates collaborative reflection by

means of computer-mediated communication. Research has

shown that students who have interacted with each other in e-

portfolioplatformshave valued the opportunity to give and receive

mutual

feedback.

20

This

way

of

working

has

also

enabled

them

to

work together in communities of practice to share knowledge and

develop collective expertise, which has resulted in enhanced

reflection and deeper learning.21 The main barrier to deep learning

in this environment is implementation of the technology itself.

Students require support and scaffolding to develop the digital

literacy skills they need in order to be able to communicate and

expand their practice in their space [22]

2.5. E-portfolio and social networking

Social networking tools and processes encourage collabora-

tion and sharing because they are specially designed to bring

people together. E-portfolio using public online spaces has no

boundaries, and thus has the ability to reach a larger audience

and increase opportunities for collaboration.23 Reflecting in

open online spaces can affect what and how practitioner

communicates. Commentators may have their own agenda

and distort the practitioners thinking and learning, be that

knowingly or unknowingly.20 Open reflection may have con-

sequences when practitioners come upwith conclusions that do

not necessarily fit with the view of the commentators or indeed,

the wider professional community. Thus, practitioners may not

be authentic and honest in their reflections but rather articulate

what they think others want them to say.20 Alongside theworryabout what others may think is the major concern about talking

in public online spaces about patients and clients.24 Divulging

confidential patient and client information, as well as unprofes-

sional online behavior can lead to litigation and breach of

professional standards.25 Regulatory and professional bodies

have developed policies and guidelines for the professional use

of social media.26 However, there continues to be debate about

what is and what is not acceptable online behavior. On the one

hand, anecdotal stories of the unprofessional use of social media

by health practitioners cause consternation, such as the

anesthetist who called birthing suites birthing sheds, and

intensive care units cabbage patches on Twitter.27 This

episode generated international discussion about the doctors

lack of empathy and use of dehumanizing language.28 On theother hand, regulatory and professional bodies have been

accused of developing social media policies that demonstrate

a lack of understanding of how people communicate these

days.29 Advocates of social media fear that punitive policies will

impact on midwives engagement with social media, and

adversely restrict its use for personal learning.30

Whilst there are a number of empirical studies and theoretical

musings about e-portfolio for midwifery education especially at

undergraduate level,5,9,31 there is little evidence about how

midwives use e-portfolio for ongoing learning. What is also

uncertain in the literature is how reflecting in e-portfolio using

open online spaces with an audience changes learning outcomes

compared to private media, such as a paper portfolio. As yet

midwives

who

use

e-portfolios

do

not

know

how

concerns

aboutpatient and client confidentiality impacts on the quality of

reflection. This investigation explores ways in which reflective

midwifery practice be carried out using e-portfolio in open, social

networking platforms and collaborative processes.

3. Methods

My research tool is my e-portfolio which I have maintained

since 2007 using a combination of free, online social networking

tools including a blog, which is a web-based journal22 (http://

sarah-stewart.blogspot.com), YouTube, Blip.TV, Animoto, Flickr,

SlideShare. All these elements are coordinated, integrated and

presented in my e-portfolio wiki (http://sarahstewart-eportfolio.-

wikispaces.com).

For

this

investigation

I

chose

to

focus

on

my

blog,

S.M. Stewart/ Women and Birth xxx (2013) xxxxxx2

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because that is where I do most of my reflection. At the time of

writing this paper I had written 1097 blog posts which have

attracted 194,000 page views, 133,700 unique visitors and

generated 4253 comments. I selected to analyze blog posts that

had attracted six or more comments, which totaled 243 posts and

2218 comments. I chose six comments and more because I felt

conversations were more likely to reveal learning, as opposed to

one-off comments. I used an auto-ethnographic approach to

identify themes within the textual conversations in the blog posts

and responses posted by readers. Auto-ethnography is the process

of examining and reflecting on ones personal experience, and

relating themes to wider contexts.32 I chose this approach because

I was researching myself, in a qualitative, subjective paradigm. I

advised readers that I was writing this paper via a generic post in

my blog, and gave them the option to remove their comments, or

ask menot to discuss them in this paper. Idid not obtain individual

consent because the comments were already in the public space.33

4. Findings

The blog posts were initially sorted according to their labels,

which are the categories I award posts when I first write them,

including teaching and learning, education, midwifery practice,

and personal learning. The labels were then sorted into four main

themes.

4.1. Provide commentary and discuss issues

My blog posts cover a wide range of midwifery and educational

issues. Sometimes this is a one-way process whereby all I aim is to

publish a personal opinion as a cathartic release. Other times I

deliberately choose issues that I think may interest others and

generate conversation. Here is an example of an opinion post.

I am 1000% behind making caesarean section as family-friendly

as possible and I totally applaud obstetricians and midwives

who

encourage

things

such

as

immediate

mother-to-baby

skin-to-skin contact. But please dont try to sell caesarean section to

mothers or midwives as being natural. . .it isnt and never will

be!!!

4.2. Reflect and process learning

My blog posts contain reflections about my practice and

professional development activities. Reflecting in my open blog

has facilitated continuous peer review via the comments left by

readers. Readers discuss what I have written, challenge me and

provide multiple perspectives and alternative views. The quality of

comments varies and I use my professional judgment to decide

how much attention I pay to the comments. When talking about

ultrasound scans, I was concerned that one hospital was turningthem into mp3 files which I considered was another way of

selling unnecessary scans to women. But one of my male readers

had this to say:

I look at this asjust an extension of the family photo, and a little

way of getting excited about the new member to be.

I may not have changed my mind on this issue, but the reader

put forward an opinion from the perspective of a father-to-be

which resulted in me thinking about how I could include fathers in

my midwifery practice more than I did at the time.

Reflecting in the open is also a way of seeking validation and

support from the community. In one post I talked about a new role

as midwifery lecturer.

I am wondering how much I will be able to talk about my new

role and my experiences of teaching under-graduate midwifery

students [in my blog]? Will processing my thoughts here make

it look like I dont know what I am doing? Will that impact on

students perceptions of my knowledge and expertise?

I am mindful of the potential for criticism by the profession. I

wrote a reflective blog post some years about my experiences of

burnout when midwives were being advised about time and

caseload management in New Zealand. I felt vulnerable writingthat post because I feared I would be criticized and told that my

burnout was my fault for mis-managing my workload. There was a

danger that fear would either prevent me from reflecting on or

telling my story, or not being honest about my feelings and

experience. However, I felt so strongly about the topic that I was

driven to write about it.

The crunch came for me when I attended a home birth which I

spent the whole time in a state of fear: I felt like a rabbit frozen

in a cars headlights. There was no joy or excitement from the

home birth which usually makes up for the more complicated

births that happen in hospital and invigorates my midwifery

soul. Looking back on this year, I was exhibiting all the

symptoms of burnout.

Sometimes I feel it is important to speak out, to bring issues out

into the open to facilitate honest discussion, rather than being

swept under the carpet. Or as a reader put it:

Hopefully blogging will offer us the opportunity to get outside

our insulation from time to time. Every now and then we might

find an ah ha moment that we can bring back to our work and

transform something for the better - or worse...

The blog post actually generated lots of conversation which gave

validity to my experience, which helped me come to terms with it.

4.3. Seek advice, brainstorm and process ideas for practice, projects

and research

The collective wisdom of the community who interact with me

via my blog has been invaluable to me in my practice. At one time I

was struggling to think how to teach midwives about social

networking without access to a computer laboratory in a

conference workshop. When I posted this dilemma I received a

number of suggestions which I incorporated into my workshop.

One reader suggested

Record a video of what you would like them to see if you did

have an Internet connection.

Another said

Do a simulated Twitter with your audience using post-its

One reader passed on a resource.

Not sure if this would suit this situation, but there is a social

media game that helps people understand the implications of

using online tools. You find out more: http://socialmedia.wi-

kispaces.com/Social+media+game

Indeed, the workshop was so successful it led to an invitation to

be a keynote speaker at another midwifery conference.

Another example is when I was debating how to frame up a

literature review question for my educational doctorate. One

reader advised

Yourplan follows a logical pathbut feels like yougobeyond your

questions leading to a big, big review. Itmaybemoremanagable

to really focus on your questions - keep focused - that will in

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depth rather than trying togo toobroad.Asacolleague oncesaid -

its a doctorate not a Nobel prize:)

Another wrote

I think one of the most interesting areas here is the differences

(if any) between networked learning and Communities of

Practice. If you havent already looked at it, Etienne Wenger

stuff on COPs - albeit quite old now is interesting. . . I found this

article quite useful too: http://www.irrodl.org/index.php/

irrodl/article/view/523/1103

All the advice and comments enabled me to focus my literature

review more effectively.

4.4. Provide evidence of professional development

I embed evidence of my activities into my blog. For example,

when I give a conference presentation, I upload my presentation

slides into a website called Slideshare.net, and then link to it in my

blog, along with my reflections on how the presentation went. I

have had to think about the authenticity of the evidence I provide

in my e-portfolio to ensure others do not steal my identity. I have

branded myself online as Sarah Stewart which makes it very easy

to

track

my

work.

I

also

publish

my

work

with

a

Creative

CommonsAttribution license which means that people can use my work for

their own purposes. These precautions make it difficult for people

to steal my work because I have already gifted it to the wider

community. As a result I have become a resource for others,both in

terms of the content I publish, as well as the e-portfolio itself.

Nevertheless, I do not publish work or details about myself that I

am not prepared to share with others.

5. Discussion

An e-portfolio provides a viable avenue for midwives to fulfill

statutory obligations, and supports life-long learning which drives

professional

development.

Social

networking

platforms

and

toolscan be used effectively to support open and collaborative reflection

as part of the e-portfolioprocess.Open discussion allowsmidwives

to engage with others both inside and outside midwifery, which

provides another perspective to their reflection. The readers of my

blog takemebeyond a surface exploration of thoughts, activities or

achievements. By asking critical questions, passing on their

perspectives and sharing information, readers support me to think

deeper, which results in additional learning and enables me to

make changes to practice. This is one advantage of collaborative

reflection over personal reflection.16

Talking about practice in open online spaces is problematic for

midwives and continues to be debated at the highest professional

level.26 Discussing practice online can be inappropriate, not least

for

legal

reasons.

It

can

also

make

the

midwife

vulnerable

tocriticism by the profession, especially if the conclusions of her

reflection do not concur with the general opinion of the

profession.20 Thus, open reflection can lead to mind control,

whereby the midwife is unable to think in an autonomous way for

fear of professional ramifications. There is no doubt that I have

been aware of what others think of me as a result of what I have

written in my blog, and there have been times when I have not

been as open as I would have liked. Yet there are aspects of my

midwifery practice that I canmake open to the public. For instance,

my practice statistics are available to help pregnant women make

an informed choice about choosing me as theirmidwife.However, I

use a closed, private space to reflect on specific clinical cases, take

key learning from the cases and write about learning in a generic

way in my open blog. Whilst this approach has led to learning, I am

unsure if the learning outcomes are different compared to

situations where I can be totally honest.

As a reflexive researcher, I must acknowledge that the analysis,

findings and meaning of this research is heavily influenced by how

I see the world.34 My experience of e-portfolio has been hugely

positive, and my blog is an essential part of my day-to-day

learning.However, I recognise that I cannot generalizemyfindings,

and e-portfolio using social networking will not be appropriate for

all midwives. Many midwives lack digital and computer literacy

required by e-portfolio, as well as time to develop those skills.35 A

lack of integration of e-portfolio into statutory registration

processes and systems also acts as a barrier for midwives.5When

I attempted to present my e-portfolio for my bi-annual midwifery

review several years ago in New Zealand,2 I was asked to print it

out on paper. The reviewers felt they did not have the time to

engage fully with my e-portfolio, and had difficulty accessing the

websites because of slow internet connections. As more midwives

are taught computer skills pre-registration, and e-portfolio is

introduced into educational programs, it may be time for statutory

and professional bodies, as well as employers, to examine how e-

portfolio can be smoothly transitioned from education into

practice. What I hope to have done in this paper is to have

contributed to this discussion, and raised issues for further

exploration.

6. Recommendations

TheUKNursing andMidwiferyCouncil have issueddetailedand

balanced guidelines on how to use social networking in general.26

Here are some additional recommendations for midwives who

wish to use social networking platforms such as blogs and wiki to

develop their e-portfolio.

(1) Use technologies that are supported by reputable companies

such as Blogger, Google Documents, Google Sites and

Wikispaces. Reputable companies will keep data secure and

private. However, be mindful that no website is totally secure,

so do not post any information that is sensitive and you wantto keep confidential.

(2) Take time to play with the technology so that you become

confident with theuseof socialnetworking tools aswellas the

hardware that supports them including video cameras, audio

recorders and cell phones.

(3) If you do not have digital skills, go to YouTube (http://

www.youtube.com) where you will find lots of videos that

will show you how to set up a blog, wiki, etc.

(4) If you wish to use an online tool to develop your e-portfolio

but you do not wish to make it open, choose a platform that

you can keep private and invite selected readers. Most blogs

and wiki have that functionality.

(5) Think carefully about what you say in an open online

environment

and

how

you

say

it.

Talk

about

clinical

practicein generalities, as opposed to specific cases that can be

identified. This is no different in the online environment, as it

is in the face-to-face context. The difference is that if you say

something unprofessional online, many more people have

access to it, and its always available in one form or another on

the internet.

(6) Always respond to people who comment on your blog or wiki.

But do not expect visitors or comments overnight. It takes

time and work to develop a community of practice based

around your e-portfolio.

(7) Be creative. Your reflections dont necessarily need to be

writtenpieces. Explore the internet for tools that willhelp you

make videos, photo collages, word puzzles, mindmaps and so

on.

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(8) Turn your paper evidence in pdf files, such as certificates of

attendance and upload them into your e-portfolio to

accompany your stories and reflections.

(9) If you are required to present your portfolio in paper form,

either copy and paste into a document, or use tools that turn

web pages into pdf files such as Eco-Safe (http://eco-safe.-

com).

(10) Back-up your e-portfolio regularly onto your computer

hard-drive, in case the technology you use becomes

unavailable.

7. Conclusion

E-portfolio provides a viable option to paper-based portfolio

formidwives. It allows a creative approach to tellingstories about

professional learning and life-journeys. Social networking tools

provide the ability to showcase work, provide evidence of

learning, and reflect on practice. However, midwives need to

carefully consider how to do this in a way that protects their

professional reputationandclient information. In order to be able

to develop open e-portfolio to support their learning, midwives

need to be educated about the professional use of open spaces.

Open reflection, which is social and collaborative, result in sharedlearning and support. Whether e-portfolio is implemented using

open social networking tools or closed proprietary platforms, it

needs to incorporate a social aspect. Social interaction and

collaboration encourages deep learning and ensures the e-

portfolio isnt just a repository for information. Additional

research is required to find out what effect reflecting in an open

e-portfolio environment has on learning and clinical practice

outcomes.

References

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2.

Midwifery Council

of

New

Zealand. Recertification

program:

competence-based pra cti sing cer tifi cates for midwives . 2010 Available at:http://www.midwiferycouncil.health.nz/images/stories/pdf/recertification%

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