The Unintended Consequences of Portfolios in Graduate Medical Education

Portfolios have emerged in graduate medical education despite lack of consensus on their definition, purpose, or usefulness. Portfolios can be used as a tool for residents to record their accomplishments, reflect on their experiences, and gain formative feedback. This exercise may help prepare physicians for lifelong learning as well as enhance patient care. The Accreditation Council for Graduate Medical Education has endorsed and may soon require the use of portfolios as an assessment tool to evaluate resident competence. However, using portfolios for summative evaluation purposes such as making high-stakes decisions on resident promotion or matriculation may deter resident candidness. In addition, the use of portfolios in clinical settings raises issues unique to the health care setting such as patient privacy, disclosure of clinical information, and professional liability exposure of physicians. It is not clear that peer-review statutes that sometimes protect educational materials used in teaching and evaluation of residents would also bar disclosure and/or evidentiary use of portfolio contents. Is the teaching institution, resident, or graduate vulnerable to requests and subpoenas for the portfolio contents? If so, then a resident's documentation of insecurities, suboptimal performance, or bad outcomes would be ripe for discovery in a medical malpractice lawsuit. If embraced too quickly and without sufficient reflection on the nuances of implementation, this well-intentioned initiative may present unintended legal consequences. Acad Med. 2009; 84: 1522-1526.