Table 5.

Limitations of MSPs.

LIMITATIONS	ELABORATION AND/OR EXAMPLES
Learning	Limited use for theoretical knowledge 121 Limited use for reflective learning Does not guarantee that reflection will take place7,54,56,64,78,87,103 Students are sceptical about the reflective process53,67,68,87,110 Challenging for individuals who are not intuitively reflective64,72 Overly prescriptive structure of reflective prompts may hinder reflective process 64
Assessment	Limited reliability and validity4,54,55,59,62,63,71,72,91,108,111,112,117,135,137 Inauthentic ▪ Provide only vignettes of a student’s journey 59 , and students may hide evidence of their weaknesses54,59,63,70,104,126, fail to express their authentic views 63 or even fabricate reflections 78 ▪ They may also perform poorly under stress during assessments included in their portfolios such as directly observed work-based assessments59,137 ▪ Students tend to have a poor self-assessment capacity72,111,151 ▪ Perceived quality of portfolio relies heavily on the individual’s reflective ability55,105,121 which is unfavourable for students with poor reflective skills Subjective ▪ Students may create their portfolios differently based on their own interpretation of the purpose of the portfolio 59 ▪ Student’s portfolios may unknowingly be judged on irrelevant aspects such as layout and format 4 ▪ This may be amplified if student identity is not anonymised to examiners evaluating the portfolios 119 Overly structured47,53,57,59,62,64,119 ▪ Highly structured portfolios with a rigid format can lead to students including less of their personal observations and reflections, which diminishes the portfolio’s capacity for authentic assessment of the student and their development Problematic assessment process Poor student understanding11,53,62,63,73,104,116 Time consuming ▪ There may be insufficient time for comprehensive assessments in the clinical setting as taking time to assess students must be balanced with providing quality patient care 59 ▪ Time consuming for assessors1,5,11,13,53,55,60,63,65,68,74,104,112,116,140 ▪ Human resource intensive6,112,137,140 ▪ Excessive paperwork1,55,74,106 Lack of standardisation among examiners ▪ Poorly standardised assessment procedure leads to poor consensus among assessors 117 Lack of training for assessors limits the use of work-based assessments within portfolios for assessing student competence 137
Portfolio Implementation	Negative student sentiments Resistance5,11,53,59,61,63,66,67,74,102,104,106,126 ▪ Perceived to be redundant61,102 and incompatible with studying format61,77,78 Non-priority ▪ Students prioritise coursework that contributes towards their final examination marks 146 ▪ Interference with other studies 123 , including clinical learning 91 and time that should be spent with patients 1 or studying for exams 78 Poor understanding and engagement1,4,54,61,66,74,78,108,150 ▪ Unaware of how portfolios can be integrated into their education 110 ▪ Stressful 78 and difficult to fill out61,78 Burdensome ▪ Time consuming11,66,79,108,115,116 ▪ Excessive paperwork1,55,77,102,106,108 Worried about the negative comments they could receive from their mentors 61 Felt the time given to complete their portfolios was too short, leading to reduced value 123 Lack of support from mentors64,66,110 Not all mentors provided feedback and engaged the students64,78,103,118 Factors leading to faculty’s lack of support ▪ Poor time management 64 ▪ Failure to understand role as portfolio mentors64,110 ▪ Did not engage in reflection personally 64 ▪ Difficulty finding methods to help students 78 ▪ Poor impression of portfolios and their role in education66,78 ▪ Poor relationship with student 103