The development of an ePortfolio for life-long reflective learning and auditable professional certification R. L. Kardos1, J. M. Cook1, R. J. Butson2 and T. B. Kardos1 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Otago, New Zealand, 2 Higher Education Development Centre, University of Otago, Otago, New Zealand Introduction Legislative changes leading to audits for healthcare practitioners in New Zealand The Health Practitioners��� Competence Assurance Act (HPCAA) was passed by the New Zealand Parliament in 2003 and came fully into effect on 18 September 2004. The Act repealed 11 occupational statutes governing 13 health professions, including dentistry. It is now illegal for any health practitioner to practice in New Zealand without being registered. The principal purpose of the HPCAA is to protect the health and safety of members of the public by providing mechanisms to ensure that health practitioners are competent and fit to practise their professions (1). Prior to the introduction of the HPCAA, only Dentists and Dental Technologists were required to hold regis- tration with an independent self-regulatory body, the Dental Council of New Zealand (DCNZ). The legislation resulted in the constitution of a new com- bined DCNZ that embodies all dental professions and special- ties. The Minister of Health appoints members of the Council, of which there are fourteen: 11 oral health professionals (five Dentists, two Dental Therapists, one Dental Hygienist, two clinical Dental Technicians and one person involved in teaching dentistry) and three lay members (2). The Council sets ���clinical, cultural and ethical standards��� (3) for dental professionals, authorises certification, and holds responsibility for dealing with practitioners whose fitness to practice or competence has been called into question (3). The DCNZ also ensures that those undergraduate and postgraduate programmes in dentistry which lead to registration, meet acceptable national and inter- national standards prior to accreditation. Both the DCNZ and Australian Dental Council have accredited the Bachelor of Oral Health (BOH) programme at the University of Otago, thus allowing BOH graduates to register as either Dental Hygienists or Dental Therapists (or both) in New Zealand and/or Australia. Under the HPCAA a practitioner may hold registration for one or more scopes of practice. A ���scope of practice��� describes what a practitioner is entitled to do. Practice outside a desig- nated scope warrants significant penalty (4). The DCNZ has responsibility for determining dental scopes of practice and also requires self-assessment of personal performance, demonstra- tion of reflective practice, and clinical and practice appraisal. In addition to registration, all dental professionals are required to hold an Annual Practising Certificate (APC). The DCNZ���s Dental Hygienist Board and Dental Therapist Board are respon- sible for ensuring the continuing professional competence and Keywords electronic portfolio reflective writing audit higher education continued professional development professional portfolio. Correspondence R. L. Kardos Department of Oral Sciences Faculty of Dentistry University of Otago Otago, New Zealand Tel: +64 3 479 7476 Fax: +64 3 479 7113 e-mail: rosemary.kardos@dent.otago.ac.nz Accepted: 6 November 2008 doi:10.1111/j.1600-0579.2008.00551.x Abstract Recent legislative changes, that affect all healthcare practitioners in New Zealand, have resulted in mandatory audits of practitioners who are now required to provide evi- dence of competence and continued professional development in the form of a profes- sional portfolio. These changes were the motivation for our development of an electronic portfolio (ePortfolio) suitable for both undergraduate and life-long learning. Bachelor of Oral Health (BOH) students, studying to qualify as Dental Hygienists and Dental Therapists, and BOH teaching staff (who held registrations in Dental Hygiene, Dental Therapy and Dentistry) trialled the use of a personal ePortfolio for advancing their academic and professional development. The ePortfolio enables BOH students to collect evidence of their achievements and personal reflections throughout their 3 years of undergraduate study, culminating in registration and the award of an Annual Prac- tising Certificate (APC). The ePortfolio was designed to allow users to store informa- tion and then select appropriate material to be displayed or published, thus assisting health practitioners to present high-quality evidence of their participation and achieve- ments, and to meet the professional requirements for their APC. European Journal of Dental Education ISSN 1396-5883 Eur J Dent Educ 13 (2009) 135���141 �� 2009 The Authors. Journal compilation �� 2009 Blackwell Munksgaard 135

fitness to practise of all registered Dental Hygienists and Dental Therapists. The recertification programme for Dental Hygienists and Dental Therapists operates on a 2-year cycle and is designed to assist practitioners in maintaining their competence to practice and meeting defined professional standards (5). To qualify for an APC, dental practitioners are required to ���show that they are participating in a system of Continuing Professional Devel- opment (CPD), which must include continuing dental educa- tion and peer contact relevant to the scope/s of practice in which they are registered��� (5). Under the recertification scheme, 10% of all registered Dental Hygienists and Dental Therapists will be required to provide evidence of professional develop- ment activities, competence, and fitness to practice (within a 10-day time period) in the form of a professional portfolio (5). Compliance monitoring was phased-in last year (2007). Professionalism The DCNZ���s requirement that all dental practitioners maintain a Professional Portfolio offered a rationale for our development and introduction of electronic portfolios (ePortfolios) into the Faculty of Dentistry, using the BOH programme as a pilot. In addition to facilitating students��� development and maintenance of an ePortfolio, this created an opportunity to engage both students and teaching staff in order to support learning. The current ePortfolio was designed to foster professionalism and preparation for practice, within the relevant scopes, for BOH students. It could readily be realigned to ePortfolio preparation by dentists or other health practitioners. In 1987, Shirley Grundy defined professionalism as ���a process of transformation in which knowledge and action are dialecti- cally related through the mediation of critical reflection���with the transformation displaying itself in increasing moments of emancipatory praxis rather than developmentally improved practice��� (6). That is, it is through a process of ongoing critical self-reflection, that practitioners can continuously improve their understanding, knowledge and practice, in a more holistic manner. Reflection is a process that requires both cognitive and humanitarian attributes and enables practitioners to deter- mine their own actions, execute these actions, and then criti- cally review them (7). The capacity to reflect is an increasingly definitive key component of medical professionalism (7, 8) and was identified as a necessary attribute of a BOH graduate. BOH teaching staff are instrumental in the development of reflective thinking in their students and should, therefore, have a thor- ough appreciation and understanding of the cognitive processes involved in developing the capacity for reflective thought (9). The new BOH programme provided a timely opportunity to introduce these skills into the curriculum. ePortfolio The European Institute for E-Learning (EIfEL) has described the ePortfolio concept as ���a digital collection of authentic and diverse evidence, drawn from a larger archive representing what a person��� has learned over time and on which the person��� has reflected, and designed for presentation to one or more audiences for a particular rhetorical purpose��� (10). From an educational perspective, there are several identifi- able advantages for students arising from the implementation of an ePortfolio. These are: reflective thinking, personal devel- opment planning, gathering evidence of learning outcomes/ skills development and providing support for life-long learning. The requirements of an ePortfolio can vary depending on the context in which it is utilised (11). The approach adopted was intended to seamlessly integrate the professional development requirements within undergraduate education. In a recent study at the Glasgow Dental School (GDS) (which commenced in 2004), a portfolio was introduced to first year Bachelor of Dental Surgery (BDS) students ���as a key component of the revised undergraduate dental degree��� The purpose of the portfolio [was] to promote student-centred learning and reflection and to fulfil the role of a progress file for the length of the BDS programme��� (8). Whilst the study at GDS is still in its early stages, a preliminary evaluation con- cluded that written reflection is not popular with students, and that ���perhaps all that can be achieved is that students begin to acquire the skills which will enable them to reflect purposefully in later professional life��� (8). Little research appears to have been published that reports on student perceptions of the design and development of ePortfolios. In 2006, Ayala (12) discussed concern about this apparent lack of consultation with users. It was observed that ���fewer than 5%��� of the published reports on ePortfolios that Ayala reviewed ���used students��� voices to illustrate student concerns and needs���. He went on to say that ���when articles did mention students, [ePortfolios] were done unto them and not by them. That is to say, administrators did most of the planning and design [of ePortfolios] for students��� (12). Further, he predicted that unless portfolios become more student-centred, the trend of ePortfolios would likely ���crash��� (12). Ayala noted that the first step in making ePortfolios more student-centred is to ���involve students and faculty in the process��� [to] provide fresh perspectives and pro- duce a more useful product��� (12) in terms of ePortfolio development. Method Research design and methodology A Design-Based Research (DBR) approach was used as a suit- able method for addressing complex problems in real con- texts. DBR facilitated collaboration with students and practitioners, in order to achieve the long-term objective of meeting DCNZ requirements for registration and APCs. DBR is premised on the notion that important aspects about the nature and conditions of learning can be determined through attempting to engineer and sustain educational innovation in everyday settings (13). Use of a DBR approach requires iden- tification of problems prior to building solutions. The process allowed for theoretical questions, about the nature of what we were trying to achieve, to be addressed through integrating known and hypothetical design principles (13). The approach adopted was one that would support a participatory model of development whilst upholding a rigorous and reflective inquiry. An ePortfolio for life-long learning and certification Kardos et al. 136 Eur J Dent Educ 13 (2009) 135���141 �� 2009 The Authors. Journal compilation �� 2009 Blackwell Munksgaard