title: Portfolios Enhance Clinical Activity in Surgical Clerks.
abstract: OBJECTIVE
  A change in German licensing legislation imposed a portfolio for surgical clerks. We aimed to analyze whether the implementation of the portfolio changed the amount of clinical exposure and activities during surgical clerkships.
  
  
  METHODS
  The study was conducted with a modified pre-post design at the University Hospital of Tuebingen, Germany. Before and after the implementation of the portfolio on April 1, 2013, final-year students (n = 557) who had just finished their surgical clerkship were interviewed with an online questionnaire. A total of 21 basic surgical skills were evaluated.
  
  
  RESULTS
  Overall, 230 questionnaires were returned and analyzed; 51% were preintervention. Overall clinical activity for the whole study cohort varied for different activities between 98% and 32%. For 16 of 21 parameters, there was more clinical activity in the postintervention (portfolio) group. This difference was statistically significant for the following 7 activities: discharge, analgesia, local infiltration, patient positioning, drain in, blood transfusion, and emergency diagnostics.
  
  
  CONCLUSIONS
  The implementation of the portfolio did enhance clinical activity for surgical clerks in the study cohort. Nevertheless, overall exposure is still unsatisfactory low for some activities. Additional changes and studies are necessary to further improve surgical education.
authors.affiliation: Department of Pediatric Surgery, University Hospital of Tuebingen, Germany. Electronic address: sabine.zundel@med.uni-tuebingen.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Zundel
authors.affiliation: Department of Medical Biometry, University of Tuebingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Department of Psychosomatic Medicine, University Hospital of Tuebingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.affiliation: Department of Psychosomatic Medicine and Medical Faculty Tuebingen, Germany; Multidisciplinary Skills Lab "DocLab", University Hospital of Tuebingen, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Herrmann-Werner
authors.affiliation: Department of Internal Medicine, University Hospital of Tuebingen, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Holderried
mesh_terms: D000328:Adult; D002982:Clinical Clerkship; D002983:Clinical Competence; D004282:Documentation; D004504:Education, Medical, Undergraduate; D005260:Female; D013502:General Surgery / Q000193:education*; D005858:Germany; D006801:Humans; D007858:Learning; D008007:Licensure, Medical; D008297:Male; D011795:Surveys and Questionnaires
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; portfolio; surgical clerkship; surgical teaching; workplace-based education